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Escherichia coli O157 Pennington H. (2010) The Lancet 376 (9750): 1428-1435. Dr. Claudio Scotti. GI tract infections in the UK. Campylobacter Rotavirus Salmonella Norovirus Cryptosporidium Giardia Shigella Escherichia coli O157. Escherichia coli.

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Escherichia coli o157 pennington h 2010 the lancet 376 9750 1428 1435

Escherichia coli O157Pennington H. (2010) The Lancet 376 (9750): 1428-1435

Dr. Claudio Scotti


GI tract infections in the UK

Campylobacter

Rotavirus

Salmonella

Norovirus

Cryptosporidium

Giardia

Shigella

Escherichia coli O157


Escherichia coli
Escherichia coli

  • Six different groups of pathogenic E. coli:

    - EPEC: enteropathogenic

    - ETEC: enterotoxigenic

    - EHEC: enterohaemorrhagic (VTEC)

    - EIEC: enteroinvasive

    - EAEC: enteroaggregative

    - DAEC: diffuse-aggregative


E. coli O157 in England & Wales


Typical features
Typical features

  • Abdominal pain

  • Five or more bowel movements in the day before presentation

  • Non-bloody diarrhoea, becoming bloody after 1-4 days

  • No fever

  • 10-15% of patients develop haemolytic uraemic syndrome (HUS) 5-13 days after the onset of diarrhoea


Haemolytic uraemic syndrome
Haemolytic uraemic syndrome

  • Acute onset of renal impairment with oliguria or anuria and high concentrations of serum urea and creatinine

  • Platelet counts less than 15x109 cells/L

  • Microangiopathic haemolytic anaemia with haemoglobin <10 g/dL and with fragmented red cells in a peripheral blood smear


The first oubreak
The first oubreak

  • 1982, in Oregon and Michigan, USA

  • Bloody diarrhoea and severe abdominal cramps after eating hamburgers in a restaurant chain

  • First outbreak in the UK: 1983


The largest outbreak
The largest outbreak

  • Sakai City, Japan, in 1996

  • Associated with white radish sprouts served as school meals

  • 7,966 cases

  • 2,764 microbiologically confirmed

  • 106 with haemolytic uraemic syndrome (HUS)


The source of e coli o157
The source of E. coli O157

  • Ruminants, particularly cattle (prevalence between 0.2 and 48.8%) and sheep

  • 80% of transmission arise from the 20% of animals that are most infectious (supershedders)

  • Secondary spread (20% of outbreak cases)


Transmission of e coli o157
Transmission of E. coli O157


Transmission of e coli o1571
Transmission of E. coli O157


Transmission of e coli o1572
Transmission of E. coli O157

  • Quantitative microbial risk assessment showed that the risk is 100 times greater for visits to pastures than for consumption of burgers in the northeast of Scotland

  • Heavy rain is frequently associated with outbreaks (e.g. Glastonbury festival in 1997)



Incidence of infection
Incidence of infection

  • Per 100,000:

    • 4.7 in Scotland

    • 4 in Canada

    • 2.87 in Ireland

    • 2.74 in Japan

    • 2.1 in England and Wales

    • 1.3 in the USA

    • 0.43 in Germany

    • 0.08 in France


Disease caused by e coli o157
Disease caused by E. coli O157

  • 1996, in central Scotland, associated with meat from a butcher: 279 individuals, 17 people died from the direct effects of infection

  • Irish outbreak, water-borne spread: 18 individuals, 2 children with HUS

  • 2010 English outbreak on an open farm: 17 developed HUS (8 of them receiving dialysis)


Typical features1
Typical features

  • HUS is most common in children younger than 5 years

  • In England and Scotland, between 1997 and 2001, 226 (65%) of the 350 cases occurred in this age group

  • Once an infection has been established, no therapeutic interventions are available to lessen the risk of the development of the HUS



Extrarenal effects
Extrarenal effects

  • Increase in pancreatic enzymes and oedema

  • Necrosis of the colon wall

  • Myocardial damage

  • CNS damage (25% of cases), with seizures, paralysis, coma

  • Deaths are usually associated with severe extra-renal complications


Virulence factors
Virulence factors

  • Two different Shiga toxins (Stx1, Stx2)

  • Correlation with bloody diarrhoea and HUS

  • Shiga toxin binds to glycosphingolipidglobotriaosylceramide (Gb3), a cell surface receptor

  • In the human kidney, Gb3 is present on glomerular endothelial cell types and various tubular epithelial cell types


Virulence factors1
Virulence factors

  • Enterocyte effacement genes: mediate the intimate attachment of bacteria to the intestinal epithelium

  • Several plasmid-encoded genes promoting adherence

  • Upregulation of flagellar and chemotaxis genes


Prevention failure points
Prevention (failure points)

  • Failure during or after milk pasteurisation

  • Rare and light cooking of hamburger patties

  • Failure in municipal water chlorination

  • Failure to prevent cross-contamination or ready-to-eat foods by direct or indirect contact with raw meat

  • Handwashing


Conclusion
Conclusion

  • Ground beef outbreaks still occur in the USA but are now associated with home-made burgers

  • A vaccine that shows promise has been developed

  • Investigation of “supershedders” (> reduction of ruminant carriage)


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