Enterohemorrhagic Escherichia coli as Causes of Hemolytic Uremic Syndrome in the Czech RepublicReportar como inadecuado




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Background

Enterohemorrhagic Escherichia coli EHEC cause diarrhea-associated hemolytic uremic syndrome D+ HUS worldwide, but no systematic study of EHEC as the causative agents of HUS was performed in the Czech Republic. We analyzed stools of all patients with D+ HUS in the Czech Republic between 1998 and 2012 for evidence of EHEC infection. We determined virulence profiles, phenotypes, antimicrobial susceptibilities and phylogeny of the EHEC isolates.

Methodology-Principal Findings

Virulence loci were identified using PCR, phenotypes and antimicrobial susceptibilities were determined using standard procedures, and phylogeny was assessed using multilocus sequence typing. During the 15-year period, EHEC were isolated from stools of 39 69.4% of 56 patients. The strains belonged to serotypes fliC types O157:H7-NMfliCH7 50% of which were sorbitol-fermenting; SF, O26:H11-NMfliCH11, O55:NMfliCH7, O111:NMfliCH8, O145:H28fliCH28, O172:NMfliCH25, and Orough:NMfliCH25. O26:H11-NMfliCH11 was the most common serotype associated with HUS 41% isolates. Five stx genotypes were identified, the most frequent being stx2a 71.1% isolates. Most strains contained EHEC-hlyA encoding EHEC hemolysin, and a subset all SF O157:NM and one O157:H7 harbored cdt-V encoding cytolethal distending toxin. espPα encoding serine protease EspPα was found in EHEC O157:H7, O26:H11-NM, and O145:H28, whereas O172:NM and Orough:NM strains contained espPγ. All isolates contained eae encoding adhesin intimin, which belonged to subtypes β O26, γ O55, O145, O157, γ2-θ O111, and ε O172, Orough. Loci encoding other adhesins efa1, lpfAO26, lpfAO157OI-141, lpfAO157OI-154, iha were usually associated with particular serotypes. Phylogenetic analysis demonstrated nine sequence types STs which correlated with serotypes. Of these, two STs ST660 and ST1595 were not found in HUS-associated EHEC before.

Conclusions-Significance

EHEC strains, including O157:H7 and non-O157:H7, are frequent causes of D+ HUS in the Czech Republic. Identification of unusual EHEC serotypes-STs causing HUS calls for establishment of an European collection of HUS-associated EHEC, enabling to study properties and evolution of these important pathogens.



Autor: Monika Marejková , Květa Bláhová, Jan Janda, Angelika Fruth, Petr Petráš

Fuente: http://plos.srce.hr/



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