Optimization of Notification Criteria for Shiga Toxin–Producing  Escherichia coli  Surveillance, the Netherlands

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Abstract

We describe the consequences of 2 major changes in notification criteria for Shiga toxin–producing Escherichia coli surveillance in the Netherlands. The change to reporting acute, more severe infections appears to be a good compromise between workload, redundancy, and public health relevance, provided isolates remain available for typing and sequencing.

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Most cited references 12

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Improved detection of five major gastrointestinal pathogens by use of a molecular screening approach.

Barbara Kesztyüs, A. Kooistra, Alewijn Ott … (2010)

The detection of bacterial and parasitic gastrointestinal pathogens through culture and microscopy is laborious and time-consuming. We evaluated a molecular screening approach (MSA) for the detection of five major enteric pathogens: Salmonella enterica, Campylobacter jejuni, Giardia lamblia, Shiga toxin-producing Escherichia coli (STEC), and Shigella spp./enteroinvasive E. coli (EIEC), for use in the daily practice of a clinical microbiology laboratory. The MSA consists of prescreening of stool specimens with two real-time multiplex PCR (mPCR) assays, which give results within a single working day, followed by guided culture/microscopy of the positive or mPCR-inhibited samples. In the present 2-year overview, 28,185 stool specimens were included. The MSA was applied to 13,974 stool samples (49.6%), whereas 14,211 samples were tested by conventional methods only (50.4%). The MSA significantly increased the total detection rate compared to that of conventional methods (19.2% versus 6.4%). The detection of all included pathogens, with the exception of S. enterica, significantly improved. MSA detection frequencies were as follows: C. jejuni, 8.1%; G. lamblia, 4.7%; S. enterica, 3.0%; STEC, 1.9%; and Shigella spp./EIEC, 1.4%. The guided culture/microscopy was positive in 76.8%, 58.1%, 88.9%, 16.8%, and 18.1% of mPCR-positive specimens, respectively. Of all mPCRs, only 1.8% was inhibited. Other findings were that detection of mixed infections was increased (0.9% versus 0.02%) and threshold cycle (C(T)) values for MSA guided culture/microscopy-positive samples were significantly lower than those for guided culture/microscopy-negative samples. In conclusion, an MSA for detection of gastrointestinal pathogens resulted in markedly improved detection rates and a substantial decrease in time to reporting of (preliminary) results.

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Verocytotoxin-producing Escherichia coli (VTEC).

Mohamed Karmali, Victor Gannon, Jan Sargeant (2010)

Escherichia coli O157:H7 and other Verocytotoxin-producing E. coli (VTEC) are zoonotic pathogens associated with food and waterborne illness around the world. E. coli O157:H7 has been implicated in large outbreaks as well as in sporadic cases of haemorrhagic colitis and the sometimes fatal haemolytic uremic syndrome. VTs produced by these bacteria are thought to damage host endothelial cells in small vessels of the intestine, kidney and brain resulting in thrombotic microangiopathy. All VTs have the same subunit structure, glycolipid cell receptor and inhibit protein synthesis. During VTEC infection, it is thought one or more bacterial adhesins initiates colonization and establishes intimate attachment and is responsible for the translocation of a variety of effectors which alter the structure and function of host cells. VTEC are widespread in animals but ruminants are thought to be their natural reservoir. E. coli O157:H7 colonizes the terminal colon of cattle and can be shed in very large numbers by specific herdmates known as "supershedders". Faeces containing these organisms act as a source of contamination for a variety of foods and the environment. Many VTEC control efforts have been investigated along the "farm to fork" continuum including, vaccination of cattle with colonization factors, and the use of novel antimicrobials, such as bacteriocins, chloral hydrate, bacteriophage and substances which disrupt quorum sensing. In addition, many barriers have been developed for use in the slaughter and food processing industry such as steam pasteurization and irradiation. Despite these efforts many scientific, technical and regulatory challenges remain in the control and prevention of VTEC-associated human illness. Copyright 2009 Elsevier B.V. All rights reserved.

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Enterohaemorrhagic Escherichia coli: emerging issues on virulence and modes of transmission.

Alfredo Caprioli, Stefano Morabito, Hubert Brugère … (2015)

Enterohaemorrhagic Escherichia coli (EHEC) constitute a subset of serotypes (E. coli O157 and some other serogroups) of Shiga toxin (Stx)-producing E. coli (STEC) firmly associated with severe human illnesses like bloody diarrhoea and haemolytic uraemic syndrome. Stx production is essential but not sufficient for EHEC virulence. Most strains are capable of colonising the intestinal mucosa of the host with the "attaching and effacing" mechanism, genetically governed by a large pathogenicity island (PAI) defined as the Locus of Enterocyte Effacement. Other virulence factors carried by mobile genetic elements like PAI and plasmids have been recently described, and their role in the pathogenic process has not been fully elucidated. EHEC are zoonotic pathogens. They rarely cause disease in animals, and ruminants are recognised as their main natural reservoir. Cattle are considered to be the most important source of human infections with EHEC O157, and the ecology of the organism in cattle farming has been extensively studied. The organism has also been reported in sheep, goats, water buffalos, and deer. Pigs and poultry are not considered to be a source of EHEC and the sporadic reports may derive from accidental exposure to ruminant dejections. The epidemiology of EHEC infections has remarkably changed during the past ten years and an increasing number of unusual food vehicles have been associated with human infections. New routes of transmission have emerged, like contact with animals during farm visits and a wide variety of environment-related exposures. As for other zoonotic agents, having animals and raw products that are free from EHEC is not possible in practice. However, their occurrence can be minimised by applying high standards of hygiene in all the steps of the food production chain.

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Author and article information

Journal

Journal ID (nlm-ta): Emerg Infect Dis

Journal ID (iso-abbrev): Emerg Infect Dis

Journal ID (publisher-id): EID

Title: Emerging Infectious Diseases

Publisher: Centers for Disease Control and Prevention

ISSN (Print): 1080-6040

ISSN (Electronic): 1080-6059

Publication date (Print): January 2021

Volume: 27

Issue: 1

Pages: 258-261

Affiliations

[1]National Institute for Public Health and the Environment, Bilthoven, the Netherlands (I.H.M. Friesema, S. Kuiling, Z. Igloi, E. Franz);

[2]European Program for Public Health Microbiology Training, Stockholm, Sweden (Z. Igloi)

Author notes

Address for correspondence: Ingrid Friesema, RIVM-EPI, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Box 1, 3720 BA Bilthoven, the Netherlands; email: ingrid.friesema@ 123456rivm.nl

Article

Publisher ID: 20-0339

DOI: 10.3201/eid2701.200339

PMC ID: 7774539

PubMed ID: 33350915

SO-VID: 5385dc70-921a-4b63-9566-4779487f8221

Optimization of Notification Criteria for Shiga Toxin–Producing Escherichia coli Surveillance, the Netherlands

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Abstract

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Zoonoses

Most cited references 12

Improved detection of five major gastrointestinal pathogens by use of a molecular screening approach.

Verocytotoxin-producing Escherichia coli (VTEC).

Enterohaemorrhagic Escherichia coli: emerging issues on virulence and modes of transmission.

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