A case of haemolytic uraemic syndrome (HUS) revealed an outbreak of shiga toxin-2-producing escherichia coli o26:H11 infection in a nursery, with long-lasting shedders and person-to-person transmission, Italy 2015

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Abstract

Purpose. Shiga toxin-producing Escherichia coli (STEC) represents a major issue for public health because of the severity of the associated illnesses, including haemolytic uraemic syndrome (HUS). In 2015, investigation of a case of HUS revealed an outbreak of Shiga toxin-2-producing E. coli O26: H11 infection in a nursery in Italy. The investigation showed that the infection was transmitted to cases’ contacts via person to person. Methods. The case finding was performed by testing for STEC stool samples of the HUS case’s contacts within the family and the nursery. STEC O26 isolates were characterized by whole genome sequencing. Confirmed cases were repeatedly tested to monitor the duration of STEC shedding. Results. Eleven STEC O26 cases were identified, including adults and asymptomatic patients. Clinical illness was only observed in children. Strain characterization revealed that a single clone harbouring the stx2a and eae genes and the complete array of STEC-associated virulence genes, belonging to ST(21), was implicated in the outbreak. To reduce bacterial shedding, patients were treated with cefixime following clinical recovery. This antibiotic was well tolerated and did not induce any apparent consequences on patients’ health. Conclusions. This study confirms that Stx2-producing E. coli O26 represents an emerging public health problem. The occurrence of outbreaks of infection by Stx2-producing E. coli O26 in nurseries is of particular concern, given the high probability of infection progressing in severity and resulting in secondary cases.

Original languageEnglish
Article number000738
Pages (from-to)775-781
Number of pages7
JournalJournal of Medical Microbiology
Volume67
Issue number6
DOIs
Publication statusPublished - Jun 1 2018

Fingerprint

Shiga Toxin 2
Shiga-Toxigenic Escherichia coli
Hemolytic-Uremic Syndrome
Nurseries
Italy
Disease Outbreaks
Infection
Bacterial Shedding
Public Health
Cefixime
Escherichia coli
Genes
Virulence
Clone Cells
Genome
Anti-Bacterial Agents
Health

Keywords

  • Antibiotic treatment
  • Epidemiology
  • Italy
  • Shiga toxin-producing E. coli
  • Whole genome sequencing

ASJC Scopus subject areas

  • Microbiology
  • Microbiology (medical)

Cite this

@article{4e0947cc338b4002aa764543b87b2238,
title = "A case of haemolytic uraemic syndrome (HUS) revealed an outbreak of shiga toxin-2-producing escherichia coli o26:H11 infection in a nursery, with long-lasting shedders and person-to-person transmission, Italy 2015",
abstract = "Purpose. Shiga toxin-producing Escherichia coli (STEC) represents a major issue for public health because of the severity of the associated illnesses, including haemolytic uraemic syndrome (HUS). In 2015, investigation of a case of HUS revealed an outbreak of Shiga toxin-2-producing E. coli O26: H11 infection in a nursery in Italy. The investigation showed that the infection was transmitted to cases’ contacts via person to person. Methods. The case finding was performed by testing for STEC stool samples of the HUS case’s contacts within the family and the nursery. STEC O26 isolates were characterized by whole genome sequencing. Confirmed cases were repeatedly tested to monitor the duration of STEC shedding. Results. Eleven STEC O26 cases were identified, including adults and asymptomatic patients. Clinical illness was only observed in children. Strain characterization revealed that a single clone harbouring the stx2a and eae genes and the complete array of STEC-associated virulence genes, belonging to ST(21), was implicated in the outbreak. To reduce bacterial shedding, patients were treated with cefixime following clinical recovery. This antibiotic was well tolerated and did not induce any apparent consequences on patients’ health. Conclusions. This study confirms that Stx2-producing E. coli O26 represents an emerging public health problem. The occurrence of outbreaks of infection by Stx2-producing E. coli O26 in nurseries is of particular concern, given the high probability of infection progressing in severity and resulting in secondary cases.",
keywords = "Antibiotic treatment, Epidemiology, Italy, Shiga toxin-producing E. coli, Whole genome sequencing",
author = "Gaia Scavia and Alessandra Gianviti and Vincenzo Labriola and Paola Chiani and Antonella Maugliani and Valeria Michelacci and Fabio Minelli and Rosangela Tozzoli and Alfredo Caprioli and Stefano Morabito",
year = "2018",
month = "6",
day = "1",
doi = "10.1099/jmm.0.000738",
language = "English",
volume = "67",
pages = "775--781",
journal = "Journal of Medical Microbiology",
issn = "0022-2615",
publisher = "Society for General Microbiology",
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TY - JOUR

T1 - A case of haemolytic uraemic syndrome (HUS) revealed an outbreak of shiga toxin-2-producing escherichia coli o26:H11 infection in a nursery, with long-lasting shedders and person-to-person transmission, Italy 2015

AU - Scavia, Gaia

AU - Gianviti, Alessandra

AU - Labriola, Vincenzo

AU - Chiani, Paola

AU - Maugliani, Antonella

AU - Michelacci, Valeria

AU - Minelli, Fabio

AU - Tozzoli, Rosangela

AU - Caprioli, Alfredo

AU - Morabito, Stefano

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Purpose. Shiga toxin-producing Escherichia coli (STEC) represents a major issue for public health because of the severity of the associated illnesses, including haemolytic uraemic syndrome (HUS). In 2015, investigation of a case of HUS revealed an outbreak of Shiga toxin-2-producing E. coli O26: H11 infection in a nursery in Italy. The investigation showed that the infection was transmitted to cases’ contacts via person to person. Methods. The case finding was performed by testing for STEC stool samples of the HUS case’s contacts within the family and the nursery. STEC O26 isolates were characterized by whole genome sequencing. Confirmed cases were repeatedly tested to monitor the duration of STEC shedding. Results. Eleven STEC O26 cases were identified, including adults and asymptomatic patients. Clinical illness was only observed in children. Strain characterization revealed that a single clone harbouring the stx2a and eae genes and the complete array of STEC-associated virulence genes, belonging to ST(21), was implicated in the outbreak. To reduce bacterial shedding, patients were treated with cefixime following clinical recovery. This antibiotic was well tolerated and did not induce any apparent consequences on patients’ health. Conclusions. This study confirms that Stx2-producing E. coli O26 represents an emerging public health problem. The occurrence of outbreaks of infection by Stx2-producing E. coli O26 in nurseries is of particular concern, given the high probability of infection progressing in severity and resulting in secondary cases.

AB - Purpose. Shiga toxin-producing Escherichia coli (STEC) represents a major issue for public health because of the severity of the associated illnesses, including haemolytic uraemic syndrome (HUS). In 2015, investigation of a case of HUS revealed an outbreak of Shiga toxin-2-producing E. coli O26: H11 infection in a nursery in Italy. The investigation showed that the infection was transmitted to cases’ contacts via person to person. Methods. The case finding was performed by testing for STEC stool samples of the HUS case’s contacts within the family and the nursery. STEC O26 isolates were characterized by whole genome sequencing. Confirmed cases were repeatedly tested to monitor the duration of STEC shedding. Results. Eleven STEC O26 cases were identified, including adults and asymptomatic patients. Clinical illness was only observed in children. Strain characterization revealed that a single clone harbouring the stx2a and eae genes and the complete array of STEC-associated virulence genes, belonging to ST(21), was implicated in the outbreak. To reduce bacterial shedding, patients were treated with cefixime following clinical recovery. This antibiotic was well tolerated and did not induce any apparent consequences on patients’ health. Conclusions. This study confirms that Stx2-producing E. coli O26 represents an emerging public health problem. The occurrence of outbreaks of infection by Stx2-producing E. coli O26 in nurseries is of particular concern, given the high probability of infection progressing in severity and resulting in secondary cases.

KW - Antibiotic treatment

KW - Epidemiology

KW - Italy

KW - Shiga toxin-producing E. coli

KW - Whole genome sequencing

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U2 - 10.1099/jmm.0.000738

DO - 10.1099/jmm.0.000738

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EP - 781

JO - Journal of Medical Microbiology

JF - Journal of Medical Microbiology

SN - 0022-2615

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