J Bacteriol Virol.  2018 Dec;48(4):113-120. 10.4167/jbv.2018.48.4.113.

Molecular Characterization of Enterotoxigenic Escherichia coli in Foodborne Outbreak

• Park SH
• Seung HJ
• Jeong HW
• Park SY
• Jung JH
• Jin YH
• Han SH
• Kim HS
• Kim JS
• Park JH
• Gong YJ
• Hong CK
• Lee JH
• Kim IY
• Jung K

• KMID: 2452063
• DOI: http://doi.org/10.4167/jbv.2018.48.4.113

Abstract

Diarrheagenic Escherichia coli (E. coli) is a main cause of diarrhea worldwide. This study reports the investigation on the occurrence of enterotoxigenic E. coli (ETEC) serotype O27:H7-associated foodborne gastrointestinal disease that occurred at two schools, one middle school and one high school, in Seoul, Korea in June 2015. The immediate government investigation in 1,216 students and 19 food handlers in these two schools revealed that 116 students, 32 students in the middle school and 84 students in the high school, and 2 food handlers, one from middle school and the other from high school, developed gastrointestinal illness symptoms including diarrhea. Following lab investigation identified 29 ETEC serotype O27:H7 strains, 27 from 116 students and 2 from 19 food handlers. Pattern of pulsed-field gel electrophoresis analysis of ETEC isolates suggested that ETEC serotype O27:H7 caused the diarrheal outbreak in June 2015 in Seoul, Korea was a specific clone. In addition, these ETEC serotype O27:H7 isolates were highly resistance to the several antibiotics. The results from the present study provide the evidence that ETEC serotype O27:H7 can be an important cause of domestic foodborne outbreak in Korea.

Keyword

Enterotoxigenic E. coli; Pulsed-field gel electrophoresis; Foodborne outbreak

MeSH Terms

Anti-Bacterial Agents
Clone Cells
Diarrhea
Electrophoresis, Gel, Pulsed-Field
Enterotoxigenic Escherichia coli*
Escherichia coli
Gastrointestinal Diseases
Humans
Korea
Seoul
Serogroup
Anti-Bacterial Agents

Figure

• 

  Figure 1. Dendrogram of Xba I PFGE profiles of ETEC serotype O27:H7 isolates. The dendrogram was constructed using the Unweighted Pair Group Method with Arithmetic Mean method. Degrees of similarity (% values) are shown. SS indicates the middle school investigated, and SD indicates the high school investigated.

Reference

1). Black RE. Epidemiology of travelers' diarrhea and relative importance of various pathogens. Rev Infect Dis. 1990; 12:S73–9.

2). Black RE. Epidemiology of diarrhoeal disease: implications for control by vaccines. Vaccine. 1993; 11:100–6.

3). Steffen R, Castelli F, Dieter-Nothdurft H, Rombo L, Jane Zuckerman N. Vaccination against enterotoxigenic Escherichia coli, a cause of travelers' diarrhea. J Travel Med. 2005; 12:102–7.

4). Wennerå s C, Erling V. Prevalence of enterotoxigenic Escherichia coli-associated diarrhoea and carrier state in the developing world. J Health Popul Nutr. 2004; 22:370–82.

5). Barrett J, Brown M. Travellers' diarrhoea. BMJ. 2016; 353:i1937.

6). Sack RB. Enterotoxigenic Escherichia coli: identification and characterization. J Infect Dis. 1980; 142:279–86.

7). Sjöling A, Wiklund G, Savarino SJ, Cohen DI, Svennerholm AM. Comparative analyses of phenotypic and genotypic methods for detection of enterotoxigenic Escherichia coli toxins and colonization factors. J Clin Microbiol. 2007; 45:3295–301.

8). Kim NO, Jung SM, Na HY, Chung GT, Yoo CK, Seong WK, et al. Enteric Bacteria Isolated from Diarrheal Patients in Korea in 2014. Osong Public Health Res Perspect. 2015; 6:233–40.

9). Park SH, Kim EJ, Oh SA, Kim CK, Choi SS, Cho SJ, et al. Viral agents associated with acute gastroenteritis in Seoul, Korea. Clin Lab. 2011; 57:59–65.

10). Ewing WH. Genus Escherichia. Ewing WH, editor. Edwards and Ewing's Identification of Enterobacteriaceae. New York: Elsevier Science;1986. p. 93–134.

11). PulseNet international. http://www.pulsenetinternational.org/protocols/. Last modified: 22nd October. 2015.

12). Jin YH, Seung HJ, Oh YH, Jung JH, Jeon SJ, Lee JK, et al. Epidemiological relationship of enterotoxigenic Escherichia coli and enteroaggregative E. coli isolated from patients with diarrhea in Seoul. J Bacteriol Virol. 2013; 43:37–44.

13). Kim KA, Yong KC, Jeong JA, Huh JW, Hur ES, Park SH, et al. Analysis of Epidemiological Characteristics, PFGE Typing and Antibiotic Resistance of Pathogenic Escherichia coli Strains Isolated from Gyeonggi-do. Kor J Microbiol. 2014; 50:285–95.

14). MacDonald E, M⊘ller KE, Wester AL, Dahle UR, Hermansen NO, Jenum PA, et al. An outbreak of enterotoxigenic Escherichia coli (ETEC) infection in Norway, 2012: a reminder to consider uncommon pathogens in outbreaks involving imported products. Epidemiol Infect. 2015; 143:486–93.

15). Pakalniskiene J, Falkenhorst G, Lisby M, Madsen SB, Olsen KE, Nielsen EM, et al. A foodborne outbreak of enterotoxigenic E. coli and Salmonella Anatum infection after a high-school dinner in Denmark, November 2006. Epidemiol Infect. 2009; 137:396–401.

16). Yoder JS, Cesario S, Plotkin V, Ma X, Kelly-Shannon K, Dworkin MS. Outbreak of enterotoxigenic Escherichia coli infection with an unusually long duration of illness. Clin Infect Dis. 2006; 42:1513–7.

17). Beatty ME, Adcock PM, Smith SW, Quinlan K, Kamimoto LA, Rowe SY, et al. Epidemic diarrhea due to enterotoxigenic Escherichia coli. Clin Infect Dis. 2006; 42:329–34.

18). Jain S, Chen L, Dechet A, Hertz AT, Brus DL, Hanley K, et al. An outbreak of enterotoxigenic Escherichia coli associated with sushi restaurants in Nevada, 2004. Clin Infect Dis. 2008; 47:1–7.

19). Taneja N, Das A, Raman Rao DS, Jain N, Singh M, Sharma M. Nosocomial outbreak of diarrhoea by enterotoxigenic Escherichia coli among preterm neonates in a tertiary care hospital in India: pitfalls in healthcare. J Hosp Infect. 2003; 53:193–7.

20). Castro-Rosas J, Cerna-Cortés JF, Méndez-Reyes E, Lopez-Hernandez D, Gómez-Aldapa CA, Estrada-Garcia T. Presence of faecal coliforms, Escherichia coli and diarrheagenic E. coli pathotypes in ready-to-eat salads, from an area where crops are irrigated with untreated sewage water. Int J Food Microbiol. 2012; 156:176–80.

21). Devasia RA, Jones TF, Ward J, Stafford L, Hardin H, Bopp C, et al. Endemically acquired foodborne outbreak of enterotoxin-producing Escherichia coli serotype O169: H41. Am J Med. 2006; 119:168. e7-10.

22). Konishi N, Obata H, Monma C, Nakama A, Kai A, Tsuji T. Bacteriological and epidemiological characteristics of enterotoxigenic Escherichia coli isolated in Tokyo, Japan, between 1966 and 2009. J Clin Microbiol. 2011; 49:3348–51.

23). Binsztein N, Picandet AM, Notario R, Patrito E, De Lesa ME, De Petris A, et al. Antimicrobial resistance among species of Salmonella, Shigella, Escherichia, and Aeromonas isolated from children with diarrhea in 7 Argentinian centers. Rev Latinoam Microbiol. 1999; 41:121–6.

24). Estrada-García T, Cerna JF, Paheco-Gil L, Velázquez RF, Ochoa TJ, Torres J, et al. Drug-resistant diarrheogenic Escherichia coli, Mexico. Emerg Infect Dis. 2005; 11:1306–8.

25). Shaheen HI, Khalil SB, Rao MR, Abu Elyazeed R, Wierzba TF, Peruski LF Jr, et al. Phenotypic profiles of enterotoxigenic Escherichia coli associated with early childhood diarrhea in rural Egypt. J Clin Microbiol. 2004; 42:5588–95.

26). Al-Gallas N, Abbassi SM, Hassan AB, Aissa RB. Genotypic and phenotypic profiles of enterotoxigenic Escherichia coli associated with acute diarrhea in Tunis, Tunisia. Curr Microbiol. 2007; 55:47–55.

27). Cohen MB, Grannella RA. Enterotoxigenic Escherichia coli. Blaser MJ, Smith PD, Ravdin JI, Greenberg MB, Guerrant RL, editors. Infections of the gastrointestinal tract. New York: NY Raven Press;1995. p. 691–707.

28). Ochoa TJ, Ecker L, Barletta F, Mispireta ML, Gil AI, Contreras C, et al. Age-related susceptibility to infection with diarrheagenic Escherichia coli among infants from Periurban areas in Lima, Peru. Clin Infect Dis. 2009; 49:1694–702.

29). Vilchez S, Becker-Dreps S, Amaya E, Perez C, Paniagua M, Reyes D, et al. Characterization of enterotoxigenic Escherichia coli strains isolated from Nicaraguan children in hospital, primary care and community settings. J Med Microbiol. 2014; 63:729–34.