Enterohemorrhagic Escherichia coli as Causes of Hemolytic Uremic Syndrome in the Czech Republic
Creators: name: Marejková, Monika
name: Bláhová, Květa
name: Janda, Jan
name: Fruth, Angelika
name: Petráš, Petr
Publisher: name: Robert Koch-Institut, Infektionskrankheiten / Erreger
Year: 2013
Subjects: subject: Humans
subject: Female
subject: Male
subject: Genotype
subject: Multilocus Sequence Typing
subject: Phenotype
subject: Phylogeny
subject: Seasons
subject: Virulence/genetics
subject: Child Preschool
subject: Infant
subject: Serotyping
subject: Hemolytic-Uremic Syndrome/epidemiology
subject: Anti-Bacterial Agents/pharmacology
subject: Microbial Sensitivity Tests
subject: Czech Republic/epidemiology
subject: Enterohemorrhagic Escherichia coli/classification
subject: Enterohemorrhagic Escherichia coli/drug effects
subject: Enterohemorrhagic Escherichia coli/genetics
subject: Enterohemorrhagic Escherichia coli/isolation &amp; purification
subject: Hemolytic-Uremic Syndrome/diagnosis
subject: Hemolytic-Uremic Syndrome/microbiology
subject: Shiga Toxin/genetics
subject: 610 Medizin

description: Background: Enterohemorrhagic Escherichia coli (EHEC) cause diarrhea-associated hemolytic uremic syndrome (D+ HUS) worldwide, but no systematic study of EHEC as the causative agents of HUS was performed in the Czech Republic. We analyzed stools of all patients with D+ HUS in the Czech Republic between 1998 and 2012 for evidence of EHEC infection. We determined virulence profiles, phenotypes, antimicrobial susceptibilities and phylogeny of the EHEC isolates. Methodology/Principal Findings: Virulence loci were identified using PCR, phenotypes and antimicrobial susceptibilities were determined using standard procedures, and phylogeny was assessed using multilocus sequence typing. During the 15-year period, EHEC were isolated from stools of 39 (69.4%) of 56 patients. The strains belonged to serotypes [fliC types] O157:H7/NM[fliCH7] (50% of which were sorbitol-fermenting; SF), O26:H11/NM[fliCH11], O55:NM[fliCH7], O111:NM[fliCH8], O145:H28[fliCH28], O172:NM[fliCH25], and Orough:NM[fliCH25]. O26:H11/NM[fliCH11] was the most common serotype associated with HUS (41% isolates). Five stx genotypes were identified, the most frequent being stx2a (71.1% isolates). Most strains contained EHEC-hlyA encoding EHEC hemolysin, and a subset (all SF O157:NM and one O157:H7) harbored cdt-V encoding cytolethal distending toxin. espPα encoding serine protease EspPα was found in EHEC O157:H7, O26:H11/NM, and O145:H28, whereas O172:NM and Orough:NM strains contained espPγ. All isolates contained eae encoding adhesin intimin, which belonged to subtypes β (O26), γ (O55, O145, O157), γ2/θ (O111), and ε (O172, Orough). Loci encoding other adhesins (efa1, lpfAO26, lpfAO157OI-141, lpfAO157OI-154, iha) were usually associated with particular serotypes. Phylogenetic analysis demonstrated nine sequence types (STs) which correlated with serotypes. Of these, two STs (ST660 and ST1595) were not found in HUS-associated EHEC before. Conclusions/Significance: EHEC strains, including O157:H7 and non-O157:H7, are frequent causes of D+ HUS in the Czech Republic. Identification of unusual EHEC serotypes/STs causing HUS calls for establishment of an European collection of HUS-associated EHEC, enabling to study properties and evolution of these important pathogens.