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

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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


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

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


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

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)


Isolation rates uk 1984 2008

Isolation rates, UK 1984-2008


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


Outcomes of hus

Outcomes of 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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