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Anouschka Den Ouden1, David R Greig1,2, Ella V Rodwell1,2,3

  • 1National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK.

Journal of Medical Microbiology
|June 9, 2023
PubMed
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Shiga toxin-producing Escherichia coli (STEC) carrying the stx2f gene can cause severe illness, including hemolytic uremic syndrome (HUS). Further research into STEC stx2f reservoirs and transmission is crucial for public health. Keywords: STEC, Shiga toxin, HUS, public health, stx2f.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Genomics

Background:

  • Shiga toxin-producing Escherichia coli (STEC) are gastrointestinal pathogens defined by Shiga toxin genes (stx).
  • STEC encoding stx2f were recently linked to severe hemolytic uremic syndrome (HUS), necessitating further investigation into their public health impact.

Purpose of the Study:

  • To analyze clinical outcomes and genome data of patients infected with STEC encoding stx2f in England.
  • To assess the public health risk associated with STEC stx2f infections.

Main Methods:

  • Genome sequencing of 112 E. coli isolates (58 with stx2f, 54 from CC122/CC722 without stx).
  • Analysis of virulence genes and construction of a maximum-likelihood phylogeny for CC122 and CC722 isolates.
  • Linking genomic data with epidemiological and clinical outcome data from patients (2015-2022).
Keywords:
Shiga toxin subtypeShiga toxin-producing Escherichia colihaemolytic uraemic syndromepublic health surveillance

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Main Results:

  • 52 cases of STEC stx2f infection were identified between 2015 and 2022, predominantly in 2022, in Northern England, affecting females and children under five.
  • 17.5% (7/40) of cases with available data were diagnosed with STEC-HUS.
  • In CC122 and CC722, stx2f prophage presence correlated with additional virulence genes (astA, bfpA, cdt) on an IncFIB plasmid.

Conclusions:

  • Certain STEC serotypes harboring stx2f are associated with severe clinical outcomes, including STEC-HUS.
  • Limited knowledge of STEC stx2f reservoirs and transmission routes hinders public health interventions.
  • Recommendations include enhanced data collection, standardized reporting, and global sharing of sequencing data.