title: Molecular microbiological investigation of an outbreak of hemolytic-uremic syndrome caused by dry fermented sausage contaminated with Shiga-like toxin-producing Escherichia coli.
abstract: Shiga-like toxin-producing Escherichia coli (SLTEC) strains are a diverse group of organisms which are known to cause diarrhea and hemorrhagic colitis in humans. This can lead to potentially fatal systemic sequelae, such as hemolytic-uremic syndrome (HUS). Strains belonging to more than 100 different O:H serotypes have been associated with severe SLTEC disease in humans, of which only O157 strains (which are uncommon in Australia) have a distinguishable cultural characteristic (sorbitol negative). During an outbreak of HUS in Adelaide, South Australia, a sensitive PCR assay specific for Shiga-like toxin genes (slt) was used to test cultures of feces and suspected foods. This enabled rapid confirmation of infection and identified a locally produced dry fermented sausage (mettwurst) as the source of infection. Cultures of feces from 19 of 21 HUS patients and 7 of 8 mettwurst samples collected from their homes were PCR positive for slt-I and slt-II genes. SLTEC isolates belonging to serotype O111:H- was subsequently isolated from 16 patients and 4 mettwurst samples. Subsequent restriction fragment length polymorphism analysis of chromosomal DNA from these isolates with slt-specific probes indicated that at least three different O111:H- genotypes were associated with the outbreak. Pulsed-field gel electrophoresis of genomic DNA restricted with XbaI showed that two of these restriction fragment length polymorphism types were closely related, but the third was quite distinct. However, SLTEC strains of other serotypes, including O157:H-, were also isolated from some of the HUS patients.
authors.affiliation: Molecular Microbiology Unit, Women's and Children's Hospital, North Adelaide, Australia. patonj@wch.sa.gov.au
authors.forename: A W
authors.initials: AW
authors.lastname: Paton
authors.forename: R M
authors.initials: RM
authors.lastname: Ratcliff
authors.forename: R M
authors.initials: RM
authors.lastname: Doyle
authors.forename: J
authors.initials: J
authors.lastname: Seymour-Murray
authors.forename: D
authors.initials: D
authors.lastname: Davos
authors.forename: J A
authors.initials: JA
authors.lastname: Lanser
authors.forename: J C
authors.initials: JC
authors.lastname: Paton
mesh_terms: D018829:Adhesins, Bacterial; D001425:Bacterial Outer Membrane Proteins / Q000235:genetics; D001427:Bacterial Toxins / Q000096:biosynthesis; D001483:Base Sequence; D002352:Carrier Proteins; D017931:DNA Primers / Q000235:genetics; D004196:Disease Outbreaks; D004926:Escherichia coli / Q000235:genetics* / Q000302:isolation & purification / Q000378:metabolism; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology*; D019453:Escherichia coli O157 / Q000235:genetics / Q000302:isolation & purification; D029968:Escherichia coli Proteins; D005243:Feces / Q000382:microbiology; D005516:Food Microbiology; D005798:Genes, Bacterial; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology*; D006801:Humans; D008461:Meat Products / Q000382:microbiology; D017720:Molecular Epidemiology; D016133:Polymerase Chain Reaction; D022622:Shiga Toxin 1; D013021:South Australia / Q000453:epidemiology
chemical_list: D018829:Adhesins, Bacterial; D001425:Bacterial Outer Membrane Proteins; D001427:Bacterial Toxins; D002352:Carrier Proteins; D017931:DNA Primers; D029968:Escherichia coli Proteins; D022622:Shiga Toxin 1; C073819:eaeA protein, E coli