title: An outbreak of foodborne illness caused by Escherichia coli O39:NM, an agent not fitting into the existing scheme for classifying diarrheogenic E. coli.
abstract: An outbreak of gastrointestinal illness with clinical and epidemiologic features of enterotoxigenic Escherichia coli (ETEC) occurred among patrons of a restaurant during April 1991. Illnesses among several groups of patrons were characterized by diarrhea (100%) and cramps (79%-88%) lasting a median of 3-5 days. Median incubation periods ranged from 50 to 56 h. A nonmotile strain of E. coli (E. coli O39), which was negative for heat-labile (LT) and heat-stable (STa, STb) ETEC toxins, was isolated only from ill patrons. This organism produced enteroaggregative E. coli heat-stable enterotoxin 1 and contained the enteropathogenic E. coli gene locus for enterocyte effacement; it did not display mannose-resistant adherence, but produced attaching and effacing lesions in the absence of mannose on cultured HEp-2 cells. E. coli that are not part of highly characterized but narrowly defined groups may be important causes of foodborne illness.
authors.affiliation: Public Health Laboratory, Minnesota Department of Health, Minneapolis 55440-9441, USA.
authors.forename: C W
authors.initials: CW
authors.lastname: Hedberg
authors.forename: S J
authors.initials: SJ
authors.lastname: Savarino
authors.forename: J M
authors.initials: JM
authors.lastname: Besser
authors.forename: C J
authors.initials: CJ
authors.lastname: Paulus
authors.forename: V M
authors.initials: VM
authors.lastname: Thelen
authors.forename: L J
authors.initials: LJ
authors.lastname: Myers
authors.forename: D N
authors.initials: DN
authors.lastname: Cameron
authors.forename: T J
authors.initials: TJ
authors.lastname: Barrett
authors.forename: J B
authors.initials: JB
authors.lastname: Kaper
authors.forename: M T
authors.initials: MT
authors.lastname: Osterholm
mesh_terms: D001422:Bacterial Adhesion; D001427:Bacterial Toxins / Q000032:analysis / Q000378:metabolism; D001431:Bacteriological Techniques; D002460:Cell Line; D003967:Diarrhea / Q000382:microbiology*; D004196:Disease Outbreaks; D004768:Enterotoxins / Q000032:analysis / Q000378:metabolism; D004926:Escherichia coli / Q000145:classification / Q000276:immunology / Q000302:isolation & purification* / Q000472:pathogenicity; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology*; D029968:Escherichia coli Proteins; D005516:Food Microbiology; D006801:Humans; D008358:Mannose / Q000378:metabolism; D019081:O Antigens / Q000032:analysis; D016036:Seroepidemiologic Studies
chemical_list: D001427:Bacterial Toxins; D004768:Enterotoxins; D029968:Escherichia coli Proteins; D019081:O Antigens; C034151:heat stable toxin (E coli); C027538:heat-labile enterotoxin, E coli; D008358:Mannose