Community-wide outbreak of haemolytic uraemic syndrome associated with Shiga toxin 2-producing Escherichia coli O26:H11 in southern Italy, summer 2013.
In summer 2013, an excess of paediatric cases of haemolytic uraemic syndrome (HUS) in a southern region of Italy prompted the investigation of a community-wide outbreak of Shiga toxin 2-producing Escherichia coli (STEC) O26:H11 infections. Case finding was based on testing patients with HUS or bloody diarrhoea for STEC infection by microbiological and serological methods. A case-control study was conducted to identify the source of the outbreak. STEC O26 infection was identified in 20 children (median age 17 months) with HUS, two of whom reported severe neurological sequelae. No cases in adults were detected. Molecular typing showed that two distinct STEC O26:H11 strains were involved. The case-control study showed an association between STEC O26 infection and consumption of dairy products from two local plants, but not with specific ready-to-eat products. E.coli O26:H11 strains lacking the stx genes were isolated from bulk milk and curd samples, but their PFGE profiles did not match those of the outbreak isolates. This outbreak supports the view that infections with Stx2-producing E. coli O26 in children have a high probability of progressing to HUS and represent an emerging public health problem in Europe.
Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy.
Cinzia
C
Germinario
Alfredo
A
Caprioli
Mario
M
Giordano
Maria
M
Chironna
Maria Serena
MS
Gallone
Silvio
S
Tafuri
Fabio
F
Minelli
Antonella
A
Maugliani
Valeria
V
Michelacci
Luisa
L
Santangelo
Onofrio
O
Mongelli
Cosimo
C
Montagna
Gaia
G
Scavia
D000818:Animals; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D004926:Escherichia coli / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000453:epidemiology*; D029968:Escherichia coli Proteins / Q000235:genetics; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008297:Male; D058889:Molecular Typing; D011159:Population Surveillance; D022641:Shiga Toxin 2 / Q000235:genetics*; D054323:Shiga-Toxigenic Escherichia coli / Q000302:isolation & purification*
D029968:Escherichia coli Proteins; D022641:Shiga Toxin 2
Disease outbreak; Epidemiology; Haemolytic Uraemic Syndrome; Italy; Molecular epidemiology; Shiga toxin-producing Escherichia coli; Surveillance: Outbreak investigation; Vero cytotoxin-producing E. coli
Clin Infect Dis. 1994 Oct;19(4):815-6
7803672
J Clin Microbiol. 2003 Jul;41(7):2884-93
12843017
Mol Cell Probes. 2004 Jun;18(3):185-92
15135453
J Med Microbiol. 2008 Sep;57(Pt 9):1141-1146
18719185
J Appl Microbiol. 2010 Nov;109(5):1696-705
20618885
Lancet. 2005 Mar 19-25;365(9464):1073-86
15781103
Int J Infect Dis. 2003 Mar;7(1):42-5
12718809
Mol Microbiol. 2006 Jun;60(5):1136-51
16689791
Clin Infect Dis. 2009 Apr 15;48(8):e78-81
19272017
Euro Surveill. 2016;21(11):30170
27020906
Med Clin North Am. 2013 Jul;97(4):681-95, xi
23809720
Emerg Infect Dis. 2011 Feb;17(2):180-5
21291586
Microbiol Spectr. 2014 Dec;2(6):
26104435
J Infect Dis. 1999 May;179(5):1274-7
10191236
Clin Infect Dis. 2013 May;56(10):1373-81
23378282
Pediatr Int. 2012 Feb;54(1):166-7
22335333
J Infect Dis. 1994 Jan;169(1):208-11
8277184
Appl Environ Microbiol. 2007 May;73(10):3144-50
17400784
Pediatr Infect Dis J. 2008 Jul;27(7):595-601
18520972
Epidemiol Infect. 2009 Jun;137(6):889-96
18945376
J Clin Microbiol. 2012 Sep;50(9):2951-63
22760050
Euro Surveill. 2008 Feb 14;13(7):
18445416
Emerg Infect Dis. 2011 Sep;17(9):1777-9
21888827
J Infect Dis. 2002 Aug 1;186(3):419-22
12134240
Foodborne Pathog Dis. 2006 Spring;3(1):88-96
16602984
Zoonoses Public Health. 2014 Nov;61(7):492-8
24484079
J Appl Microbiol. 2008 Jan;104(1):14-25
18171379
J Infect Dis. 2002 Aug 15;186(4):493-500
12195376
Semin Thromb Hemost. 2010 Sep;36(6):586-93
20865635
Emerg Infect Dis. 2003 Jan;9(1):106-8
12533290