Tiempo de excreción fecal de Escherichia coliproductora de toxina Shiga en niños con síndrome urémico hemolítico / Duration of fecal shedding of Shiga toxin-producing Escherichia coli among children with hemolytic uremic syndrome

Introducción. Conocer el tiempo de excreción fecal de Escherichia coli productora de toxina Shiga (Shiga toxin-producing Escherichia coli; STEC, por sus siglas en inglés) en pacientes con síndrome urémico hemolítico sería útil para controlar la transmisión de la enfermedad.Objetivos. 1) Analizar las características del tiempo de excreción de STEC. 2) Evaluar la asociación con las variables sexo, edad, necesidad de diálisis, antibióticos y serotipos de STEC.Población y métodos. Estudio prospectivo, observacional, longitudinal y analítico. Período 2013-2019. Se realizaron coprocultivos al ingresar y cada 5-7 días hasta obtener 2 negativos. Se definió tiempo de excreción desde el inicio de la diarrea hasta el primer negativo. Se confirmó STEC por detección de los genes stx1, stx2 y rfbO157 por reacción en cadena de la polimerasa. Se calculó la media (IC 95 %) y percentilos del tiempo de excreción de STEC, y se compararon las variables estudiadas mediante el test de t.Resultados. Se incluyeron 43 pacientes. La media de tiempo de excreción fue 10,2 días (IC 95 %: 8,92-11,59), rango: 3-22 días. El 90 % de los pacientes negativizaron el coprocultivo a los 15 días. No hubo diferencias según sexo (p = 0,419), edad (p = 0,937), necesidad de diálisis (p = 0,917), antibióticos (p = 0,147) ni serotipos (p = 0,231).Conclusión. El 90 % de los pacientes negativizó el coprocultivo a los 15 días del inicio de la diarrea, y todos, al día 22. No se encontró asociación entre el tiempo de excreción y las variables estudiadas.

Introduction. Knowing the duration of fecal shedding of Shiga toxin-producing Escherichia coli(STEC) among patients with hemolytic uremic syndrome would be useful to control disease transmission.Objectives. 1) To analyze the characteristics of STEC shedding duration. 2) To assess the association with sex, age, need of dialysis, antibiotics, and STEC serotypes.Population and methods. Prospective, observational, longitudinal, and analytical study in the 2013-2019 period. Stool cultures were done upon admission and every 5-7 days until 2 negative results were obtained. Shedding duration was defined as the period from diarrhea onset to the first negative result. STEC was confirmed with polymerase chain reaction detection of stx1, stx2, and rfbO157 genes. The mean (95 % CI) and percentile values of the STEC shedding duration were estimated, and the studied outcome measures were compared using the t test.Results. A total of 43 patients were included. The mean duration of shedding was 10.2 days (95 % CI: 8.92-11.59), range: 3-22 days. After 15 days, 90 % of patients had a negative stool culture. There were no differences in terms of sex (p = 0.419), age (p = 0.937), need of dialysis (p = 0.917), antibiotics (p = 0.147) or serotype (p = 0.231).Conclusion. Fifteen days after the onset of diarrhea, 90 % of patients had a negative stool culture, and all patients had one after 22 days. No association was observed between the duration of shedding and studied outcome measures.

Genotypical characterization of thermotolerant coliforms isolated from food produced by a Solidarity Economic Venture of Bahia (Brazil) / Caracterização genotípica de coliformes termotolerantes isolados de alimentos produzidos por um Empreendimento Econômico Solidário

Abstract Many Solidarity Economic Venture (SEV) are family farmers who seek to add value to production through artisanal processing, which can lead to food contamination. Thus, this study aimed to genotypically characterize thermotolerant coliforms (TtC) strains from food produced by local agribusinesses of SEV during January to April 2019. Samples from thirteen production units (PU) from the SEV were submitted to a microbiological analysis of thermotolerant coliforms (AFNOR 3M1/2 - 09/89), using a fast count method in Petrifilm™ dishes. The Polymerase Chain Reaction (PCR) technique was used to verify the following virulence genes (VGs) associated with Escherichia coli: stx, typical from enterohemorrhagic E. coli (EHEC); bfpA typical from entheropathogenic E. coli (EPEC) and elt and slt, typical from entherotoxigenic E. coli (ETEC). The results showed that two samples of queijadinha (typical Brazilian candy made with eggs and coconut) and one sample of cassava cake presented characteristic colonies TtC. This way, three strains were isolated in order to perform the PCR technique. However, the genes used in the reaction were not detected in the isolated strains. Therefore, it is suggested that the isolated strains are from E. coli pathotypes with different virulence genes than the ones analyzed belong other types of TtC, such as Enterobacter and Klebsiella. Although the virulence of genes has not been confirmed, the presence of TtC on food indicates hygiene flaws during production and, therefore, measurements to control and prevent contamination should be taken.

Resumo Muitos Empreendimentos Econômicos Solidários (EES) são formados por agricultores familiares que buscam agregar valor à produção por meio do beneficiamento artesanal, que pode ocasionar a contaminação dos alimentos. Desta forma, este estudo objetivou caracterizar genotipicamente coliformes termotolerantes (CT) isolados em alimentos produzidos por agroindústrias de um EES no período de janeiro a abril de 2019. Então, foi realizada análise microbiológica de coliformes termotolerantes (AFNOR 3M1/2 - 09/89), utilizando um método contagem de contagem rápida em placas Petrifilm™, em amostras de alimentos de treze Unidades de Produção (UP) do EES. Foram coletadas assepticamente cinco amostras de cada UP, totalizando 65 amostras. Utilizou-se a técnica de Reação em Cadeia de Polimerase (PCR) para verificação dos seguintes genes de virulência de Escherichia coli: stx, característico de E. coli enterohemorrágica (EHEC), bfpA, característico de E. coli enteropatogênica (EPEC) e elt e stI, característicos de E. coli enterotoxigênica (ETEC). Os resultados demonstraram que duas amostras de queijadinha e uma amostra do bolo de aipim apresentaram colônias características de coliformes termotolerantes. Desta forma, foram isoladas três cepas para a realização da PCR, no entanto os genes utilizados nas reações não foram identificados nas cepas isoladas. Portanto, sugere-se que as cepas isoladas sejam de patótipos de E. coli com genes de virulência diferentes dos analisados ou de outro membro dos CT, como Enterobacter e Klebsiella. Apesar de não serem confirmados os genes de virulência analisados, a detecção dos CT nos alimentos indica falhas na higiene durante a produção, portanto medidas para controlar e prevenir a contaminação dos produtos devem ser tomadas.

Differential Diagnosis and Treatment of Thrombotic Microangiopathy Syndrome / 대한내과학회지

Diagnosis of thrombotic microangiopathy (TMA) is challenging due to its close association with other forms of microangiopathic hemolytic anemia, such as malignant hypertension and disseminated intravascular coagulation, and because other manifestations including cytopenia and acute kidney injury are manifestations of other medical comorbidities. Further challenges for accurate diagnosis include distinguishing between primary and secondary TMA, as well as between hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP). TTP is typically differentiated from HUS by the presence of more severe thrombocytopenia, along with a higher frequency of altered mental status with relatively preserved renal function. However, the clinical course can vary among patients, requiring polymerase chain reaction testing of patient stools for enterohemorrhagic Escherichia coli and a disintegrin and metalloproteinase with thrombospondin type 1 motif 13 (ADAMTS13) assay. To reduce the mortality rate, prompt initiation of plasmapheresis is important in cases where TPP cannot be excluded. Future advances enabling more rapid testing for ADAMTS13 levels will reduce the need for unnecessary plasmapheresis, so that treatment strategy can be more optimized.

Persistencia, internalización y translocación de Escherichia coli O157:H7, O157:H16 y O105ab en plantas y frutos de tomate (Solanum lycopersicum L.) / Persistence, internalization and translocation of Escherichia coli O157:H7, O157:H16 and O105ab in plants and tomato fruits (Solanum lycopersicum L.)

La presencia de bacterias patógenas, como Escherichia coli, afecta la calidad e inocuidad de las hortalizas que se consumen en fresco y se relaciona con graves problemas de salud. El objetivo de este trabajo fue determinar si 3 cepas diferentes de E. coli tienen la capacidad de penetrar y permanecer en plantas y frutos de tomate. Se siguió un diseño experimental completamente al azar, para lo cual se estableció un cultivo de tomate (variedad «Cid¼) en condiciones de invernadero y se evaluaron 3 tratamientos, T1 (E. coli O157: H7), T2 (E. coli de cultivo de tomate -#91;EcT-#93; O157: H16), T3 (E. coli de cultivo de espinaca -#91;EcH-#93; EcH O105ab) y un testigo T4, con 100 plantas cada uno y 4 formas de inoculación: en el sustrato, en el tallo, en el pecíolo y en el pedúnculo. Se realizaron muestreos en etapa vegetativa, floración, fructificación y madurez fisiológica para cuantificar en placa las UFC/g y saber si las bacterias lograban moverse y recuperarse en la raíz, el tallo, la flor y el fruto. Los grupos filogenéticos a los que correspondieron las bacterias recuperadas fueron confirmados mediante pruebas bioquímicas, serotipificación y PCR. A los 120 días la recuperación de bacterias en la planta fue del 23% (E. coli O157: H7), 28% (EcT O157: H16) y 55% (EcH O105ab) con la inoculación al sustrato, mientras que con la inoculación por punción la recuperación fue (en igual orden) del 5%, 3% y 4% a los 30 días; del 37%, 35% y 30% a los 90 días; y del 42%, 39% y 13% a los 65 días. Las cepas utilizadas mostraron la capacidad de entrar en la planta de tomate y de permanecer en ella y transportarse hasta llegar al fruto, sin producir síntomas que indiquen su presencia.

The presence of pathogenic bacteria, such as Escherichia coli affects the quality and safety of vegetables that are consumed fresh and is associated with serious health problems. The objective of this study was to determine if three different strains of E. coli can penetrate and remain in plants and tomato fruits. A completely randomized experimental design was followed for which a tomato crop ("Cid" variety) was established under greenhouse conditions and three treatments were evaluated, T1 (E. coli O157: H7), T2 (E. coli from tomato cultivation -#91;EcT-#93; O157: H16), T3 (E. coli from spinach cultivation -#91;EcH-#93; O105ab) and a T4 control, with 100 plants each and four forms of inoculation: in the substrate, steam, petiole and the peduncle. Samples were carried out in vegetative stage, flowering, fruiting and physiological maturity to quantify in petri dish CFU/g and know if the bacteria managed to move around and recover in root, stem, flower and fruit. The phylogenetic groups that corresponded to the bacteria recovered were confirmed by biochemical tests, serotyping and PCR. At 120 days the recovery of bacteria in the plant was 23% (E. coli O157: H7), 28% (EcT O157: H16) and 55% (EcH O105ab) whit inoculation to the substrate while the inoculation by puncture the recovery was (in the same order) of 5%, 3%, and 4% at 30 days; 37%, 35% and 30% at 90 days; and 42%, 39% and 13% at 65 days. The strains submit the ability to enter the tomato plant and to stay in it and transported to the fruit, without producing that indicate their presence.

Comparative study on the epidemiological aspects of enterohemorrhagic Escherichia coli infections between Korea and Japan, 2006 to 2010

BACKGROUND/AIMS: To compare the epidemiological aspects of enterohemorrhagic Escherichia coli (EHEC) between Korea and Japan by analyzing the current state of EHEC infection outbreaks and related risk factors. METHODS: We investigated the epidemiological aspects of EHEC infection cases between Korea and Japan from 2006 to 2010. The following factors were analyzed: national prevalence rate (PR), regional prevalence rate, epidemic aspects (i.e., Cases related to gender), male to female morbidity ratio, age, and seasonal distribution. RESULTS: In total, there were 254 cases of EHEC with an average PR of 0.11 per 100,000 populations in Korea from 2006 to 2010. During the same period in Japan, there were 20,883 cases of EHEC with an average PR of 3.26 per 100,000 populations. The PR in Japan was significantly higher than that in Korea (p 50%) observed for individuals younger than 9 years. EHEC is an emerging zoonosis and may be caused by consumption of raw or undercooked meat products from ruminants. CONCLUSIONS: This study provides a quantitative analysis of the epidemiological aspects and risk factors of EHEC infections in Korea and Japan and will provide insight on effective future strategies to reduce these infections.

Enteropatógenos de importancia en salud pública / Relevant public health enteropathogens

La diarrea continúa siendo la tercera causa de muerte en niños menores de 5 años, pese a los avances recientes en el manejo y prevención de esta enfermedad. Es causada por múltiples patógenos, sin embargo, la prevalencia de cada uno varía según el grupo de edad, la zona geográfica y el escenario donde se registran los casos (comunitario vs hospitalario). Los patógenos de mayor relevancia en salud pública son aquellos asociados con mayor carga de enfermedad, severidad, complicaciones y mortalidad. En nuestro medio, el norovirus, Campylobacter y las E. coli diarrogénicas, son los patógenos más prevalentes a nivel comunitario en niños. En este artículo se revisa la epidemiología local y las potenciales áreas de desarrollo en cinco patógenos seleccionados: rotavirus, norovirus, E. coli productora de toxina Shiga (STEC), Shigella y Salmonella. De estos, el rotavirus es el más importante en la población pediátrica y el principal responsable de la mortalidad infantil por diarrea. La introducción de la vacunación contra rotavirus en nuestro país tendrá un importante impacto en la carga de enfermedad y la mortalidad por diarrea. Sin embargo, se requieren estudios de vigilancia para determinar el impacto de la vacunación y el cambio en la epidemiología de la diarrea en el Perú luego de la introducción de nuevas vacunas, así como la vigilancia de las tasas de resistencia antibiótica para las bacterias de importancia clínica.

Diarrhea remains the third leading cause of death in children under five years, despite recent advances in the management and prevention of this disease. It is caused by multiple pathogens, however, the prevalence of each varies by age group, geographical area and the scenario where cases (community vs hospital) are recorded. The most relevant pathogens in public health are those associated with the highest burden of disease, severity, complications and mortality. In our country, norovirus, Campylobacter and diarrheagenic E. coli are the most prevalent pathogens at the community level in children. In this paper we review the local epidemiology and potential areas of development in five selected pathogens: rotavirus, norovirus, Shiga toxin-producing E. coli (STEC), Shigella and Salmonella. Of these, rotavirus is the most important in the pediatric population and the main agent responsible for child mortality from diarrhea. The introduction of rotavirus vaccination in Peru will have a significant impact on disease burden and mortality from diarrhea. However, surveillance studies are needed to determine the impact of vaccination and changes in the epidemiology of diarrhea in Peru following the introduction of new vaccines, as well as antibiotic resistance surveillance of clinical relevant bacteria.

Shiga toxin-associated hemolytic uremic syndrome complicated by intestinal perforation in a child with typical hemolytic uremic syndrome / 소아과

Hemolytic uremic syndrome (HUS) is one of the most common causes of acute renal failure in childhood and is primarily diagnosed in up to 4.5% of children who undergo chronic renal replacement therapy. Escherichia coli serotype O157:H7 is the predominant bacterial strain identified in patients with HUS; more than 100 types of Shiga toxin-producing enterohemorrhagic E. coli (EHEC) subtypes have also been isolated. The typical HUS manifestations are microangiopathic hemolytic anemia, thrombocytopenia, and renal insufficiency. In typical HUS cases, more serious EHEC manifestations include severe hemorrhagic colitis, bowel necrosis and perforation, rectal prolapse, peritonitis, and intussusceptions. Colonic perforation, which has an incidence of 1%-2%, can be a fatal complication. In this study, we report a typical Shiga toxin-associated HUS case complicated by small intestinal perforation with refractory peritonitis that was possibly because of ischemic enteritis. Although the degree of renal damage is the main concern in HUS, extrarenal complications should also be considered in severe cases, as presented in our case.

Low Compliance with National Guidelines for Preventing Transmission of Group 1 Nationally Notifiable Infectious Diseases in Korea

PURPOSE: This study was performed to evaluate the compliance with, and adequacy of, the Korean national guidelines which had been recommended until 2011 for isolation of patients with group 1 nationally notifiable infectious diseases (NNIDs), namely cholera, typhoid fever, paratyphoid fever, shigellosis, and enterohemorrhagic Escherichia coli (EHEC) infection. MATERIALS AND METHODS: We evaluated the clinical and microbiological characteristics of confirmed cases of group 1 NNIDs and compliance with the guidelines in 20 Korean hospitals nationwide in 2000-2010. We also compared the Korean guidelines with international guidelines. RESULTS: Among 528 confirmed cases (8 cases of cholera, 232 of typhoid fever, 81 of paratyphoid fever, 175 of shigellosis, and 32 EHEC infections), strict compliance with the Korean guideline was achieved in only 2.6% to 50.0%, depending on the disease. While the Korean guidelines recommend isolation of all patients with group 1 NNIDs, international guidelines recommend selective patient isolation and screening for fecal shedding, depending on the type of disease and patient status. CONCLUSION: Compliance with the previous national guidelines for group 1 NNIDs in Korea was generally very low. Further studies are needed to evaluate whether compliance was improved after implementation of the new guideline in 2012.

Inhibitory effect of black and red pepper and thyme extracts and essential oils on enterohemorrhagic Escherichia coli and DNase activity of Staphylococcus aureus

In this study, extracts and essential oils of Black and Red pepper and Thyme were tested for antibacterial activity against Escherichia coli O157:H7 and Staphylococcus aureus. Black and Red pepper and Thyme were provided from Iranian agricultural researches center. 2 g of each plant powder was added to 10 cc ethanol 96 degrees. After 24 h, the crude extract was separated as an alcoholic extract and concentrated by distillation method. Plants were examined for determining their major component and essential oils were separated. Phytochemical analyses were done for detection of some effective substances in extracts. The antibacterial activity against. Escherichia coli O157:H7 and Staphylococcus aureus was tested and the results showed that all extracts and essential oils were effective and essential oils were more active. The extracts and oils that showed antimicrobial activity were later tested to determine the Minimum Inhibitory Dilution [MID] for those bacteria. They were also effective on the inhibition of DNase activity. This study was indicated that extracts and essential oils of Black and Red pepper and Thyme can play a significant role in inhibition of Escherichia coli O157:H7 and Staphylococcus aureus

Detection of 13 Enteric Bacteria and 5 Viruses Causing Acute Infectious Diarrhea Using Multiplex PCR from Direct Stool Specimens / 대한임상미생물학회지

BACKGROUND: We investigated the prevalence of various pathogens (13 enteric bacteria and 5 viruses) which cause diarrhea using multiplex PCR of stool specimens and compared two multiplex PCR methods for detecting diarrheagenic Escherichia coli. METHODS: A total of 405 stool specimens submitted between November 2010 to February 2011 for routine culture of enteric pathogens were included and screened for five viruses (astrovirus, Group A rotavirus, enteric adenovirus, norovirus G1/G2) and eight bacteria (Salmonella spp., Shigella spp., Campylobacter spp., Vibrio spp., C. difficile Toxin B, C. perfringens, Y. enterolytica, Aeromonas spp.) using the Seeplex(R) Diarrhea ACE detection kit (Seegene). In addition, virulence-associated genes of enteropathogenic E. coli, (EPEC), enterohemorrhagic E. coli (EHEC), enteroinvasive E. coli, (EIEC), enterotoxigenic E. coli (ETEC), and enteroaggressive E. coli (EAEC) were detected using 16-plex PCR and a commercial diarrheagenic E. coli detection (DEC) PCR kit (SSI Diagnostica). RESULTS: Overall, 138 (34.1%) of 405 samples was positive for pathogen. The positive rate for virus was 18.5%. norovirus G2, Group A rotavirus, enteric adenovirus, astrovirus and norovirus G1 were detected in 40, 23, 8, 3 and 1 samples, respectively. The positive rate for bacteria was 24.4% (99/405). C. difficile toxin B was the most frequently detected, followed by C. perfringens, EPEC, and EAEC. The agreements of the two multiplex PCR methods for detecting EPEC and EHEC were 99.3% and 100%, respectively. CONCLUSION: The detection rate was high (34.1%) including various diarrheagenic E. coli (6.2%) and C. perfringens (5.2%). Multiplex PCR is thus useful for detecting various pathogens.

Avaliação da interação de Escherichia coli enterohemorrágica (EHEC) pertencente ao sorotipo O157: H7 isoladas de bovinos assintomáticos e de doença humana com células enterocíticas humanas (linhagem Caco-2) / Evaluation of interaction of Enterohaemorrhagic (EHEC) 0157: H7 isolated from asymptomatic cattle and human disease with human enterocitic cells

Reconhecida como agente de doença humana em 1982, E.coli enterohemorrágica (EHEC) pode causar diarréia sanguinolenta, colite hemorrágica e síndrome hemolítica urêmica (SHU). EHEC constitui um subgrupo especialmente virulento das E.coli produtoras de toxina de Shiga (Stx). O fator crítico da sua virulência é a toxina Shiga, capaz de interromper a síntese proteica da célula eucariótica. São conhecidos dois subgrupos de Stx, Stx1 e Stx2. Stx1 possui duas variantes Stx1c e Stx1d. Stx2 possui muitas variantes. Estudos epidemiológicos sugerem que cepas com os perfis toxigênicos Stx2 ou Stx2/Stx2c seriam mais frequentemente associadas a pacientes com SHU. Além da expressão de Stx, EHEC do sorotipo O157:H7 colonizam a mucosa intestinal induzindo a formação de lesões denominadas ‘attaching/effacing’ (A/E). Para a produção da lesão A/E, é necessária a presença de uma ilha de patogenicidade cromossômica denominada LEE, composta por cinco operons, LEE 1 a LEE5. Em LEE 5 são codificadas a adesina intimina e o seu receptor Tir, o qual é translocado por um sistema de secreção tipo III (SSTT) e em LEE 4 são codificadas as proteínas secretadas EspA,B e D. Em EHEC O157:H7 são descritos muitos fatores de virulência, codificados em ilhas de patogenicidade, no cromossomo e no megaplasmídio pO157. Bovinos são o principal reservatório deste patógeno e alimentos de origem bovina e produtos contaminados com fezes de bovinos são causadores de surtos epidêmicos. Em nosso país EHEC O157:H7 é isolada do reservatório animal mas é muito rara a sua ocorrência em doença humana. Notamos que nas cepas bovinas predomina Stx2c, enquanto nas cepas humanas predomina o perfil toxigenico Stx2/Stx2c...

Recognized in 1982 as a human pathogen, enterohemorrhagic Escherichia coli (EHEC) causes bloody diarrhea, hemorrhagic colitis and hemolytic uremic syndrome (HUS). EHEC belonging to serotype O157:H7 are mostly important in North America, United Kingdom and Japan. Shiga toxin (Stx) is the critical factor of STEC. Stx is capable to interrupt the protein synthesis of the eukaryotic cell. Two subgroups of Stx are known, Stx1 and Stx2. Two variants of Stx1 are known (Stx1c and Stx1d), but several Stx2 variants have been described. Epidemiological studies suggest that STEC/EHEC strains carrying the toxigenic profiles Stx2 or Stx2/Stx2c are more frequently associated to HUS. Besides the expression of Stx, EHEC O157:H7 colonize the intestinal mucosa inducing the formation of characteristic histopathological lesions denominated “attaching/effacing” (A/E). To the production of A/E lesions, it is necessary the presence of a pathogenicity island called LEE (locus of enterocyte effacement), composed by five operons, LEE 1 to LEE5. An outer membrane adhesin (intimin) and its receptor Tir, which is translocated by a type three secretion sytem (TTSS), are both codified in LEE5 while the secreted proteins EspA, B and D, that constitute part of the SSTT, are codified in LEE4. Cattle are the main reservoir of this pathogen and foods of bovine origin and products contamined with bovine feces are common causes of epidemic outbreaks. In Brazil, EHEC O157:H7 can be isolated from the animal reservoir . Stx2c prevails among the bovine strains, while the toxigenic profiles Stx2 or Stx2/Stx2c are found among the human strains...

Molecular characterization of Escherichia coli O157:H7 strains isolated from different sources and geographic regions

Escherichia (E.) coli serotype O157:H7 is a globally distributed human enteropathogen and is comprised of microorganisms with closely related genotypes. The main reservoir for this group is bovine bowels, and infection mainly occurs after ingestion of contaminated water and food. Virulence genetic markers of 28 O157:H7 strains were investigated and multilocus enzyme electrophoresis (MLEE) was used to evaluate the clonal structure. O157:H7 strains from several countries were isolated from food, human and bovine feces. According to MLEE, O157:H7 strains clustered into two main clonal groups designated A and B. Subcluster A1 included 82% of the O157:H7 strains exhibiting identical MLEE pattern. Most enterohemorrhagic E. coli (EHEC) O157:H7 strains from Brazil and Argentina were in the same MLEE subgroup. Bovine and food strains carried virulence genes associated with EHEC pathogenicity in humans.

Opinions of Infectious Disease Specialists on the Current Method for Isolation of Group 1 Nationally Notifiable Infectious Diseases in Korea / 감염과화학요법

The purpose of the study was to collect the opinions of doctors who are specialists in infectious disease with regard to the current method used for isolation of patients with group 1 nationally notifiable infectious diseases in Korea. A web-based survey was conducted from June 27 to July 7, 2011. Relevant questions included: 1) adequacy of the current policy of forced hospital isolation; evaluation of current guidelines for release from hospital isolation; and 3) priority for policy switching from forced hospital isolation to home isolation. The rate of response to the survey was 28.4% (40 out of 140). First, the majority of infectious disease specialists in Korea believed that the current method of forced hospital isolation for patients with group 1 infectious diseases should be changed to the home isolation method. Second, if the Korean government changes its policy to home isolation, the top priority of the policy switch would be typhoid fever, followed by paratyphoid fever, shigellosis, cholera, and EHEC (enterohemorigic Escherichia coli). Regarding current guidelines for release from hospital isolation, in cases of shigellosis, EHEC, and hepatitis A, the majority of respondents supported the current guidelines, while they were not able to make collective opinions in cases of cholera and typhoid/paratyphoid fever. We were able to confirm that the majority of specialists want to change the current isolation method. Therefore, the Korean government should consider switching their policy from forced hospital isolation to home isolation.

Enterohaemorrhagic E. coli outbreak in Germany

As of 10 June 2011, the German health authorities have reported 2374 cases of Entero-haemorrhagic Escherichia Coli [EHEC] and 773 cases of Haemolytic Uraemic Syndrome [HUS]. There were 22 and 12 related deaths respectively. The outbreak has since spread to 13 other countries in Europe with a total of 66 EHEC cases and 36 HUS cases with one death reported. Three HUS cases linked to this outbreak were reported from the United States. The source of infection for this outbreak is now believed to originate from contaminated bean sprout from a farm in Germany. The outbreak started in early May

Emerging Infectious Diseases in the Republic of Korea / 감염과화학요법

Many infectious diseases have emerged or re-emerged during the past 50 years in the Republic of Korea. Some of these are new infectious diseases delivered by new or newly recognized micro-organisms. Others are already known infectious diseases which have increased in frequency or have developed an expanded region of occurrence. Still others are infectious diseases that are caused by the same micro-organisms which are resistant to antibiotics, and therefore difficult to treat. Newly recognized Emerging Infectious Diseases (EIDs) include legionellosis, leptospirosis, tsutsugamushi diseases, Vibrio vulnificus sepsis, and brucellosis. New EIDs include acquired immunodeficiency syndrome, enterohemorrhagic E. coli infection, Creutzfeldt-Jacob disease. Of the EIDs occurred in the Republic of Korea during the past 50 years, healthcare-related infections, especially by antibiotic-resistant organisms, are the most important EIDs in terms of morbidity and mortality.

Awareness of Major Zoonoses among Dairy Farmers in Gyeonggi Province / 農村醫學 地域保健

OBJECTIVES: We surveyed awareness levels of brucellosis, Q fever and enterohemorrhagic Escherichia coli (EHEC) among dairy farmers in Gyeonggi Province to suggest directions for public education and public relations. METHODS: We designed questionnaires to evaluate awareness of 3 major zooneses. We conducted a questionnaire survey to assess knowledge of the general characteristics of them, information sources for the awareness of zooneses, and the mode of transmission. Subjects were 716 workers from 482 dairy farms in Gyeonggi province. RESULTS: The awareness levels for brucellosis, Q fever, and EHEC were 90.2%, 2.5% and 56.6%, respectively. Awareness of brucellosis and EHEC were tended to increase with higher number of school years. Television was the most common route of information for these zoonoses. Most common responses for questions concerning the method of transmission for each zoonoses, 'Contact with parturient fluid or placenta of animal' was 63.2% for brucellosis, 'Ingestion of raw meat or residual product' was 66.7% and 64.2% for Q fever and EHEC, respectively. The most common reason why dairy farmers think that it is difficult to prevent zoonoses was the inconvenience of wearing protection. CONCLUSIONS: Education programs for zoonoses, especially Q fever, are needed for dairy farmers. In addition, publicity information activities about prevention of zoonoses are needed for high risk groups, such as the dairy farmers surveyed.

A Case of Verotoxin-producing Escherichia coli O157:H7 with Hemorrhagic Colitis in an Infant, Diagnosed by Multiplex PCR / 대한임상미생물학회지

Enterohemorrhagic Escherichia coli (EHEC) is an important cause of bloody diarrhea in children, but is considered to be rare in infants. Herein, a case of infant hemorrhagic colitis of verotoxin-producing E. coli O157:H7 diagnosed by multiplex PCR is reported. A nine-month-old boy was admitted to our hospital with bloody diarrhea for the previous two days. Multiplex PCR using Seeplex(R) Diarrhea ACE Detection Kit (Seegene, Seoul, Korea) was directly applied to the stool specimens. Amplified bands specific for verotoxin, O157, and H7 indicated the presence of O157:H7 EHEC. The stool specimens were inoculated on sorbitol-MacConkey agar (SMA) and tryptic soy broth containing mitomycin C (TSB-M). Colorless colonies on sorbitol-MacConkey agar were O157-positive. TSB-M enrichment cultures of the stool specimen and the isolates were positive for verotoxin according to an enzyme immunoassay (EIA). The prepared ingredients of baby foods for the patient including ground meat, chopped carrot, chopped cabbage, and white rice porridge showed no EHEC on TSB-M and SMA. The patient's parents and three-year-old sister did not recently have any gastrointestinal symptoms. Cefdinir was administered for one day and was ceased after diagnosis of EHEC colitis. The stool culture and verotoxin assay were negative on the second day of hospitalization. Application of multiplex PCR and verotoxin EIA directly to diarrheal stool warrants the rapid diagnosis and appropriate treatment of EHEC colitis.