title: An imported case of bloody diarrhea in the Czech Republic caused by a hybrid enteroaggregative hemorrhagic Escherichia coli (EAHEC) O104:H4 strain associated with the large outbreak in Germany, May 2011.
abstract: A large outbreak caused by a rare Shiga toxin-producing Escherichia coli serotype O104:H4 occurred in Germany in May to July 2011. The National Reference Laboratory for E. coli and Shigella investigated the stool sample from an American tourist with bloody diarrhea who arrived in the Czech Republic from Germany where she consumed salads with raw vegetable a week ago. Using culture of the enriched stool on extended-spectrum β-lactamase agar, we isolated E. coli strain which belonged to serotype O104:H4 as determined by conventional and molecular serotyping. The strain contained the major virulence characteristics of enterohemorrhagic E. coli (stx                         (2) encoding Shiga toxin 2) and enteroaggregative E. coli (aggA encoding aggregative adherence fimbriae I). This unique combination of virulence traits demonstrated that this strain belongs to the hybrid enteroaggregative hemorrhagic E. coli clone which caused the German outbreak. Using advanced culture and molecular biological approaches is the prerequisite for identification of new, unusual pathogens.
authors.affiliation: National Reference Laboratory for E. coli and Shigella, National Institute of Public Health, Šrobárova 48, 100 42, Prague 10, Czech Republic. monmarej@szu.cz
authors.forename: M
authors.initials: M
authors.lastname: Marejková
authors.forename: H
authors.initials: H
authors.lastname: Roháčová
authors.forename: M
authors.initials: M
authors.lastname: Reisingerová
authors.forename: P
authors.initials: P
authors.lastname: Petráš
mesh_terms: D018153:Czech Republic / Q000453:epidemiology; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology*; D004196:Disease Outbreaks; D054324:Enterohemorrhagic Escherichia coli / Q000235:genetics* / Q000302:isolation & purification / Q000502:physiology; D004926:Escherichia coli / Q000235:genetics* / Q000302:isolation & purification / Q000502:physiology; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011995:Recombination, Genetic; D022641:Shiga Toxin 2 / Q000235:genetics / Q000378:metabolism
chemical_list: D022641:Shiga Toxin 2