Enterohemorrhagic Escherichia coli serogroup O80, involved in hemolytic uremic syndrome associated with extraintestinal infections, has emerged in France. We obtained circularized sequences of the O80 strain RDEx444, responsible for hemolytic uremic syndrome with bacteremia, and noncircularized sequences of 35 O80 E. coli isolated from humans and animals in Europe with or without Shiga toxin genes.
RDEx444 harbored a mosaic plasmid, pR444_A, combining extraintestinal virulence determinants and a multidrug resistance–encoding island. All strains belonged to clonal complex 165, which is distantly related to other major enterohemorrhagic E. coli lineages. All stx-positive strains contained eae-ξ, ehxA, and genes characteristic of pR444_A.
Among stx-negative strains, 1 produced extended-spectrum β-lactamase, 1 harbored the colistin-resistance gene mcr1, and 2 possessed genes characteristic of enteropathogenic and pyelonephritis E. coli. Because O80–clonal complex 165 strains can integrate intestinal and extraintestinal virulence factors in combination with diverse drug-resistance genes, they constitute dangerous and versatile multidrug-resistant pathogens.
Emerging Multidrug-Resistant Hybrid Pathotype Shiga Toxin–Producing Escherichia coli O80 and Related Strains of Clonal Complex 165, Europe
Cointe A, Birgy A, Mariani-Kurkdjian P, Liguori S, Courroux C, Blanco J, et al. Emerging multidrug-resistant hybrid pathotype Shiga toxin–producing Escherichia coli O80 and related strains of clonal complex 165, Europe. Emerg Infect Dis. 2018 Dec [date cited]. https://doi.org/10.3201/eid2412.180272
(Something may be lost in translation, which is where Pink Floyd comes in)
This was informed by the Federal office for consumer protection and food safety in Braunschweig, Germany, on Thursday.
It is the in several States product, marketed with the name “Petite Fleur herbs” (“Keiems bloempje met kruiden”) the date of minimum durability 08.11.2018 and the additional indication of “Lot 3603”, as a manufacturer Dischhof/Belgium has been specified.
In the worst case, kidney failure threatening, According to the Schwabacher company in an investigation of the image Verotoxin found E. coli in the cheeses, which are regarded as potential Ehec.
The editor recommends:
“From a consumption of the affected product is strictly not recommended”, the company said.
The Ehec can cause bloody diarrhoea and in severe cases lead to kidney failure, but there are also inconspicuous progressions. The severe course of a disease ends in about two percent of the cases fatal.
In the spring of 2011 had cost the largest German Ehec epidemic 53. In Germany, the disease occurs again and again, every year, about 1000 cases of Ehec are reported cases.
In the PCP Luke (15) died because no one recognized the symptoms – now, his mother warns all.
Escherichia coli are Gram-negative rod-shaped bacteria and part of the normal bacterial flora in the gastrointestinal tract, while diarrhoeagenic E. colipathotypes such as Shiga toxin-producing E. coli (STEC) and enteropathogenic E. coli (EPEC) are able to cause gastrointestinal infections . STEC can lead to a severe disease, such as haemolytic-uraemic syndrome (HUS) . The risk of HUS has been related especially to children under 5 years and to elderly people. HUS is characterised by acute onset of microangiopathic haemolytic anaemia, renal injury and low platelet count.
More than 400 STEC serotypes have been recognised, of which the best-known serotype is O157:H7 . The most common non-O157:H7 serotypes causing human infections are O26, O103, O111 and O145 . The virulence of STEC is largely based on the production of Shiga toxin 1 or 2 and is identified by detecting the presence of stx1 or stx2 genes [1,4]. The virulence of EPEC is caused by its capability to form attaching and effacing (A/E) lesions in the small intestine. This capability requires the presence of virulence genes called the locus of enterocyte effacement (LEE) in a pathogenity island (PAI) that encodes intimin . Unlike STEC, EPEC do not produce Shiga toxin. EPEC are divided into two distinct groups by the presence of EPEC adherence factor plasmid (pEAF) expressing bundle-forming pili (BFP), which is a virulence determinant of typical EPEC (tEPEC) . Thus atypical EPEC (aEPEC) are defined as E. coli that produce A/E lesions but do not express BFP. Typical EPEC are best known as a cause of infantile diarrhoea, especially in developing countries . Diarrhoea-causing aEPEC have been shown to be separate group without a close relation to tEPEC, but some serotypes are genetically related to STEC . The pathogenity of aEPEC has been questioned but their involvement with diarrhoeal outbreaks supports the idea that certain strains are diarrhoeagenic [1,7].
Both STEC and EPEC are transmitted through the faecal-oral route, and outbreaks caused by STEC and aEPEC have been described after ingestion of contaminated food or water [7,8]. STEC is common in ruminants and can be found in foods contaminated by ruminant faeces . Most studies on STEC have focused on the serotype O157:H7, but infections and outbreaks caused by non-O157 strains are increasingly reported in Europe and elsewhere [10–13]. Atypical EPEC strains are found in animals used for food production, such as cattle, sheep, goat, pig and poultry, in contrast to tEPEC that has been found only in humans [1,14].
Since 1995, clinicians and clinical microbiology laboratories have been obliged to report culture-confirmed STEC infections to the Finnish Infectious Disease Registry (FIDR) maintained by the National Institute for Health and Welfare (THL) in Finland. EPEC infections are not reportable. Since PCR instead of culture became the standard for screening of diarrhoeal patients in 2013, the incidence of reported STEC infections has increased in Finland to 1.2–1.8 per 100,000 population between 2013 and 2015 compared with 0.2–0.6 per 100,000 between 2000 and 2012. From 1997 to 2015, six food- or waterborne STEC outbreaks were detected in Finland (Table 1).
Outbreak of multiple strains of non-O157 Shiga toxin-producing and enteropathogenic Escherichia coli associated with rocket salad, Finland, autumn 2016
Kathie Grant and Lisa Byrne write in Public Health Matters that in November 2017, supermarket loyalty cards were used to trace the source of a large E coli outbreak affecting mainly men in England. Dr Lisa Byrne leads Public Health England’s surveillance of two key bacteria that lead to food poisoning – E Coli and Listeria. Dr Kathie Grant heads the PHE Gastrointestinal Bacteria Reference Laboratory. The two work together as part of a larger team dedicated to reducing foodborne illness and below tell us how they put the pieces of this puzzle together to find the source.
If you’ve ever had food poisoning you’ll know that feeling of mentally going through everything you ate recently, trying to pinpoint what it was that might have made you ill. It’s our job to do that at a national scale. We bring together lots of different pieces of information from the community and the lab to try to find the source of a food poisoning outbreak and then, working alongside other government agencies, ensure that more people don’t get sick.
We study and monitor many different stomach bugs – some of which you may never have heard of! While stomach bugs are a part of life, PHE works with organisations such as the Food Standards Agency and the Animal and Plant Health Agency to try and prevent them.
Every so often we see a spike in the number of cases. When this happens it is important that we find the link between the cases and the cause of their illness. To do this we need to identify the exact strain of a bug to understand if people have got ill from the exact same source.
Whole Genome Sequencing (WGS) ‒ a relatively new process for showing us the makeup of a bacterium or virus’s genes ‒ has changed the way we can find the cause of an outbreak and stop more people getting ill. You can learn more about the process and how it works in our explainer blog.
Before WGS it could take weeks to identify bacteria and sometimes the bacteria could be missed. This slowed down any investigations as we could not be sure that all the case histories we were taking could be linked to an outbreak – there was a lot of ‘noise’ and false lines of enquiry. With WGS, we can rapidly and accurately identify if bacteria of cases are the same strain and rule out people from our investigation who just happened to be ill at the same time, but with a different illness.
It has also expanded what the word ‘outbreak’ means as we can link cases across several years and different countries, meaning we can more accurately piece together a picture of how something in the food supply chain impacts human health.
Scientists working in the Gastrointestinal Bacteria reference laboratory at Public Health England. The team are processing samples from people who have reported gastrointestinal symptoms, to understand the exact cause of their illness.
Identifying the source of an outbreak is a lot like putting together a jigsaw puzzle, combining multiple pieces of evidence to get the full picture. Sometimes, a common source is obvious, such as when a group of people get ill after eating the same meal, at the same restaurant, on the same day. But other times, we need to use an arsenal of investigative tools, as was the case in a recent E coli outbreak.
In November 2017 our surveillance system alerted us to 12 cases of E coli O157 – (a particular form of E coli), over a six week window. E coliO157 is a relatively rare cause of food poisoning, with only about 700 cases a year, but it can cause a very severe illness. Because of this, any case of E coli O157 identified by doctors and laboratories must be reported to Public Health England. We monitor the number of cases with our surveillance systems to find any patterns.
Very quickly our reference laboratory used WGS which showed that the cases had the identical genetic “fingerprint” and the work began to trace the source of infection. The majority of people who became ill were men, which was unusual as E coli outbreaks are often linked to salad items ‒ traditionally more likely to be eaten by women.
It took a few rounds of interviews – carried out by colleagues in local authorities – to zero in on the potential source of food poisoning, and a picture started to emerge that implicated burgers from a particular retailer.
We asked the supermarket to analyse the loyalty card records of those who had become ill, to help identify the particular burger product the cases had eaten. As you can imagine, there were many different types of burgers supplied by the supermarket and it’s often difficult for people to remember exactly what they ate.
Working with the Food Standards Agency we were able to identify that all the cases had bought a particular brand of burger, leading to a product recall to ensure others didn’t get sick. The recall involved removing all the suspected batches of burgers from the supermarket shelves. The supermarket also contacted people who had bought the burgers, advising them not to eat them and return them for a refund.
Sometimes, as in this case, we can rapidly find what is making people ill and quickly remove it from sale. It’s an exciting role and we get a real sense of satisfaction out of using our skills to help people in this way. Other times it can be more frustrating – some outbreaks remain unsolved and it’s a real worry that people will get sick because we can’t eliminate a threat from food distribution.
The role really keeps us on our toes. Our surveillance systems mean that we have a good sense of patterns of illness across the year and how we can intervene to stop people getting unwell – but changes to food habits can catch us by surprise. For instance, raw milk has become more popular recently, bringing with it all the disease risks you would expect from a product that has come straight from a cow without any treatment to kill off bacteria!
In another case, eight people in the UK were affected while on holiday in Germany that was related to seeds. The seeds were decoratively used as a garnish on salads and were difficult for cases to remember eating. Nearly 1,000 people in Germany got ill in that outbreak and one of the approaches by authorities was to use tourist photos of food to try and identify the common item in meals that could be making people sick.
Solving food borne illness outbreaks can be a real challenge, but by using a variety of the different tools available to us we can quickly intervene to stop people getting ill.
Forensic tests showed that John Cooper, 69, suffered acute intestinal dysentery caused by E. coli, and Susan Cooper, 64, suffered hemolytic-uremic syndrome (HUS), likely because of E. coli, Sadek said.
The children, whose ages have not yet been released, were from the Charnwood area of Leicestershire and had been treated for the infection in the last 2 weeks.
Public Health England confirmed the deaths and said it is working with environmental health officers after 2 cases of hemolytic uremic syndrome were confirmed in the siblings.
It is not yet known how the children contracted E. coli.
PHE East Midlands said E coli is a relatively rare infection, adding that good hand hygiene and supervised hand hygiene for small children are essential to minimise the risk of developing an infection such as E coli.
Not rare enough for this family and handwashing is never enough.
One of the proudest things I’ve done is help train U.S. military veterinarians in food safety each year I was at Kansas State University.
I still carry the warrant officer badge in my knapsack.
Steven M. Sellers of BNA writes that Sodexo Inc. is facing a surge of foodborne illness lawsuits over undercooked beef its employees allegedly served at two Marine Corps bases in California.
Tristan Abbott’s Aug. 24 complaint, the most recent of three suits filed in the U.S. District Court for the Southern District of California, alleges he suffered kidney and brain damage from beef contaminated with a virulent strain of E. coli bacteria.
Sodexo, the food and facilities management giant that serves corporations, schools, and the military, says it provides “quality of life” food and other services at 13,000 sites across the U.S. and Canada. The suits questions whether it lived up to its mission at the Marine Corps Recruit Depot and Camp Pendleton in San Diego.
At least 244 Marine recruits were sickened in the outbreak of Shiga toxin-producing E. coli last year. Thirty were hospitalized, 15 with life-threatening kidney failure, according to researchers from the U.S. Centers for Disease Control and Prevention.
The bacteria, known as E. coli O157:H7, can cause severe abdominal cramps, diarrhea, vomiting, and life-threatening complications in some cases.
Abbott was placed on dialysis and developed neurological symptoms from the infection, for which he received a medical discharge from the Marines in April, he says.
Investigators from the CDC and the Department of Defense found a “statistically significant association” between ill recruits and undercooked ground beef, for which Sodexo employees only intermittently checked temperatures, the complaint states.
“We recommended the Navy and Marine Corps retain lot information, address food handling concerns, and improve hygiene among recruits,” CDC researchers reported at an Epidemic Intelligence Service conference in April. The investigators also noted “poor hygiene practices among recruits.”
Sodexo told Bloomberg Law Aug. 27 that the source the outbreak remains uncertain.
On September 19, 2018, Cargill Meat Solutions in Fort Morgan, Colorado recalled ground beef products.
Recalled ground beef products were produced and packaged on June 21, 2018 and were shipped to retailers nationwide.
Products are labeled with the establishment number “EST. 86R” inside the USDA mark of inspection.
Restaurants and retailers should not serve or sell recalled ground beef and should check freezers and storage for recalled products.
If possible, retailers who received recalled ground beef should contact their customers to alert them of the recall.
When available, the retail distribution list will be posted on the USDA-FSIS website.
Consumers with questions regarding the recall can call 1-844-419-1574. Consumers with ground beef in their freezers can contact the store where it was purchased to determine if it is recalled ground beef.
Laboratory testing identified the outbreak strain of E. coli O26 in leftover ground beef collected from the home of one ill person in Florida. WGS analysis showed that the E. coli O26 strain identified in the leftover ground beef was highly related genetically to the E. coli O26 strain isolated from ill people.
The Mainichi – great newspaper name – reports a total of 28 people have suffered food poisoning after dining at MOS Burger restaurants in Tokyo and other locations in Japan, the operator and other sources said.
Twelve of the 28 were infected with the same O-121 strain of E. coli bacteria, the Ministry of Health, Labor and Welfare said Friday.
Those affected had dined at 19 restaurants in eight prefectures in eastern and central Japan between Aug. 10 and 23, the operator, MOS Food Services Inc., said.
One of the restaurants in Ueda, Nagano Prefecture, suspended operations for three days through last Wednesday following an order from a local public health office, the company said.
“It is highly likely that (the illness) was caused by foodstuffs supplied (to the restaurants) by the headquarters of the chain,” it said.