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1.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1534928

ABSTRACT

La inocuidad de la carne comercializada debe estar garantizada en la cadena de producción, para evitar enfermedades transmitidas por alimentos (ETA). Escherichia coli productor de toxina Shiga (STEC) y Salmonella spp. pueden encontrarse en el tracto gastrointestinal de los bovinos y contaminar la carne de consumo humano, pudiendo causar enfermedades en el hombre. Este trabajo tuvo como objetivo evaluar las condiciones higiénico-sanitarias de 52 carnicerías localizadas en Asunción y detectar la frecuencia de STEC y Salmonella spp. en muestras de carne molida. Las condiciones higiénico-sanitarias se evaluaron mediante la estimación del riesgo, utilizando una escala de clasificación por categorías. La detección de STEC y Salmonella spp. se realizó por PCR en tiempo real. En la evaluación inicial, se clasificaron a 33% de las carnicerías como de alto y moderado riesgo. Se detectó STEC no-O157 en un 50% (130/258) de las muestras y Salmonella spp. en un 11% (29/258). Se realizaron acciones de mejora. En la etapa post-intervención, no se detectaron carnicerías de alto riesgo. En el muestreo de seguimiento se detectó un 29% (66/237) de muestras positivas para STEC no-O157 y 7% (16 /237) para Salmonella spp. Este estudio permitió realizar recomendaciones específicas y detalladas a cada carnicería, lo que tuvo un efecto significativo en la mejora de sus condiciones. Esta situación resalta la importancia de continuar fortaleciendo la vigilancia multisectorial y multidisciplinaria. Es imperativo que los establecimientos que se dedican al rubro, implementen las Buenas Prácticas de Manufactura (BPM) como una medida para reducir los riesgos asociados.


The safety of marketed meat must be guaranteed in the production chain, to avoid foodborne illness. Shiga toxin-producing Escherichia coli (STEC) and Salmonella spp. can be found in the gastrointestinal tract of cattle and contaminate meat for human consumption, potentially causing diseases in humans. This work aimed to evaluate the hygienic-sanitary conditions of 52 butcher shops located in Asunción and detect the frequency of STEC and Salmonella spp. in ground beef samples. Hygienic-sanitary conditions were evaluated by estimating risk, using a categorical classification scale. The detection of STEC and Salmonella spp. was performed by real-time PCR. In the initial evaluation, 33% of the butcher shops were classified as high and moderate risk. STEC non-O157 was detected in 50% (130/258) of the samples and Salmonella spp. in 11% (29/258). Improvement actions were carried out. In the post-intervention stage, no high-risk butcher shops were detected. In the follow-up sampling, 29% (66/237) of positive samples were detected for STEC non-O157 and 7% (16/237) for Salmonella spp. This study allowed specific and detailed recommendations to be made to each butcher shop, which had a significant effect on improving their conditions. This situation highlights the importance of continuing to strengthen multisectoral and multidisciplinary surveillance. It is imperative that establishments dedicated to the sector implement Good Manufacturing Practices (GMP) as a measure to reduce associated risks.

2.
Biomédica (Bogotá) ; 43(4)dic. 2023.
Article in English | LILACS-Express | LILACS | ID: biblio-1533959

ABSTRACT

Introduction. Shiga toxin-producing Escherichia coli (STEC) is a foodborne pathogen associated with clinical cases of diarrhea in humans. Its main virulence factors are the Shiga toxins (Stx1 and Stx2). Cattle are the main reservoir of STEC, and many outbreaks in humans have been related to the consumption of undercooked ground beef contaminated with this pathogen. Objective. To determine the prevalence of STEC in ground beef commercialized in all the butcher shops of a township in the department of Quindío and to characterize the virulence genes of the strains found. Materials and methods. Thirty ground beef samples were taken in three different times; stx genes and other STEC virulence factors (eae, ehxA, saa) were detected by multiplex PCR. Results. The overall prevalence of STEC was 33.33 % (10/30 positive samples). We isolated eight non-O157 (LEE-negative) strains with four different genetic profiles: stx 2 / stx 2-ehxA-saa / stx 1-stx 2-ehxA-saa / stx 1-saa. Conclusion. This is the first report on the prevalence of STEC in ground beef in a township in the department of Quindío.


Introducción. Escherichia coli productora de toxina Shiga (STEC) es un agente patógeno de origen alimentario asociado a casos clínicos de diarrea en humanos; sus principales factores de virulencia son las toxinas Shiga (Stx1 y Stx2). El principal reservorio de STEC es el ganado bovino y muchos brotes en humanos se han relacionado con el consumo de carne mal cocida contaminada con este agente patógeno. Objetivo. El objetivo de este trabajo fue determinar la prevalencia de STEC en carne molida comercializada en todas las carnicerías de un municipio del departamento del Quindío y caracterizar los genes de virulencia de las cepas encontradas. Materiales y métodos. Se tomaron 30 muestras de carne molida en tres momentos diferentes; se detectaron los genes stx y otros factores de virulencia de STEC (eae, ehxA, saa) mediante PCR Multiplex. Resultados. Los resultados mostraron una prevalencia global de STEC del 33,33 % (10/30 muestras positivas). En total se aislaron ocho cepas STEC no-O157 (LEE-negativas) con cuatro perfiles genéticos diferentes: stx 2 / stx 2-ehxA-saa / stx 1-stx 2-ehxA-saa / stx 1-saa. Conclusión. Este es el primer reporte que muestra la prevalencia de STEC en carne molida en un municipio del departamento del Quindío.

3.
Rev. argent. microbiol ; 55(4): 2-2, Dec. 2023.
Article in English | LILACS-Express | LILACS | ID: biblio-1550709

ABSTRACT

Abstract In Argentina, hemolytic uremic syndrome (HUS) caused by Shiga toxin-producing Escherichia coli (STEC-HUS) infection is endemic, and reliable data about prevalence and risk factors have been available since 2000. However, information about STEC-associated bloody diarrhea (BD) is limited. A prospective study was performed during the period October Surveillance; 2018-June 2019 in seven tertiary-hospitals and 18 referral units from different regions, aiming of STEC-HUS cases in the same hospitals and during the same period were also assessed. Twenty-nine (4.1%) of the BD patients were STEC-positive, as determined by the Shiga Toxin Quik Chek (STQC) test and/or the multiplex polymerase chain reaction (mPCR) assay. The highest fre-quencies were found in the Southern region (Neuquén, 8.7%; Bahía Blanca, 7.9%), in children between 12 and 23 month of age (8.8%), during summertime. Four (13.8%) cases progressed to HUS, three to nine days after diarrhea onset. Twenty-seven STEC-HUS in children under 5 years of age (77.8%) were enrolled, 51.9% were female; 44% were Stx-positive by STQC and all by mPCR. The most common serotypes were O157:H7 and O145:H28 and the prevalent geno-types, both among BD and HUS cases, were sfx2a-only or -associated. Considering the endemic behavior of HUS and its high incidence, these data show that the rate of STEC-positive cases is low among BD patients. However, the early recognition of STEC-positive cases is important for patient monitoring and initiation of supportive treatment.


Resumen En Argentina, el síndrome urémico hemolítico asociado a Escherichia coli productor de toxina Shiga (STEC-SUH) es endémico y, desde 2000, de notificación obligatoria. Sin embargo, la información sobre diarrea sanguinolenta (DS) asociada a STEC (DS-STEC) es limitada. Se realizó un estudio prospectivo desde octubre de 2018 hasta junio de 2019 en siete hospitales de tercer nivel y 18 unidades de referencia de diferentes provincias argentinas, con el objetivo de determinar la frecuencia de casos de DS-STEC en 714 niños de 1 a 9 años que tuvieron DS (I) y la tasa de progresión de DS a SUH en dicha cohorte (II). También se evaluó el número y distribución regional de casos de STEC-SUH en los mismos hospitales en dicho período. Veintinueve casos de DS (4,1%) fueron STEC-positivos, determinados por Shiga Toxin Quik Chek (STQC) o PCR múltiple (mPCR). Las frecuencias más altas se encontraron en el sur del área relevada (Neuquén, 8,7%; Bahía Blanca, 7,9%), en niños de 12 a 23 meses (8,8%), en verano. Cuatro casos de DS-STEC (13,8%) progresaron a SUH, de tres a nueve días después del inicio de la diarrea. Se registraron 27 niños con STEC-SUH, estos fueron mayoritariamente <5 anos (77,8%) del sexo femenino (51,9%). El 44% de estos casos fueron Stx-positivos por STQC y todos por mPCR. Los serotipos más comunes fueron O157:H7y O145:H28, y el genotipo predominante fue stx2a, solo o asociado, en DS y SUH. Considerando el comportamiento endémico del SUH y su alta incidencia, estos datos muestran que la tasa de casos de DS-STEC es baja. Sin embargo, su reconocimiento temprano es importante para el seguimiento e inicio del tratamiento de sostén.

4.
Rev. argent. microbiol ; 55(1): 4-10, mar. 2023. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1441180

ABSTRACT

Resumen Las cepas de Escherichia coli productoras de toxina Shiga (STEC) son reconocidas como responsables de un alto número de casos de enfermedades de transmisión alimentaria a nivel mundial. Su patogenicidad ha sido vinculada directamente con la actividad de las toxinas (Stx); sin embargo, la habilidad de estas bacterias para colonizar al huésped y otras superficies puede ser esencial para desarrollar su poder patogénico. La gran plasticidad genómica de cepas STEC se infiere de la variabilidad de perfiles de virulencia, con la frecuente emergencia de cepas con nuevos genes, codificados en nuevas islas de patogenicidad vinculadas al metabolismo y la adherencia. La formación de biofilm es un mecanismo espontáneo por el cual las cepas STEC resisten en un ambiente hostil, lo que les permite sobrevivir y, de esa forma, llegar al huésped, a través de los alimentos o de las superficies que están en contacto con ellos. Este mecanismo presenta una alta variabilidad intra e interserotipo y su desarrollo no depende solo de los microorganismos que lo conforman. Factores inherentes al ambiente (pH, temperatura) y la superficie (acero inoxidable, poliestireno) a la que pueden adherirse influyen en la expresión de biofilm. El concepto «una salud¼ implica la interrelación entre los actores de salud pública, animal y ambiental para lograr alimentos inocuos y evitar contaminación cruzada y resistencia a sanitizantes, lo cual pone de manifiesto la necesidad de identificar patógenos emergentes a través de nuevos marcadores moleculares, que detecten cepas STEC portadoras del denominado locus for enterocyte effacement (LEE) o del locus de adherencia y autoagregación (LAA).


Abstract Shiga Toxin-producing Escherichia coli (STEC) is recognized as being responsible for a large number of foodborne illnesses around the world. The pathogenicity of STEC has been related to Stx toxins. However, the ability of STEC to colonize the host and other surfaces can be essential for developing its pathogenicity. Different virulence profiles detected in STEC could cause the emergence of strains carrying new genes codified in new pathogenicity islands linked to metabolism and adherence. Biofilm formation is a spontaneous mechanism whereby STEC strains resist in a hostile environment being able to survive and consequently infect the host through contaminated food and food contact surfaces. Biofilm formation shows intra-and inter-serotype variability, and its formation does not depend only on the microorganisms involved. Other factors related to the environment (such as pH, temperature) and the surface (stainless steel and polystyrene) influence biofilm expression. The «One Health¼ concept implies the interrelation between public, animal, and environmental health actors to ensure food safety, prevent cross-contamination and resistance to sanitizers, highlighting the need to identify emerging pathogens through new molecular markers of rapid detection that involve STEC strains carrying the Locus of Enterocyte Effacement or Locus of Adhesion and Autoaggregation.

5.
Mongolian Medical Sciences ; : 3-6, 2022.
Article in English | WPRIM | ID: wpr-972902

ABSTRACT

Introduction@#PCR to detect and amplificate the virulence genes of STEC is specific and more sensitive, however, it takes five to six hours for whole test procedure and requires special lab instruments such as thermocycler. Loop-mediated isothermal amplification is a simple, rapid, specific and cost-effective nucleic acid amplification method by using four to six primers when compared to PCR, nucleic acid sequence-based amplification, self-sustained sequence replication and strand displacement amplification.@*Goal@#Detection and comparison of STEC by PCR and LAMP@*Materials and Methods@#In our study, we analyzed comparison of PCR and LAMP results on standard strain used quality control strain solution which diluted 1pg/µL DNA, 10 pg/µL DNA, 100 pg/µL DNA, 1 ng/μL DNA, 10 ng/μL DNA, and 100 ng/μL DNA concentration from LB agar cultures. @*Research ethics@#Permission to submit the survey was granted by the Ethics Review Committee of the MNUMS and the survey was conducted in accordance with the rules and regulations.@*Result@#Sensitivity of Stx1 and stx2 genes in PCR results are positive in 10 pg/µL DNA solution and negative in 1pg/µL DNA. In LAMP test results showed that positive for all concentration. It shows that LAMP method sensitivity is 10 times more than PCR. @*Conclusion@#It shows that LAMP method sensitivity is 10 times more than PCR. All in allLAMP test is cost effective test with sensitive for detection STEC.

6.
Mongolian Medical Sciences ; : 3-7, 2022.
Article in English | WPRIM | ID: wpr-972887

ABSTRACT

Introduction@#PCR to detect and amplificate the virulence genes of STEC is specific and more sensitive, however, it takes five to six hours for whole test procedure and requires special lab instruments such as thermocycler. Loop-mediated isothermal amplification is a simple, rapid, specific and cost-effective nucleic acid amplification method by using four to six primers when compared to PCR, nucleic acid sequence-based amplification, self-sustained sequence replication and strand displacement amplification.@*Materials and Methods@#In our study, we analyzed comparison of PCR and LAMP results on standard strain used quality control strain solution which diluted 1pg/µL DNA, 10 pg/µL DNA, 100 pg/µL DNA, 1 ng/μL DNA, 10 ng/μL DNA, and 100 ng/μL DNA concentration from LB agar cultures. @*Research ethics@#Permission to submit the survey was granted by the Ethics Review Committee of the MNUMS and the survey was conducted in accordance with the rules and regulations. @*Goal@#Detection and comparison of STEC by PCR and LAMP@*Result@#Sensitivity of Stx1 and stx2 genes in PCR results are positive in 10 pg/µL DNA solution and negative in 1pg/µL DNA. In LAMP test results showed that positive for all concentration. It shows that LAMP method sensitivity is 10 times more than PCR. @*Conclusion@#It shows that LAMP method sensitivity is 10 times more than PCR. All in allLAMP test is cost effective test with sensitive for detection STEC.

7.
Article in English | LILACS-Express | LILACS, VETINDEX | ID: biblio-1487624

ABSTRACT

ABSTRACT: The present study was aimed at subtyping of Stx1 and Stx2 genes and characterization of antimicrobial resistance in 106 Shiga toxin-producing Escherichia coli (STEC) strains isolated from cattle and sheep feces. PCR was used to determine the subtypes, and the disk-diffusion method was used to evaluate the antimicrobial resistance. Ten antibiotics from five different classes were tested. Among the isolates of bovine origin, two subtypes of Stx1 (Stx1a and Stx1c), and four subtypes of Stx2 (Stx2a, Stx2b, Stx2c, and Stx2d) were identified. In isolates of sheep origin, two subtypes of Stx1 (Stx1a and Stx1c), and four subtypes of Stx2 (Stx2a, Stx2b, Stx2c, and Stx2 g) were identified. The results obtained suggest the presence of high diversity in Stx1 and Stx2 genes. Further, 96.6% (57/59) of bovine fecal strains and 89.4% (42/47) of sheep fecal strains showed resistance to at least one tested antibiotic. In both animal species, most strains were multidrug-resistant (MDR) (67.8% in cattle and 59.6% in sheep), with no significant difference between host animals. Adult animals were eight times more likely to have STEC with greater pathogenic potential. STEC with the highest pathogenic potential were three times more likely to be multidrug-resistant than STEC with the lowest pathogenic potential. The data reported in this study suggests the occurrence of strains with high potential pathogenicity in the region studied. Therefore, the ruminants of this region are carriers of strains that can cause infections in humans.


RESUMO: O presente estudo teve como objetivo subtipar os genes Stx1 e Stx2 e caracterizar a resistência antimicrobiana em 106 isolados de Escherichia coli produtoras de toxinas Shiga (STEC) isoladas de fezes de bovinos e ovinos. A PCR foi utilizada para determinar os subtipos e o método de difusão em disco foi utilizado para avaliar a resistência antimicrobiana. Dez antibióticos de cinco classes diferentes foram testados. Entre os isolados de origem bovina, foram identificados dois subtipos de Stx1 (Stx1a e Stx1c) e quatro subtipos de Stx2 (Stx2a, Stx2b, Stx2c e Stx2d). Nos isolados de origem ovina, foram identificados dois subtipos de Stx1 (Stx1a e Stx1c) e quatro subtipos de Stx2 (Stx2a, Stx2b, Stx2c e Stx2g). Os resultados obtidos sugerem a presença de alta variabilidade nos genes Stx1 e Stx2. Além disso, 96,6% (57/59) dos isolados fecais de bovinos e 89,4% (42/47) dos isolados de ovinos mostraram resistência a pelo menos um antibiótico testado. Em ambas as espécies animais, a maioria das cepas foi multirresistente (MDR) (67,8% em bovinos e 59,6% em ovinos), sem diferença significativa entre as espécies animais do reservatório. Os animais adultos tiveram oito vezes mais chances de apresentar STEC com maior potencial patogênico. STEC com o maior potencial patogênico teve três vezes mais chances de ser multirresistente do que o STEC com o menor potencial patogênico. Os dados relatados neste estudo sugerem a ocorrência de cepas com alto potencial de patogenicidade na região estudada. Portanto, os ruminantes dessa região são hospedeiros de isolados que podem causar infecções em humanos.

8.
Pesqui. vet. bras ; 41: e06747, 2021. tab, graf
Article in English | LILACS, VETINDEX | ID: biblio-1279541

ABSTRACT

The present study was aimed at subtyping of Stx1 and Stx2 genes and characterization of antimicrobial resistance in 106 Shiga toxin-producing Escherichia coli (STEC) strains isolated from cattle and sheep feces. PCR was used to determine the subtypes, and the disk-diffusion method was used to evaluate the antimicrobial resistance. Ten antibiotics from five different classes were tested. Among the isolates of bovine origin, two subtypes of Stx1 (Stx1a and Stx1c), and four subtypes of Stx2 (Stx2a, Stx2b, Stx2c, and Stx2d) were identified. In isolates of sheep origin, two subtypes of Stx1 (Stx1a and Stx1c), and four subtypes of Stx2 (Stx2a, Stx2b, Stx2c, and Stx2 g) were identified. The results obtained suggest the presence of high diversity in Stx1 and Stx2 genes. Further, 96.6% (57/59) of bovine fecal strains and 89.4% (42/47) of sheep fecal strains showed resistance to at least one tested antibiotic. In both animal species, most strains were multidrug-resistant (MDR) (67.8% in cattle and 59.6% in sheep), with no significant difference between host animals. Adult animals were eight times more likely to have STEC with greater pathogenic potential. STEC with the highest pathogenic potential were three times more likely to be multidrug-resistant than STEC with the lowest pathogenic potential. The data reported in this study suggests the occurrence of strains with high potential pathogenicity in the region studied. Therefore, the ruminants of this region are carriers of strains that can cause infections in humans.(AU)


O presente estudo teve como objetivo subtipar os genes Stx1 e Stx2 e caracterizar a resistência antimicrobiana em 106 isolados de Escherichia coli produtoras de toxinas Shiga (STEC) isoladas de fezes de bovinos e ovinos. A PCR foi utilizada para determinar os subtipos e o método de difusão em disco foi utilizado para avaliar a resistência antimicrobiana. Dez antibióticos de cinco classes diferentes foram testados. Entre os isolados de origem bovina, foram identificados dois subtipos de Stx1 (Stx1a e Stx1c) e quatro subtipos de Stx2 (Stx2a, Stx2b, Stx2c e Stx2d). Nos isolados de origem ovina, foram identificados dois subtipos de Stx1 (Stx1a e Stx1c) e quatro subtipos de Stx2 (Stx2a, Stx2b, Stx2c e Stx2g). Os resultados obtidos sugerem a presença de alta variabilidade nos genes Stx1 e Stx2. Além disso, 96,6% (57/59) dos isolados fecais de bovinos e 89,4% (42/47) dos isolados de ovinos mostraram resistência a pelo menos um antibiótico testado. Em ambas as espécies animais, a maioria das cepas foi multirresistente (MDR) (67,8% em bovinos e 59,6% em ovinos), sem diferença significativa entre as espécies animais do reservatório. Os animais adultos tiveram oito vezes mais chances de apresentar STEC com maior potencial patogênico. STEC com o maior potencial patogênico teve três vezes mais chances de ser multirresistente do que o STEC com o menor potencial patogênico. Os dados relatados neste estudo sugerem a ocorrência de cepas com alto potencial de patogenicidade na região estudada. Portanto, os ruminantes dessa região são hospedeiros de isolados que podem causar infecções em humanos.(AU)


Subject(s)
Animals , Cattle , Cattle/microbiology , Sheep/microbiology , Shiga Toxins , Escherichia coli/isolation & purification , Shiga-Toxigenic Escherichia coli , Anti-Infective Agents , Polymerase Chain Reaction
9.
Pesqui. vet. bras ; 40(3): 165-169, Mar. 2020. tab
Article in English | LILACS, VETINDEX | ID: biblio-1135601

ABSTRACT

Enteropathogenic Escherichia coli (EPEC) and Shigatoxigenic E. coli (STEC) strains are among the major pathotypes found in poultry and their products, which are capable of causing human enteric infections. Colistin has been claimed the drug of choice against diseases caused by multidrug-resistant Gram-negative bacteria (MDRGN) in humans. The mcr-1 gene was the first plasmidial gene that has been described to be responsible for colistin resistance and has also been detected in birds and poultry products. Our study aimed to detect the mcr-1 gene in enteropathogenic strains of E. coli in order to evaluate the resistance to colistin in broilers. The material was obtained from 240 cloacal samples and 60 broiler carcasses. The strains were isolated by the conventional bacteriological method and by the virulence genes, which characterize the enteropathogenic strains and resistance, and the samples were detected by polymerase chain reaction (PCR). Of the 213 isolated strains of E. coli, 57 (26.76%) were characterized as atypical EPEC and 35 (16.43%) as STEC. The mcr-1 gene was found in 3.5% (2/57) of the EPEC strains and 5.7% (2/35) of the STEC strains. In this study, it was possible to confirm that the mcr-1 resistance gene is already circulating in the broiler flocks studied and may be associated with the pathogenic strains.(AU)


Escherichia coli Enteropatogênica (EPEC) e Shigatoxigênica (STEC) estão entres os principais patotipos encontrados em aves e produtos avícolas que são capazes de causar doença entérica no homem. A colistina tem sido preconizada como droga de escolha para o tratamento de doenças causadas por bactérias Gram-negativas multirresistentes em humanos. O gene mcr-1 foi o primeiro gene plasmidial a ser descrito como responsável pela resistência a colistina e tem sido descrito em aves e produtos avícolas. Este estudo tem como objetivo a detecção do gene mcr-1 em estirpes de E. coli enteropatogênicas a fim de avaliar a resistência a colistina em frangos de corte. O material foi obtido a partir de 240 amostras cloacais e 60 carcaças de frango de corte. As estirpes foram isoladas pelo método bacteriológico convencional e os genes de virulência, que caracterizam as estirpes enteropatogênicas, e resistência foram detectados pela reação em cadeia pela polimerase (PCR). Das 213 estirpes de E. coli isoladas, 57 (26,76%) foram caracterizadas como EPEC atípica e 35 (16,43%) como STEC. O gene mcr-1 foi encontrado em 3,5% (2/57) das estirpes EPEC e 5,7% (2/35) das estirpes STEC. Neste estudo foi possível confirmar que o gene de resistência mcr-1 já está em circulação nos lotes de frango de corte estudados e pode estar associado às estirpes patogênicas.(AU)


Subject(s)
Chickens/microbiology , Enteropathogenic Escherichia coli/isolation & purification , Enteropathogenic Escherichia coli/genetics , Shiga-Toxigenic Escherichia coli/isolation & purification , Shiga-Toxigenic Escherichia coli/genetics , Polymerase Chain Reaction/veterinary , Colistin , Genes, MDR , Drug Resistance, Bacterial
10.
Rev. chil. nutr ; 47(1): 148-152, feb. 2020.
Article in Spanish | LILACS | ID: biblio-1092755

ABSTRACT

Algunos profesionales de la salud desaconsejan el consumo del yogur por el riesgo de provocar Síndrome Urémico Hemolítico, una enfermedad grave causada por cepas de E. coli productor de toxina Shiga (STEC por sus siglas en inglés). Estas bacterias pueden pasar del intestino del ganado vacuno a la carne o a la leche en condiciones inadecuadas de trabajo en frigoríficos o establecimientos productores de leche, respectivamente, siendo las hamburguesas insuficientemente cocidas el principal vector de la enfermedad y la leche cruda sin pasteurizar o los productos lácteos elaborados con ésta, otro factor de riesgo. En la industria láctea, el yogur se elabora con leche que es sometida a un doble tratamiento térmico. En la bibliografía moderna reportes de la presencia de STEC en yogures industriales, y los trabajos de revisión y meta-análisis no incluyen al yogur, pero sí a la leche sin pasteurizar, como vectores de trasmisión de STEC. En este contexto, y dada la evidencia científica disponible actualmente en relación a E. coli productor de toxina Shiga, el SUH y el yogur, parecería que estamos ante la presencia de una correlación espuria, la asociación de dos hechos que no tienen relación causal entre sí, más que a un hecho científico del cual uno (el yogur) es el responsable del otro (SUH).


Some health professionals discourage yogurt because of the risk of Hemolytic Uremic Syndrome (HUS), a serious disease caused by strains of Shiga toxin-producing E. coli (STEC). These bacteria can pass from the intestine of cattle to meat or milk under inadequate working conditions in slaughterhouses or milking plants. Undercooked hamburgers the main is vector of disease and unpasteurized raw milk or dairy products made with it, are another risk factors. In the dairy industry, yoghurt is made from milk that undergoes a double heat treatment. There are no reports of the presence of STEC in industrial yogurts in the modern bibliography, and reviews and meta-analysis do not point to yogurt as a risk factor for STEC, but rather unpasteurized milk. In this context, and given the scientific evidence currently available regarding STEC, HUS and yogurt, it would seem that we are in the presence of a spurious correlation, the association between two facts that have no causal relationship between them, rather than a scientific fact for which one (yogurt) may be responsible for the other (HUS).


Subject(s)
Humans , Yogurt/adverse effects , Hemolytic-Uremic Syndrome/etiology , Yogurt/microbiology , Shiga-Toxigenic Escherichia coli/pathogenicity , Meat Products/adverse effects , Meat Products/microbiology
11.
Mem. Inst. Invest. Cienc. Salud (Impr.) ; 17(2): 71-76, ago. 2019. tab, ilus
Article in Spanish | LILACS, BDNPAR | ID: biblio-1008486

ABSTRACT

Los serogrupos O26, O45, O103, O104, O111, O121, O145 y O157 de STEC se relacionan con un elevado número de casos de SUH a nivel mundial, por lo que están incluidos dentro de las categorías de mayor riesgo para los humanos, según los criterios de autoridades alimentarias de Estados Unidos y Europa. El método convencional de identificación de antígenos O y H se realiza por aglutinación con antisueros de conejo. Este método además de ser muy costoso y laborioso, no se encuentra disponible en el país para empleo masivo. En este contexto, el objetivo de este estudio observacional descriptivo de corte transverso ha sido la estandarización de una técnica de PCR múltiple para la detección de estos 8 serogrupos, a fin de contar con un sistema de detección eficiente, sensible y con potencial de aplicación en la industria alimentaria. Se estandarizaron reacciones de PCR empleando como controles positivos cepas E. coli de referencia correspondientes a la totalidad de los serogrupos citados. Se obtuvieron productos de tamaños esperados para cada serogrupo, no se observaron amplificaciones cruzadas o falsos positivos. Esta técnica estandarizada podría representar una herramienta rápida y menos costosa que la técnica serológica, con la capacidad de ser aplicada a diferentes matrices, permitiendo la detección de estos serogrupos en aislados STEC de ganado en pie, fuentes de agua de consumo, alimentos e incluso en aislamientos clínicos asociados a enfermedades humanas(AU)


STEC serogroups O26, O45, O103, O104, O111, O121, O145, and O157, are related to a high number of cases of HUS worldwide, so they are included in the categories of greatest risk for humans, according to the food administration criteria of the United States and Europe. The conventional method of identifying antigens O and H is carried out by agglutination with rabbit antisera. This method is very expensive and laborious and is not available in the country for massive-scale use. In this context, the objective of this cross-sectional descriptive observational study has been the standardization of a multiplex PCR technique for the detection of these 8 serogroups, in order to have an efficient and sensitive detection system with the potential for application in the food industry. PCR reactions were standardized using as positive controls reference E. coli strains to correspond to all the mentioned serogroups. Products of expected sizes were obtained for each serogroup; no cross-amplification or false positives were observed. This standardized technique could represent a quick and less expensive tool than the serological technique, with the possibility to be applied to different kind of samples, allowing the detection of these serogroups in STEC isolates of live cattle, sources of drinking water, food and even in clinical isolates associated with human diseases(AU)


Subject(s)
Shiga-Toxigenic Escherichia coli/isolation & purification , Multiplex Polymerase Chain Reaction , Cross-Sectional Studies , Escherichia coli O157/isolation & purification , Escherichia coli O157/genetics , Shiga-Toxigenic Escherichia coli/genetics , Escherichia coli O104/isolation & purification , Escherichia coli O104/genetics
12.
Hig. aliment ; 33(288/289): 2449-2454, abr.-maio 2019. tab
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1482238

ABSTRACT

Os diferentes grupos de E. coli podem estar presentes no leite e seus derivados, que podem resultar em infecções em humanos. Este estudo objetivou isolar E. coli de diferentes pontos da obtenção do leite e da elaboração de queijos tipo Minas frescal, detectar os patótipos EAEC, EIEC, ETEC, EPEC, STEC, ExPEC e caracterizar os isolados pela pesquisa de genes de virulência . Para tanto, foram realizadas coletas em cinco pequenas propriedades rurais produtoras deste tipo de queijo no nordeste do estado de São Paulo. Foram coletadas amostras de suabes de fezes bovinas, de mãos de ordenhador, balde, leite, soro, água, superfície de elaboração de queijos, mãos de manipulador do queijo, peneiras, bandejas, fôrmas e escumadeiras. Foram obtidos 73 isolados de E. coli potencialmente patogênicos, sendo que nas amostras de leite e queijo foram encontrados isolados como STEC e ExPEC. Assim, a presença de cepas de E. coli potencialmente patogênicas na obtenção do leite e na produção do queijo constitui risco para a saúde pública.


Subject(s)
Escherichia coli/isolation & purification , Escherichia coli/pathogenicity , Dairy Products/analysis , Dairy Products/microbiology , Milk/microbiology , Food Handling , Food Microbiology , Cheese/analysis , Cheese/microbiology
13.
Arch. latinoam. nutr ; 69(1): 59-67, mar. 2019. ilus, tab, graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1022752

ABSTRACT

Dentro de los patotipos de Escherichia coli, el grupo STEC puede producir en el ser humano desde diarrea hemorrágica hasta insuficiencia renal aguda e incluso la muerte; el ganado bovino es el principal reservorio de este agente patógeno y por ende la ingestión de alimentos derivados de estos animales de abasto son una fuente muy importante de infección para el hombre. El objetivo principal de este estudio fue determinar la prevalencia de STEC en muestras de carne cruda comercializada en Pamplona-Colombia y en cepas obtenidas a partir de las muestras. Se analizaron cien muestras de carne cruda aplicando la técnica de Reacción en Cadena de la Polimerasa para la detección de los siguientes genes en muestras y en cepas STEC: stx1, stx2, eae y hlyA. Adicionalmente, se estableció el patrón de resistencia-susceptibilidad antibiótica de cepas STEC aisladas empleando métodos regulados. En el 39% de las muestras fue posible detectar el gen stx2; en el 38%, de ellas, se detectaron los genes stx1 y stx2. Además, se aislaron cepas STEC en el 13% de las muestras analizadas, 85% de ellas portaban el gen hlyA. No se detectó la presencia del gen eae o del serogrupo O157. Las cepas aisladas demostraron resistencia frente a algunos antibióticos de primera y segunda generación. En conclusión, se detectó la presencia de genes que codifican factores de virulencia en las muestras de carne analizadas que representan un riesgo potencial para la salud de los consumidores. Este es el primer reporte de STEC no O157 que codifica el gen de la enterohemolisina en alimentos en Colombia(AU)


Within the Escherichia coli patotypes, the STEC group can produce in humans from hemorrhagic diarrhea to acute renal failure and even death; cattle are the main reservoir of this pathogen and therefore the ingestion of food derived from these stock animals are a very important source of infection for man. The main objective of this study was to determine the prevalence of STEC in raw meat samples marketed in Pamplona-Colombia and in strains obtained from those samples. One hundred raw meat samples were analyzed using the Polymerase Chain Reaction technique for the detection of the following genes in samples and in STEC strains: stx1, stx2, eae and hlyA. In addition, STEC strains were isolated in 13% of the analyzed samples, 85% of them carried the hlyA gene. The presence of the eae gene or serogroup O157 was not detected. The isolated strains demonstrated resistance against some first and second generation antibiotics. In conclusion, the presence of genes encoding virulence factors in the meat samples analyzed, that represent a potential health risk factor to consumers, was confirmed. This is the first report of STEC non-O157 that encodes the enterohemolysin gene in foods in Colombia(AU)


Subject(s)
Cattle , Drug Resistance, Microbial , Apoptosis , Escherichia coli O157 , Shiga-Toxigenic Escherichia coli , Meat , Bacteriology , Gastrointestinal Diseases
14.
Rev. argent. microbiol ; 51(1): 32-38, mar. 2019. ilus
Article in English | LILACS | ID: biblio-1003278

ABSTRACT

The objectives of this study were: (1) to estimate STEC frequency in hide and carcass samples taken from beef slaughterhouses supplying the domestic market in Argentina, (2) to establish the pheno-genotypic characteristics of STEC and non-toxigenic Escherichia coli of serogroups O26, O45, O103, O121, O111, O145 or O157 isolated from the analyzed samples and, (3) to study their clonal relatedness. Sixty hides and 60 carcasses were analyzed. At the screening step, 48% of hide and 80% of carcass samples tested positive for the stx gene by endpoint PCR. The STEC isolation rate was 5% for hides and 8% for carcasses. The isolation rate of STEC-positive for O26, O45, O103, O111, O145 or O157 serogroups was 0% for hides and 2% for carcasses. With the purpose of studying the clonal relatedness of isolates, macrorestriction fragment analysis by pulsed-field gel electrophoresis was performed. The results indicated cross-contamination between hides and between carcasses of animals in the same lot and, that the origin of carcass contamination was their own hide, or the hides of other animals in the same lot. The high detection rate at the screening step, especially in carcasses, and the evidence of cross-contamination show the need to apply additional in-plant intervention strategies aimed at preventing carcass contamination.


Los objetivos del presente estudio fueron tres: 1) estimar la frecuencia de Escherichia coli productor de toxina Shiga (STEC) en muestras de cuero y carcasa de bovinos en frigoríficos de consumo interno de Argentina; 2) realizar la caracterización feno-genotípica de las cepas STEC y de Escherichia coli no toxigénicas pertenecientes a los serogrupos O26, O45, 0103, O121, O145 u O157 aisladas a partir de las muestras analizadas; 3) establecer la relación clonal de ese conjunto de cepas. Se analizaron 60 cueros y 60 carcasas. En la etapa de tamizaje, el gen stx se detectó en el 48% de las muestras de cuero y en el 80% de las muestras de carcasa por una PCR de punto final. La frecuencia de recuperación de cepas STEC fue del 5% en cueros y del 8% en carcasas, y la de cepas STEC positivas para los serogrupos O26, O45, O103, O121, O111, O145 u O157 fue del 0% en los cueros y del 2% en las carcasas. La relación clonal de las cepas aisladas se investigó a través de electroforesis de campo pulsado y análisis de los patrones de macrorrestricción generados. Los resultados demostraron la existencia de contaminación cruzada entre cueros y carcasas de animales pertenecientes a un mismo lote, y también que el origen de la contaminación fue el propio cuero del animal o el cuero de otros animales pertenecientes al mismo lote. Los altos porcentajes de detección en la etapa de tamizaje, especialmente en carcasas, y la evidencia de contaminación cruzada ponen de manifiesto la necesidad de evaluar la implementación de estrategias de intervención tendientes a evitar la contaminación de carcasas.


Subject(s)
Shiga-Toxigenic Escherichia coli/genetics , Shiga-Toxigenic Escherichia coli/virology , Genotyping Techniques/methods , Red Meat/microbiology , Argentina , Mass Screening/veterinary , Abattoirs
15.
Ciênc. rural (Online) ; 49(9): e20190297, 2019. graf
Article in English | LILACS | ID: biblio-1045441

ABSTRACT

ABSTRACT: Shiga-like toxin-producing Escherichia coli (STEC) is an important source of food contamination that presents risks to human health. Several industrial food processes eliminate this microorganism; however, these processes can alter the characteristics of the product. Alternative methods of preservation have been identified as an option to control these foodborne pathogens. The purpose of this study was to evaluate the action of bacteriocins produced by Enterococcus durans MF5 in STEC cells. Cell-free supernatant (CFS) containing enterocins from the MF5 isolate was tested over different time points (6, 18, and 24 h). Enterocins present in the crude CFS showed inhibition against STEC at all time points. In the investigation of cell integrity, using propidium iodide and fluorescence microscopy, considerable cell death was observed within 6 h of the cells being in contact with the enterocins, which was also observed at the 18 and 24 h time points. These results showed that the enterocins produced by the MF5 isolate have potential use in the control of STEC.


RESUMO: Escherichia coli, produtora de toxina Shiga-like (STEC), apresenta riscos à saúde humana, constituindo uma importante fonte de contaminação na indústria de alimentos. Diversos processos industriais eliminam esse microrganismo, contudo podem alterar as características do produto. Métodos alternativos de conservação tem sido uma opção para controlar esse microrganismo de alimentos. O objetivo desta pesquisa foi avaliar a ação de bacteriocinas produzidas por Enterococcus durans MF5 em células de E. coli STEC. Foram utilizados sobrenadante livre de células (CFS) contendo enterocina, nos tempos 6, 18 e 24 horas de incubação. A enterocina presente no CFS bruto apresentou inibição contra E. coli STEC em todos os tempos testados. Na observação da integridade celular utilizando iodeto de propídio e observação em microscópio de fluorescência, observou-se que em 6h da célula em contato com a enterocina, já havia considerável morte celular, estendendo até os tempos de 18 e 24 horas. Os resultados obtidos mostraram que a enterocina produzida pelo isolado MF5 apresenta uso potencial no controle de E. coli STEC.

16.
Braz. j. microbiol ; 49(4): 936-941, Oct.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-1039269

ABSTRACT

ABSTRACT Shigatoxigenic and enteropathogenic Escherichia coli with virulence and multidrug resistance profile were isolated from Nile tilapia. This study finding is of great importance to public health because they help understand this pathogen epidemiology in fish and demonstrate how these animals can transmit E. coli related diseases to humans.


Subject(s)
Humans , Animals , Enteropathogenic Escherichia coli/isolation & purification , Shiga-Toxigenic Escherichia coli/isolation & purification , Fishes/microbiology , Phylogeny , Food Contamination/analysis , Consumer Product Safety , Escherichia coli Proteins/genetics , Enteropathogenic Escherichia coli/classification , Enteropathogenic Escherichia coli/genetics , Shiga-Toxigenic Escherichia coli/classification , Shiga-Toxigenic Escherichia coli/genetics , Meat/microbiology
17.
Arq. bras. med. vet. zootec. (Online) ; 70(6): 1807-1813, nov.-dez. 2018. tab
Article in English | LILACS, VETINDEX | ID: biblio-970491

ABSTRACT

This study determined the distribution of stx1 and stx2 genes in Escherichia coli isolated from dairy herds with regard to animal age, season, and farm production-scale, and analyzed the phylogenetic distribution of the groups A, B1, B2, and D of 276 isolates of bovine feces Shiga toxin-producing E. coli (STEC). The stx1 profile was the most common, detected in 20.4% (202/990) of the isolates, followed by stx2 (4.54%, 45/990) and stx1+stx2 (2.92%, 29/990). The stx1 gene was detected more frequently in calves than in adult animals. In the dry season (winter), the presence of stx1+stx2 profile in cattle feces was higher than in the rainy season (summer), while no significant changes were observed between seasons for the stx1 and stx2 profiles. The most predominant phylogenetic groups in adult animals were B1, A, and D, while groups A and B1 prevailed in calves. Our data highlight the importance of identifying STEC reservoirs, since 7.5% of the tested isolates were positive for stx2, the main profile responsible for the hemolytic-uremic syndrome (HUS). Moreover, these microorganisms are adapted to survive even in hostile environments and can contaminate the food production chain, posing a significant risk to consumers of animal products.(AU)


Esse estudo determinou a distribuição dos genes stx1 e stx2 em Escherichia coli isolados de rebanhos leiteiros em relação a idade, estação e produção, e analisaram a distribuição filogenética dos grupos A, B1, B2 e D de 276 E. coli produtoras de toxina Shiga (STEC). O perfil stx1 foi mais comum, detectado em 20,4% (202/990) dos isolados, seguido de stx2 (4,54%, 45/990) e stx1+stx2 (2,92%, 29/990). O gene stx1 foi detectado mais frequentemente em bezerros que animais adultos. No período de seca (inverno), a presença do perfil stx1+stx2 nas fezes dos bovinos foi mais prevalente que no período chuvoso (verão), apesar de não haver diferença significativa entre estações para os perfis stx1 e stx2. Os grupos filogenéticos mais predominantes em animais adultos foram B1, A e D, enquanto grupos A e B2 prevaleceram em bezerros. Nossos dados enfatizam a importância de se detectar reservatórios de STEC já que 7,5% dos isolados testados foram positivos para stx2, o perfil mais prevalente em casos de síndrome hemolítica-urêmica. Ademais, esses microorganismos são adaptados à sobreviver em ambientes hostis e contaminam a cadeia alimentar, levando a risco significativo para consumidores de alimentos de origem animal.(AU)


Subject(s)
Animals , Cattle , Cattle/genetics , Shiga Toxin 1/genetics , Shiga Toxin 2/genetics , Escherichia coli/isolation & purification , Escherichia coli/genetics
18.
Braz. j. microbiol ; 48(4): 760-763, Oct.-Dec. 2017. tab
Article in English | LILACS | ID: biblio-889158

ABSTRACT

ABSTRACT Psittacine birds have been identified as reservoirs of diarrheagenic Escherichia coli, a subset of pathogens associated with mortality of children in tropical countries. The role of other orders of birds as source of infection is unclear. The aim of this study was to perform the molecular diagnosis of infection with diarrheagenic E. coli in 10 different orders of captive wild birds in the state of São Paulo, Brazil. Fecal samples were analyzed from 516 birds belonging to 10 orders: Accipitriformes, Anseriformes, Columbiformes, Falconiformes, Galliformes, Passeriformes, Pelecaniformes, Piciformes, Psittaciformes and Strigiformes. After isolation, 401 E. coli strains were subjected to multiplex PCR system with amplification of genes eae and bfp (EPEC), stx1 and stx2 for STEC. The results of these tests revealed 23/401 (5.74%) positive strains for eae gene, 16/401 positive strains for the bfp gene (3.99%) and 3/401 positive for stx2 gene (0.75%) distributed among the orders of Psittaciformes, Strigiformes and Columbiformes. None of strains were positive for stx1 gene. These data reveal the infection by STEC, typical and atypical EPEC in captive birds. The frequency of these pathotypes is low and restricted to few orders, but the data suggest the potential public health risk that these birds represent as reservoirs of diarrheagenic E. coli.


Subject(s)
Animals , Birds/microbiology , Disease Reservoirs/microbiology , Enteropathogenic Escherichia coli/isolation & purification , Shiga-Toxigenic Escherichia coli/isolation & purification , Animals, Wild/microbiology , Birds/classification , Brazil , Escherichia coli Proteins/genetics , Escherichia coli Proteins/metabolism , Enteropathogenic Escherichia coli/classification , Enteropathogenic Escherichia coli/genetics , Enteropathogenic Escherichia coli/metabolism , Shiga-Toxigenic Escherichia coli/classification , Shiga-Toxigenic Escherichia coli/genetics , Shiga-Toxigenic Escherichia coli/metabolism , Animals, Wild/classification
19.
Rev. argent. microbiol ; 49(3): 242-246, set. 2017. ilus
Article in Spanish | LILACS | ID: biblio-1041790

ABSTRACT

Los bovinos son el principal reservorio de Escherichia coli productor de toxina Shiga (STEC); las estrategias para evitar su transmisión se concentran en la planta de faena. El objetivo de este trabajo fue evaluar la calidad higiénico-sanitaria y la frecuencia de detección de STEC en medias reses bovinas de frigoríficos de tránsito provincial. Se procesaron 274 esponjados de media res; en 9 (3,3%) el recuento de E. coli genérico fue marginal, en 4 (1,4%) se aisló E. coli O157, de los cuales 2 fueron caracterizados como stx2c(vh-a)/eae/ehxA, y los otros 2 como no toxigénicos. A partir de una (0,4%) muestra se aisló E. coli no-O157 ONT:H49, stx2a/ehxA/saa. En este trabajo la calidad del producto analizado indica que en la provincia de Tucumán se cumplen las buenas prácticas de manufactura en la faena de bovinos.


Cattle are the main reservoir of Shiga toxin-producing Escherichia coli (STEC), and the strategies to prevent the transmission of these microorganisms are concentrated in the slaughtering plant. The aim of this study was to evaluate the hygienic-sanitary quality and the frequency of detection of STEC in beef carcasses in abattoirs from Tucuman province. Two hundred and seventy four beef carcass sponges were processed; the count of generic E. coli was marginal in 9 (3,3%) of them. Escherichia coli O157 was isolated in 4 (1,4%) samples; 2 of which were characterized as stx2c(vh-a)/eae/ehxA whereas the other 2 were non-toxigenic strains. Non-O157 E. coli ONT:H49, stx2a/ehxA/saa was isolated from 1 sample (0,4%). In this work the quality of the analyzed product indicates that the good practices of manufacture are fulfilled in slaughtering facilities in Tucumán province.


Subject(s)
Animals , Cattle , Abattoirs , Shiga-Toxigenic Escherichia coli , Meat , Argentina , Escherichia coli O157 , Escherichia coli Proteins/analysis , Escherichia coli Infections , Shiga-Toxigenic Escherichia coli/isolation & purification , Meat/microbiology
20.
Rev. argent. microbiol ; 48(4): 325-328, dic. 2016. tab
Article in English | LILACS | ID: biblio-1041769

ABSTRACT

Shigatoxigenic Escherichia coli (STEC) is a foodborne pathogen that causes hemolytic uremic syndrome (HUS) and the consumption of chicken products has been related to some HUS cases. We performed a non-selective isolation and characterization of STEC strains from retail chicken products. STEC isolates were characterized according to the presence of stx1, stx2, eae, saa and ehxA; stx subtypes and serotypes. Most of them carried stx2, showing subtypes associated with severe human disease. Although reported in other avian species, the stx2f subtype was not detected. The isolates corresponded to different serotypes and some of them, such as O22:H8, O113:H21, O130:H11, O171:H2 and O178:H19, have also been identified among STEC isolated from patients suffering from diarrhea, hemorrhagic colitis, HUS, as well as from cattle. Considering the virulence profiles and serotypes identified, our results indicate that raw chicken products, especially hamburgers sold at butcheries, can be vehicles for high-risk STEC strains.


Escherichia coli productor de toxina de Shiga (STEC) es un patógeno transmitido por alimentos que causa el síndrome urémico hemolítico (SUH). Algunos casos de SUH están relacionados con el consumo de productos de pollo. Se realizó el aislamiento no selectivo y la caracterización de cepas STEC provenientes de productos de pollo atendiendo a la presencia de stx1, stx2, eae, saa y ehxA, subtipos de stx y serotipos. La mayoría de los aislamientos portaba stx2 y subtipos de stx asociados con enfermedades graves en humanos. Aunque se ha detectado en otras especies aviares, el subtipo stx2f no se encontró. Se detectaron diferentes serotipos, entre ellos O22:H8, O113:H21, O130:H11, O171:H2 y O178:H19, también identificados como STEC aislados de pacientes con diarrea, colitis hemorrágica y SUH, y de ganado bovino. Teniendo en cuenta los perfiles de virulencia y los serotipos identificados, nuestros resultados indican que los productos de pollo crudos, especialmente las hamburguesas que se venden en las carnicerías, pueden ser vehículos de cepas STEC de alto riesgo.


Subject(s)
Animals , Virulence , Shiga Toxin/classification , Shiga Toxin/adverse effects , Escherichia coli/classification , Shiga-Toxigenic Escherichia coli/isolation & purification , Chickens/microbiology , Hemolytic-Uremic Syndrome/prevention & control
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