Angelika Fruth

Publications of Angelika Fruth

• Clonal Dissemination of Salmonella enterica Serovar Infantis in Germany.

  Authors: Elisabeth Hauser, Erhard Tietze, Reiner Helmuth, Ernst Junker, Rita Prager, Andreas Schroeter, Wolfgang Rabsch, Angelika Fruth, Anne Toboldt, Burkhard Malorny

  Foodborne pathogens and disease. 03/2012; 9(4):352-60.

  Abstract Salmonella enterica serovar Infantis (Salmonella Infantis) is consistently isolated from broiler chickens, pigs, and humans worldwide. This study investigated 93 epidemiologically unrelatedAbstract Salmonella enterica serovar Infantis (Salmonella Infantis) is consistently isolated from broiler chickens, pigs, and humans worldwide. This study investigated 93 epidemiologically unrelated Salmonella Infantis strains isolated in Germany between 2005 and 2008 in respect to their transmission along the food chain. Various phenotypic and genotypic methods were applied, and the pathogenicity and resistance gene repertoire was determined. Phenotypically, 66% of the strains were susceptible to all 17 antimicrobials tested, while the others were almost all multidrug-resistant (two or more antimicrobial resistances), with different resistance profiles and preferentially isolated from broiler chickens. A number of phage types (PTs) were shared by strains from pigs, broiler chickens, and humans (predominated by PT 29). One, PT 1, was only detected in strains from pigs/pork and humans. Pulsed-field gel electrophoresis (PFGE) subdivided strains in seven different clusters, named A-G, consisting of 35 various XbaI profiles with coefficient of similarity values of 0.73-0.97. The majority of XbaI profiles were assigned to clusters A and C, and two predominant XbaI profiles were common in strains isolated from all sources investigated. Multi-locus sequence typing (MLST) analysis of selected strains representing the seven PFGE clusters revealed that they all belonged to ST32. The pathogenicity gene repertoire of 37 representative Salmonella Infantis strains analyzed by microarray was also identical. The resistance gene repertoire correlated perfectly with the phenotypic antimicrobial resistance profiles, and multidrug-resistant strains were associated with class 1 integrons. Overall, this study showed that two major closely related genotypes of Salmonella Infantis can transmit in Germany to humans through contaminated broiler meat or pork, and consequently presents a hazard for human health.

• Real-time multiplex polymerase chain reaction for detecting Shiga toxin 2-producing Escherichia coli O104:H4 in human stools.

  Authors: Wenlan Zhang, Martina Bielaszewska, Andreas Bauwens, Angelika Fruth, Alexander Mellmann, Helge Karch

  Journal of clinical microbiology. 02/2012;

  A real-time multiplex PCR targeting stx(2), wzy(O104), and fliC(H4) of enterohemorrhagic Escherichia coli (EHEC) O104:H4 correctly determined the presence or absence of these genes in 253 EHECA real-time multiplex PCR targeting stx(2), wzy(O104), and fliC(H4) of enterohemorrhagic Escherichia coli (EHEC) O104:H4 correctly determined the presence or absence of these genes in 253 EHEC isolates and 132 patients' stool enrichment cultures. It is a rapid, sensitive and specific tool for detecting EHEC O104:H4 in human stools.

• Outbreaks of virulent diarrhoeagenic Escherichia coli - are we in control?

  Authors: Dirk Werber, Gerard Krause, Christina Frank, Angelika Fruth, Antje Flieger, Martin Mielke, Lars Schaade, Klaus Stark

  BMC medicine. 02/2012; 10(1):11.

  ABSTRACT: Shiga toxin-producing E. coli (STEC) are the most virulent diarrhoeagenic E. coli known to date. They can be spread with alarming ease via food as exemplified by a large sprout-borneABSTRACT: Shiga toxin-producing E. coli (STEC) are the most virulent diarrhoeagenic E. coli known to date. They can be spread with alarming ease via food as exemplified by a large sprout-borne outbreak of STEC O104:H4 in 2011 that was centered in northern Germany and affected several countries. Effective control of such outbreaks is an important public health task and necessitates early outbreak detection, fast identification of the outbreak vehicle and immediate removal of the suspected food from the market, flanked with consumer advice and measures to prevent secondary spread. In our view, opportunities to improve control of STEC outbreaks lie in early clinical suspicion for STEC infection, timely diagnosis of all STEC at the serotype-level and integrating molecular subtyping information into surveillance systems. Furthermore, conducting analytic studies that supplement patients' imperfect food history recall and performing, as an investigative element, product tracebacks, are pivotal but underutilised tools for successful epidemiologic identification of the suspected vehicle in food-borne outbreaks. As a corollary, these tools are amenable to tailor microbiological testing of suspected food. Please see related article: http://www.biomedcentral.com/1741-7015/10/12.

• Identifying risk factors for shiga toxin-producing Escherichia coli by payment information.

  Authors: Hendrik Wilking, Udo Götsch, Helma Meier, Detlef Thiele, Mona Askar, Manuel Dehnert, Christina Frank, Angelika Fruth, Gérard Krause, Rita Prager, Klaus Stark, Boris Böddinghaus, Oswald Bellinger, René Gottschalk

  Emerging infectious diseases. 01/2012; 18(1):169-70.

• Diversity of Salmonella enterica serovar Derby isolated from pig, pork and humans in Germany.

  Authors: Elisabeth Hauser, Franka Hebner, Erhard Tietze, Reiner Helmuth, Ernst Junker, Rita Prager, Andreas Schroeter, Wolfgang Rabsch, Angelika Fruth, Burkhard Malorny

  International journal of food microbiology. 08/2011; 151(2):141-9.

  Salmonella enterica serovar Derby (S. Derby) is one of the most prevalent serovars in pigs in Europe and in the U.S. and ranks among the 10 most frequently isolated serovars in humans. Therefore, aSalmonella enterica serovar Derby (S. Derby) is one of the most prevalent serovars in pigs in Europe and in the U.S. and ranks among the 10 most frequently isolated serovars in humans. Therefore, a set of 82 epidemiologically unrelated S. Derby strains isolated between 2006 and 2008 from pigs, pork and humans in Germany was selected and investigated in respect to the transmission of clonal groups of the serovar along the food chain. Various phenotypic and genotypic methods were applied and the pathogenicity and resistance gene repertoire was determined. Phenotypically 72% of the strains were susceptible to all 17 antimicrobials tested while the others were monoresistant to tetracycline or multi-resistant with different resistance profiles. Four major clonal groups were identified based on PFGE, sequence data of the virulence genes sopA, sopB and sopD, VNTR-locus STTR5 and MLST revealing also the new sequence type ST774. Thirty different PFGE profiles were detected resulting in four clusters representing the four groups. The pathogenicity gene repertoire of 32 representative S. Derby strains analyzed by microarray showed six types with differences in the Salmonella pathogenicity islands, pathogenicity genes on smaller islets or prophages and fimbriae coding genes. The pathogenicity gene repertoire of the predominant types PAT DE1 and DE2 were most similar to the ones of S. Paratyphi B (dT+, O5-) and to a minor degree to S. Infantis and S. Virchow PATs. Overall this study showed that in Germany currently one major S. Derby clone is frequently isolated from pigs and humans. Contaminated pork was identified as one vehicle and consequently is a risk for human health. To prevent this serovar from entering the food chain, control measurements should be applied at the farm level.

• Epidemic profile of Shiga-toxin-producing Escherichia coli O104:H4 outbreak in Germany.

  Authors: Christina Frank, Dirk Werber, Jakob P Cramer, Mona Askar, Mirko Faber, Matthias an der Heiden, Helen Bernard, Angelika Fruth, Rita Prager, Anke Spode [......] Alexander Zoufaly, Sabine Jordan, Markus J Kemper, Per Follin, Luise Müller, Lisa A King, Bettina Rosner, Udo Buchholz, Klaus Stark, Gérard Krause

  The New England journal of medicine. 06/2011; 365(19):1771-80.

  We describe an outbreak of gastroenteritis and the hemolytic-uremic syndrome caused by Shiga-toxin-producing Escherichia coli in Germany in May, June, and July, 2011. The consumption of sprouts wasWe describe an outbreak of gastroenteritis and the hemolytic-uremic syndrome caused by Shiga-toxin-producing Escherichia coli in Germany in May, June, and July, 2011. The consumption of sprouts was identified as the most likely vehicle of infection. We analyzed data from reports in Germany of Shiga-toxin-producing E. coli gastroenteritis and the hemolytic-uremic syndrome and clinical information on patients presenting to Hamburg University Medical Center (HUMC). An outbreak case was defined as a reported case of the hemolytic-uremic syndrome or of gastroenteritis in a patient infected by Shiga-toxin-producing E. coli, serogroup O104 or serogroup unknown, with an onset of disease during the period from May 1 through July 4, 2011, in Germany. A total of 3816 cases (including 54 deaths) were reported in Germany, 845 of which (22%) involved the hemolytic-uremic syndrome. The outbreak was centered in northern Germany and peaked around May 21 to 22. Most of the patients in whom the hemolytic-uremic syndrome developed were adults (88%; median age, 42 years), and women were overrepresented (68%). The estimated median incubation period was 8 days, with a median of 5 days from the onset of diarrhea to the development of the hemolytic-uremic syndrome. Among 59 patients prospectively followed at HUMC, the hemolytic-uremic syndrome developed in 12 (20%), with no significant differences according to sex or reported initial symptoms and signs. The outbreak strain was typed as an enteroaggregative Shiga-toxin-producing E. coli O104:H4, producing extended-spectrum beta-lactamase. In this outbreak, caused by an unusual E. coli strain, cases of the hemolytic-uremic syndrome occurred predominantly in adults, with a preponderance of cases occurring in women. The hemolytic-uremic syndrome developed in more than 20% of the identified cases.

• Characterisation of the Escherichia coli strain associated with an outbreak of haemolytic uraemic syndrome in Germany, 2011: a microbiological study.

  Authors: Martina Bielaszewska, Alexander Mellmann, Wenlan Zhang, Robin Köck, Angelika Fruth, Andreas Bauwens, Georg Peters, Helge Karch

  The Lancet infectious diseases. 06/2011; 11(9):671-6.

  In an ongoing outbreak of haemolytic uraemic syndrome and bloody diarrhoea caused by a virulent Escherichia coli strain O104:H4 in Germany (with some cases elsewhere in Europe and North America), 810In an ongoing outbreak of haemolytic uraemic syndrome and bloody diarrhoea caused by a virulent Escherichia coli strain O104:H4 in Germany (with some cases elsewhere in Europe and North America), 810 cases of the syndrome and 39 deaths have occurred since the beginning of May, 2011. We analysed virulence profiles and relevant phenotypes of outbreak isolates recovered in our laboratory. We analysed stool samples from 80 patients that had been submitted to the National Consulting Laboratory for Haemolytic Uraemic Syndrome in Münster, Germany, between May 23 and June 2, 2011. Isolates were screened with standard PCR for virulence genes of Shiga-toxin-producing E coli and a newly developed multiplex PCR for characteristic features of the outbreak strain (rfb(O104), fliC(H4), stx(2), and terD). Virulence profiles of the isolates were determined with PCR targeting typical virulence genes of Shiga-toxin-producing E coli and of other intestinal pathogenic E coli. We sequenced stx with Sanger sequencing and measured Shiga-toxin production, adherence to epithelial cells, and determined phylogeny and antimicrobial susceptibility. All isolates were of the HUSEC041 clone (sequence type 678). All shared virulence profiles combining typical Shiga-toxin-producing E coli (stx(2), iha, lpf(O26), lpf(O113)) and enteroaggregative E coli (aggA, aggR, set1, pic, aap) loci and expressed phenotypes that define Shiga-toxin-producing E coli and enteroaggregative E coli, including production of Shiga toxing 2 and aggregative adherence to epithelial cells. Isolates additionally displayed an extended-spectrum β-lactamase phenotype absent in HUSEC041. Augmented adherence of the strain to intestinal epithelium might facilitate systemic absorption of Shiga toxin and could explain the high progression to haemolytic uraemic syndrome. This outbreak demonstrates that blended virulence profiles in enteric pathogens, introduced into susceptible populations, can have extreme consequences for infected people. German Federal Ministry of Education and Research, Network Zoonoses.

• Characterization of Escherichia coli strains isolated from patients with diarrhea in Sao Paulo, Brazil: identification of intermediate virulence factor profiles by multiplex PCR.

  Authors: Ariane Liebchen, Inga Benz, Alexander Mellmann, Helge Karch, Tânia A T Gomes, Denise Yamamoto, Rodrigo T Hernandes, Jorge Sampaio, Suely C F Sampaio, Angelika Fruth, M Alexander Schmidt

  Journal of clinical microbiology. 06/2011; 49(6):2274-8.

  Intestinal pathogenic Escherichia coli is a major causative agent of severe diarrhea. In this study the prevalences of different pathotypes among 702 E. coli isolates from Brazilian patients withIntestinal pathogenic Escherichia coli is a major causative agent of severe diarrhea. In this study the prevalences of different pathotypes among 702 E. coli isolates from Brazilian patients with diarrhea were determined by multiplex PCR. Interestingly, most strains were enteroaggregative E. coli (EAEC) strains, followed by atypical EPEC (ATEC) strains. Classical enteropathogenic E. coli (EPEC) strains were not detected.

• Comparative analysis of virulence genes, genetic diversity, and phylogeny of Shiga toxin 2g and heat-stable enterotoxin STIa encoding Escherichia coli isolates from humans, animals, and environmental sources.

  Authors: Rita Prager, Angelika Fruth, Ulrich Busch, Erhard Tietze

  International journal of medical microbiology : IJMM. 03/2011; 301(3):181-91.

  An analysis for stx(2) variants among the 2010 human stx(2)-positive Shiga toxin-producing Escherichia coli (STEC) strains from Germany collected at the National Reference Centre 1999-2008 revealedAn analysis for stx(2) variants among the 2010 human stx(2)-positive Shiga toxin-producing Escherichia coli (STEC) strains from Germany collected at the National Reference Centre 1999-2008 revealed 0.6% to possess the recently described stx(2g) gene. Sequencing of the whole stx(2g) operons showed new alleles and pseudogenes. The further molecular, phenotypic, and phylogenetic comparison of 12 human stx(2g)-harbouring isolates with 12 stx(2g)-harbouring isolates from animals or environmental sources demonstrated that both groups are closely related, indicating the human infections as a potential zoonotic disease. Although originating from various different sources, the stx(2g)-containing strains belong to only 3 phylogenetic lineages, represented by 4 serovars belonging to 4 sequence types. In view of the huge diversity among other STEC, this suggests the emergence of the stx(2g) variant as a rather recent microevolutionary event. Interestingly, in the strains under investigation, Stx2g was not expressed. However, all of them contained the estIa gene which typically is associated with enterotoxin-producing E. coli and did express STIa. By this combination of virulence genes of different pathotypes of intestinal pathogenic E. coli, these strains represent a new, intermediate pathotype and emerging pathogens. Given a rising number of intermediate pathotypes becoming described among E. coli, a wider range of virulence markers should be included in the regular pathotype diagnostics.

• Evolutionary analysis and distribution of type III effector genes in pathogenic Escherichia coli from human, animal and food sources.

  Authors: Kristina Creuzburg, Barbara Middendorf, Alexander Mellmann, Tatjana Martaler, Christina Holz, Angelika Fruth, Helge Karch, Herbert Schmidt

  Environmental microbiology. 09/2010; 13(2):439-52.

  Molecular analysis of Shiga toxin-producing Escherichia coli (STEC) from different sources is considered as a major approach to assess their risk potential. However, only limited data are availableMolecular analysis of Shiga toxin-producing Escherichia coli (STEC) from different sources is considered as a major approach to assess their risk potential. However, only limited data are available about the correlation of evolutionary relationship, the presence of major virulence factor genes and the putative risk of an STEC strain for human infection. In this study, we analysed the evolutionary relationship of 136 pathogenic E. coli strains from human, animal and food sources by multi-locus sequence typing (MLST) and molecular subtyping of their Shiga toxin (stx) and intimin (eae) genes. Moreover, the distribution of three type III effector genes, encoded within the locus of enterocyte effacement (LEE), and 16 effector genes, which are encoded outside the LEE, was analysed. One hundred and five strains from different sources harboured 5-15 of the analysed non-LEE-encoded effector genes. In 101 of these strains, the LEE genes eae, map, espF and espG were present simultaneously. Thirty-one isolates deriving mainly from food and patients suffering from haemolytic uraemic syndrome (HUS) were eae-negative and did not carry any of the analysed effector genes. By combination of MLST and virulence gene data, we defined five genetic clusters. Within these clusters a clear-cut affiliation of particular sequence types and the occurrence of certain effector genes was observed. However, in contrast to other studies, a significant correlation between the amount and type of effector genes and the risk to cause HUS could not be demonstrated.

• Distribution and phylogeny of immunoglobulin-binding protein G in Shiga toxin-producing Escherichia coli and its association with adherence phenotypes.

  Authors: Viktor Merkel, Barbara Ohder, Martina Bielaszewska, Wenlan Zhang, Angelika Fruth, Christian Menge, Erika Borrmann, Barbara Middendorf, Johannes Müthing, Helge Karch, Alexander Mellmann

  Infection and immunity. 08/2010; 78(8):3625-36.

  eibG in Shiga toxin-producing Escherichia coli (STEC) O91 encodes a protein (EibG) which binds human immunoglobulins G and A and contributes to bacterial chain-like adherence to human epithelialeibG in Shiga toxin-producing Escherichia coli (STEC) O91 encodes a protein (EibG) which binds human immunoglobulins G and A and contributes to bacterial chain-like adherence to human epithelial cells. We investigated the prevalence of eibG among STEC, the phylogeny of eibG, and eibG allelic variations and their impact on the adherence phenotype. eibG was found in 15.0% of 240 eae-negative STEC strains but in none of 157 eae-positive STEC strains. The 36 eibG-positive STEC strains belonged to 14 serotypes and to eight multilocus sequence types (STs), with serotype O91:H14/H(-) and ST33 being the most common. Sequences of the complete eibG gene (1,527 bp in size) from eibG-positive STEC resulted in 21 different alleles with 88.11% to 100% identity to the previously reported eibG sequence; they clustered into three eibG subtypes (eibG-alpha, eibG-beta, and eibG-gamma). Strains expressing EibG-alpha and EibG-beta displayed a mostly typical chain-like adherence pattern (CLAP), with formation of long chains on both human and bovine intestinal epithelial cells, whereas strains with EibG-gamma adhered in short chains, a pattern we termed atypical CLAP. The same adherence phenotypes were displayed by E. coli BL21(DE3) clones containing the respective eibG-alpha, eibG-beta, and eibG-gamma subtypes. We propose two possible evolutionary scenarios for eibG in STEC: a clonal development of eibG in strains with the same phylogenetic background or horizontal transfer of eibG between phylogenetically unrelated STEC strains.

• Pork contaminated with Salmonella enterica serovar 4,[5],12:i:-, an emerging health risk for humans.

  Authors: Elisabeth Hauser, Erhard Tietze, Reiner Helmuth, Ernst Junker, Kathrin Blank, Rita Prager, Wolfgang Rabsch, Bernd Appel, Angelika Fruth, Burkhard Malorny

  Applied and environmental microbiology. 07/2010; 76(14):4601-10.

  Salmonella enterica subsp. enterica serovar 4,[5],12:i:- is a monophasic variant of S. enterica serovar Typhimurium (antigenic formula 4,[5],12:i:1,2). Worldwide, especially in several EuropeanSalmonella enterica subsp. enterica serovar 4,[5],12:i:- is a monophasic variant of S. enterica serovar Typhimurium (antigenic formula 4,[5],12:i:1,2). Worldwide, especially in several European countries and the United States, it has been reported among the 10 most frequently isolated serovars in pigs and humans. In the study reported here, 148 strains of the monophasic serovar isolated from pigs, pork, and humans in 2006 and 2007 in Germany were characterized by various phenotypic and genotypic methods. This characterization was done in order to investigate their clonality, the prevalence of identical subtypes in pigs, pork, and humans, and the genetic relatedness to other S. enterica serovar Typhimurium subtypes in respect to the pathogenic and resistance gene repertoire. Two major clonal lineages of the monophasic serovar were detected which can be differentiated by their phage types and pulsed-field gel electrophoresis (PFGE) profiles. Seventy percent of the strains tested belonged to definite phage type DT193, and those strains were mainly assigned to PFGE cluster B. Nineteen percent of the strains were typed to phage type DT120 and of these 86% belonged to PFGE cluster A. Sixty-five percent of the isolates of both lineages carried core multiresistance to ampicillin, streptomycin, tetracycline, and sulfamethoxazole encoded by the genes bla(TEM1-like), strA-strB, tet(B), and sul2. No correlation to the source of isolation was observed in either lineage. Microarray analysis of 61 S. enterica serovar 4,[5],12:i:- and 20 S. enterica serovar Typhimurium isolates tested determining the presence or absence of 102 representative pathogenicity genes in Salmonella revealed no differences except minor variations in single strains within and between the serovars, e.g., by presence of the virulence plasmid in four strains. Overall the study indicates that in Germany S. enterica serovar 4,[5],12:i:- strains isolated from pig, pork, and human are highly related, showing their transmission along the food chain. Since the pathogenicity gene repertoire is highly similar to that of S. enterica serovar Typhimurium, it is essential that interventions are introduced at the farm level in order to limit human infection.

• Phylogeny and disease association of Shiga toxin-producing Escherichia coli O91.

  Authors: Alexander Mellmann, Angelika Fruth, Alexander W Friedrich, Lothar H Wieler, Dag Harmsen, Dirk Werber, Barbara Middendorf, Martina Bielaszewska, Helge Karch

  Emerging infectious diseases. 09/2009; 15(9):1474-7.

  The diversity and relatedness of 100 Shiga toxin-producing Escherichia coli O91 isolates from different patients were examined by multilocus sequence typing. We identified 10 specific sequence typesThe diversity and relatedness of 100 Shiga toxin-producing Escherichia coli O91 isolates from different patients were examined by multilocus sequence typing. We identified 10 specific sequence types (ST) and 4 distinct clonal groups. ST442 was significantly associated with hemolytic uremic syndrome.

• Shiga Toxin, Cytolethal Distending Toxin and Hemolysin Repertoirs in Clinical Escherichia coli O91 Isolates.

  Authors: Martina Bielaszewska, Franziska Stoewe, Angelika Fruth, Wenlan Zhang, Rita Prager, Jens Brockmeyer, Alexander Mellmann, Helge Karch, Alexander W Friedrich

  Journal of clinical microbiology. 05/2009;

  Shiga toxin (Stx)-producing Escherichia coli (STEC) of serogroup O91 are the most common human pathogenic eae-negative STEC. To facilitate diagnosis and subtyping of these pathogens, we genotypicallyShiga toxin (Stx)-producing Escherichia coli (STEC) of serogroup O91 are the most common human pathogenic eae-negative STEC. To facilitate diagnosis and subtyping of these pathogens, we genotypically and phenotypically characterized 100 clinical STEC O91 isolates. Motile strains expressed flagellar antigens H8 (n = 1), H10 (n = 2), H14 (n = 52) or H21 (n = 20), or were H nontypeable (Hnt; n = 10); 15 strains were nonmotile. All nonmotile and Hnt strains possessed the flagellin subunit-encoding gene fliCH14. Most STEC O91 possesed EHEC-hlyA and expressed an enterohemolytic phenotype. Among seven stx alleles identified, stx2d-activatable encoding mucus- and elastase-activatable Stx2d was solely present in STEC O91:H21, whereas most strains in the other serotypes possessed stx1. Moreover, only STEC O91:H21 possessed the cdt-V cluster encoding cytolethal distending toxin V; the toxin was regularly expressed and was lethal to human microvascular endothelial cells. Infection with STEC O91:H21 was associated with hemolytic-uremic syndrome (P = 0.0015), whereas strains of the other serotypes mostly originated in patients with nonbloody diarrhea. We conclude that STEC O91 clinical isolates belong to at least four lineages that differ by H antigens/fliC types, stx genotypes and non-stx putative virulence factors, with accumulation of virulence determinants in the O91:H21 lineage. Isolation of STEC O91 from patients stools on enterohemolysin agar and their rapid initial subtyping using fliC genotyping facilitates identification of these emerging pathogens in clinical and epidemiological studies and enables prediction of the risk of a severe clinical outcome.

• Escherichia coli encoding Shiga toxin 2f as an emerging human pathogen.

  Authors: Rita Prager, Angelika Fruth, Ute Siewert, Ute Strutz, Helmut Tschäpe

  International journal of medical microbiology : IJMM. 02/2009;

  Escherichia coli harbouring the stx2f gene have been previously reported in pigeons. Here we demonstrate the presence of this allele in human diarrhoeagenic E. coli strains originally classified asEscherichia coli harbouring the stx2f gene have been previously reported in pigeons. Here we demonstrate the presence of this allele in human diarrhoeagenic E. coli strains originally classified as atypical enteropathogenic E. coli (aEPEC). Thirty-two stx2f-positive E. coli serotyped as O63:H6, O128:H2, O132:H34, O145:H34, and O178:H7 were found to belong to a large number of clonal groups due to their different MLST-, PFGE- and virulence patterns. The appearance of various stx2f-positive clonal lineages among E. coli reveals emerging clinical significance. Therefore, it seems to be prudent to include stx2f into the diagnostic scope employed for laboratory investigation of enteric infections.

• Shiga toxin-producing Escherichia coli serogroups in food and patients, Germany.

  Authors: Dirk Werber, Lothar Beutin, Rohtraud Pichner, Klaus Stark, Angelika Fruth

  Emerging infectious diseases. 12/2008; 14(11):1803-6.

  We compared 61 Shiga toxin-producing Escherichia coli (STEC) serogroups from 448 food isolates with 71 STEC serogroups from 1,447 isolates from patients in Germany. Two thirds (41/61), representingWe compared 61 Shiga toxin-producing Escherichia coli (STEC) serogroups from 448 food isolates with 71 STEC serogroups from 1,447 isolates from patients in Germany. Two thirds (41/61), representing 72% of food isolates, were also found in patients. Serogroups typically isolated from patients with hemolytic uremic syndrome were rarely found in food.

• Inhibition of growth of Shiga toxin-producing Escherichia coli by nonpathogenic Escherichia coli.

  Authors: Rolf Reissbrodt, Walter P Hammes, Fabio Dal Bello, Rita Prager, Angelika Fruth, Klaus Hantke, Alexander Rakin, Marjanca Starcic Erjavec, Peter H Williams

  FEMS microbiology letters. 12/2008;

  Abstract During routine quality control testing of diagnostic methods for Shiga toxin-producing Escherichia coli (STEC) using stool samples spiked with STEC, it was observed that the Shiga toxinAbstract During routine quality control testing of diagnostic methods for Shiga toxin-producing Escherichia coli (STEC) using stool samples spiked with STEC, it was observed that the Shiga toxin could not be detected in 32 out of 82 samples tested. Strains of E. coli isolated from such stool samples were shown to be responsible for this inhibition. One particular isolate, named E. coli 1307, was intensively studied because of its highly effective inhibitory effect; this strain significantly reduced growth and Shiga toxin levels in coculture of several STEC strains regardless of serovar or Shiga toxin type. The probiotic E. coli Nissle 1917 inhibited growth and reduced Shiga toxin levels in STEC cultures to an extent similar to E. coli 1307, but commensal E. coli strains and several other known probiotic bacteria (enterococci, Bacillus sp., Lactobacillus acidophilus) showed no, or only small, inhibitory effects. Escherichia coli 1307 lacks obvious fitness factors, such as aerobactin, yersiniabactin, microcins and a polysaccharide capsule, that are considered to promote the growth of pathogenic bacteria. We therefore propose strain E. coli 1307 as a candidate probiotic for use in the prevention and treatment of infections caused by STEC.

• Analysis of collection of hemolytic uremic syndrome-associated enterohemorrhagic Escherichia coli.

  Authors: Alexander Mellmann, Martina Bielaszewska, Robin Köck, Alexander W Friedrich, Angelika Fruth, Barbara Middendorf, Dag Harmsen, M Alexander Schmidt, Helge Karch

  Emerging infectious diseases. 09/2008; 14(8):1287-90.

  Multilocus sequence typing of 169 non-O157 enterohemorrhagic Escherichia coli (EHEC) isolated from patients with hemolytic uremic syndrome (HUS) demonstrated 29 different sequence types (STs); 78.1%Multilocus sequence typing of 169 non-O157 enterohemorrhagic Escherichia coli (EHEC) isolated from patients with hemolytic uremic syndrome (HUS) demonstrated 29 different sequence types (STs); 78.1% of these strains clustered in 5 STs. From all STs and serotypes identified, we established a reference panel of EHEC associated with HUS (HUSEC collection).

• Shiga toxin-negative attaching and effacing Escherichia coli: distinct clinical associations with bacterial phylogeny and virulence traits and inferred in-host pathogen evolution.

  Authors: Martina Bielaszewska, Barbara Middendorf, Robin Köck, Alexander W Friedrich, Angelika Fruth, Helge Karch, M Alexander Schmidt, Alexander Mellmann

  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 08/2008; 47(2):208-17.

  BACKGROUND: Attaching and effacing Escherichia coli (AEEC) that lack Shiga toxin genes (stx) and the enteropathogenic E. coli adherence factor (EAF) plasmid (stx-/EAF-) are classified as atypicalBACKGROUND: Attaching and effacing Escherichia coli (AEEC) that lack Shiga toxin genes (stx) and the enteropathogenic E. coli adherence factor (EAF) plasmid (stx-/EAF-) are classified as atypical enteropathogenic E. coli and cause diarrhea worldwide. However, it is unknown whether there are bacterial lineage-specific human disease phenotypes. We compared stx-/EAF- AEEC recovered from patients (mostly children) with bloody and nonbloody diarrhea. METHODS: stx-/EAF- AEEC were isolated using eae colony blot hybridization and were serotyped, tested (by polymerase chain reaction) for putative virulence genes, and analyzed for phylogenetic relationships by use of multilocus sequence typing. RESULTS: During the period 1995-2007, stx-/EAF- AEEC were isolated as the only bacterial pathogens from stool specimens obtained from 18 (15.3%) of 118 patients with bloody diarrhea and from 141 (1.3%) of 10,550 patients with nonbloody diarrhea ([Formula: see text]). All but 1 of 18 strains recovered from patients with bloody diarrhea resembled enterohemorrhagic E. coli (EHEC) on the basis of serotypes, non-stx virulence profiles, and multilocus sequence types. In contrast, most (75.9%) of 141 stx-/EAF- AEEC recovered from patients with nonbloody diarrhea belonged to other serotypes and differed from the former strains phylogenetically and with regard to virulence genes. Three of 18 patients with bloody diarrhea and none of 141 patients with nonbloody diarrhea who shedded stx-/EAF- AEEC developed hemolytic uremic syndrome. CONCLUSIONS: Most stx-/EAF- AEEC associated with bloody diarrhea are plausibly EHEC that lost Shiga toxin during infection (EHEC-LST). To prevent serious complications of such infections, Shiga toxin-independent diagnostic strategies to accurately and rapidly identify such patients should be developed and applied. Multilocus sequence typing has potential to distinguish EHEC-LST from less pathogenic stx-/EAF- AEEC.

• Looking for tips to find icebergs--surveillance of haemolytic uraemic syndrome to detect outbreaks of Shiga toxin-producing E. coli infection.

  Authors: Dirk Werber, Christina Frank, Maria Wadl, Helge Karch, Angelika Fruth, Klaus Stark

  Euro surveillance : bulletin européen sur les maladies transmissibles = European communicable disease bulletin. 03/2008; 13(9).