title: Enteroaggregative Shiga toxin-producing Escherichia coli of serotype O104:H4 in Belgium and Luxembourg.
abstract: In 2011, a large outbreak of infections caused by Shiga toxin-producing Escherichia coli (STEC) O104:H4 occurred in Germany. This exceptionally virulent strain combined virulence factors of enteroaggregative E. coli (EAggEC) and STEC. After the outbreak only a few sporadic cases of infection with this rare serotype were reported, most of which were related to travel to the Middle East or North Africa. Here we describe two cases of enteroaggregative STEC (Agg-STEC) O104:H4 infection that occurred in Belgium in 2012 and 2013 respectively. In both cases travel in a Mediterranean country preceded the infection. The first strain was isolated from the stool of a 42-year-old woman presenting bloody diarrhoea, who had travelled to Tunisia the week before. The second case involves a 14-year-old girl who, upon her return from Turkey to Belgium, suffered from an episode of bloody diarrhoea and haemolytic uraemic syndrome. Extended typing of the isolates with pulsed field gel electrophoresis revealed that the strains were closely related, though not exactly the same as the 2011 outbreak strain. This report supports the previously made hypothesis that Agg-STEC has a human reservoir and might be imported by travellers coming from an area where the pathogen is endemic. Furthermore, it emphasizes the concern that these bacteria may cause future outbreaks as evenly virulent O104:H4 isolates seem to be widespread.
authors.affiliation: National Reference Centre for STEC/VTEC, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB) Brussels, Belgium ; Department of Microbiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB) Brussels, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: De Rauw
authors.affiliation: Department of Internal Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB) Brussels, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Vincken
authors.affiliation: Department of Pediatric Nephrology, Universitair Ziekenhuis Leuven, Katholieke Universiteit Leuven (KUL) Leuven, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Garabedian
authors.affiliation: Department of Pediatric Nephrology, Universitair Ziekenhuis Leuven, Katholieke Universiteit Leuven (KUL) Leuven, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Levtchenko
authors.affiliation: Department of Emergency, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB) Brussels, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: Hubloue
authors.affiliation: Department of Microbiology, Universitair Ziekenhuis Leuven, Katholieke Universiteit Leuven (KUL) Leuven, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Verhaegen
authors.affiliation: Department of Microbiology, Algemeen Ziekenhuis Vesalius Tongeren, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Craeghs
authors.affiliation: National Reference Centre ESBL and carbapenemase-producing Enterobacteriaceae, CHU Dinant-Godinne|UCL Namur, Université Catholique de Louvain (UCL) Yvoir, Belgium.
authors.forename: Y
authors.initials: Y
authors.lastname: Glupczynski
authors.affiliation: Surveillance & Epidemiology of Infectious Diseases, National Health Laboratory Dudelange, Luxembourg.
authors.forename: J
authors.initials: J
authors.lastname: Mossong
authors.affiliation: National Reference Centre for STEC/VTEC, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB) Brussels, Belgium ; Department of Microbiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB) Brussels, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Piérard
keywords: Enteroaggregative Escherichia coli; Shiga toxin-producing E. coli; enterohaemorrhagic E. coli; gastrointestinal disease; haemolytic uraemic syndrome; travel