title: Virulence profiling and quantification of verocytotoxin-producing Escherichia coli O145:H28 and O26:H11 isolated during an ice cream-related hemolytic uremic syndrome outbreak.
abstract: In September-October 2007, a mixed-serotype outbreak of verocytotoxin-producing Escherichia coli (VTEC) O145:H28 and O26:H11 occurred in the province of Antwerp, Belgium. Five girls aged between 2 and 11 years developed hemolytic uremic syndrome, and seven other coexposed persons with bloody diarrhea were identified. Laboratory confirmation of O145:H28 infection was obtained for three hemolytic uremic syndrome patients, one of whom was coinfected with O26:H11. The epidemiological and laboratory investigations revealed ice cream as the most likely source of the outbreak. The ice cream was produced at a local dairy farm using pasteurized milk. VTEC of both serotypes with indistinguishable pulsed-field gel electrophoresis patterns were isolated from patients, ice cream, and environmental samples. Quantitative analysis of the ice cream indicated concentrations of 2.4 and 0.03 CFU/g for VTEC O145 and O26, respectively. Virulence typing revealed that the repertoire of virulence genes carried by the O145:H28 outbreak strain was comparable to that of O157 VTEC and more exhaustive as compared to the O26:H11 outbreak strain and nonrelated clinical strains belonging to these serotypes. Taken together, these data suggest that O145:H28 played the most important role in this outbreak.
authors.affiliation: Belgian Reference Laboratory for VTEC/EHEC, Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium. gbuvens@vub.ac.be
authors.forename: Glenn
authors.initials: G
authors.lastname: Buvens
authors.forename: Björn
authors.initials: B
authors.lastname: Possé
authors.forename: Koen
authors.initials: K
authors.lastname: De Schrijver
authors.forename: Lieven
authors.initials: L
authors.lastname: De Zutter
authors.forename: Sabine
authors.initials: S
authors.lastname: Lauwers
authors.forename: Denis
authors.initials: D
authors.lastname: Piérard
mesh_terms: D000383:Agriculture; D000818:Animals; D001530:Belgium / Q000453:epidemiology; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D016521:Electrophoresis, Gel, Pulsed-Field; D004927:Escherichia coli Infections / Q000453:epidemiology*; D019453:Escherichia coli O157 / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity*; D005260:Female; D005506:Food Contamination / Q000032:analysis / Q000706:statistics & numerical data; D005517:Foodborne Diseases / Q000453:epidemiology / Q000382:microbiology; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D007054:Ice Cream / Q000382:microbiology*; D012703:Serotyping; D022603:Shiga Toxins / Q000096:biosynthesis; D054323:Shiga-Toxigenic Escherichia coli / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity*; D014774:Virulence / Q000235:genetics
chemical_list: D022603:Shiga Toxins