E. COLI VTEC NON-O157 - USA: O45, SMOKED MEAT, ALERT, RECALL
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A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Wed 5 Jan 2011
Source: Wausau (MI) Daily Herald [edited]
Three new cases of _E. coli_-related illness have been traced from
Michigan back to a Wausau butcher shop in which an outbreak 1st was
reported just before Christmas 2010.
The illnesses bring to 7 the number of people sickened by _E.
coli_-infected smoked meat products produced at Zillman Meat Market
in late 2010, the Marathon County Health Department said Tuesday [4
Jan 2011]. The department also expanded its advisory on smoked meats
produced at Zillman's to between 30 Sep and 23 Dec 2010, rather than
beginning on 13 Nov 2010, because the department still has not pinned
down the source of the bacteria.
While the 3 cases announced are new, they are related to the prior 4
illnesses and involve some of the same people, said Judy Burrows, the
Health Department's chronic disease prevention director. "The folks
we know from Wausau who were sick had shared some of their smoked
meat products with others from Michigan," Burrows said.
The Health Department advises that any ready-to-eat smoked meat
produced at Zillman's within the advisory range be thrown away, or
that customers contact Zillman's about returns. The advisory relates
only to the smoked meat, and none of Zillman's other meat products
were included in the advisory.
Since the initial advisory on 22 Dec 2010, Zillman's has thoroughly
cleaned all of its equipment, Burrows said. "There are no additional
steps Zillman needs to take because these new cases happened prior to
all of the cleaning, so they're good to go," she said.
Burrows said the Health Department still is trying to pin down
whether the _E. coli_ contamination came from a person or somehow
ended up on Zillman's equipment. She also said very few people came
forward with tales of sickness from the smoked meat after 3 news
releases were issued in December 2010, hampering the investigation on
how and when the contamination 1st occurred. Less information means
the Health Department must cast a wider net with its advisory, Burrows said.
Burrows said the Michigan cases were discovered after the Wisconsin
Department of Health Services contacted other state health
departments in search of illnesses caused by this particular
bacterial strain, _E. coli_ O45, because it is a newer, slightly
different form of bacteria studied for only about 10 years.
Tim Monson, a microbiologist with the Wisconsin State Lab of Hygiene,
said Tuesday [4 Jan 2011] that E. coli O45 is an "emerging pathogen"
that can transfer its toxins to other bacteria, but it also tends to
be less toxic than other strains of _E. coli_.
--
Communicated by:
ProMED-mail
[This outbreak once again underscores the relevance of non-O157
strains of verotoxin-producing _E. coli_. Other _E. coli_ serogroups
that have been associated with VTEC (verotoxin-producing _E. coli_)
disease include motile ones such as O26:H11 and O104:H21 and
non-motile ones such as O111:NM (or H-). Such non-O157 isolates can
be obtained from sheep and cattle and, although they cause as many as
30 percent of outbreaks of VTEC (1), appear to be somewhat less (or
at least more variably) virulent in a variety of in vivo and in vitro
assays (2-4).
In analyzing the genetic and phenotypic profiles of non-O157 groups,
it has been found that they belong to their own lineages and have
unique profiles of virulence traits different from O157 (5). The
serogroups appearing to be most prominent are O26, O111, O128, and
O103 (6), the former serotype being the implicated strain in this outbreak.
If a laboratory is using sorbitol-MacConkey (sMAC) plates to identify
VTEC by virtue of O157's inability to ferment sorbitol, the non-O157
strains will be missed. In a 3-year pediatric study from the
University of Washington, USA (7), 1851 stool samples were processed
for sorbitol fermentation as well as toxin production by EIA (enzyme
immunoassay), and 28 strains of O157 were found along with O103 (4
strains), O118 (2 strains), O111 (2 strains), and 3 other strains.
Clinically, the O157 infections had a higher frequency of bloody
stools, fecal leukocytes, and abdominal pain with shorter symptom
duration. Five (18 percent) of O157 infections developed HUS; none of
the non-O157 strains did. Since toxin assay did not identify all O157
strains found on sMAC plates, the investigators did not advocate
performing toxin assay alone. Non-O157 can produce hemolytic-uremic
syndrome, as demonstrated by a cluster of O121 cases associated with
a lake in Connecticut, USA (8).
Since toxin assays are not uniformly performed in many areas, and
most cases do not produce HUS, it is likely that cases due to
non-O157 strains are being missed. How frequent this phenomenon will
become over time is unclear.
Because of the higher risk of morbidity and mortality in VTEC
infections treated with antimicrobials (9), antimicrobials should not
be used for known acute cases.
References
----------
1. Hussain HS, Omaye ST: Introduction to the food safety concerns of
verotoxin-producing _Escherichia coli_. Exp Biol Med 2003; 228(4):
331-2; available at
2. Blanco J, Blanco M, Blanco JE, et al: Verotoxin-producing
_Escherichia coli_ in Spain: prevalence, serotypes, and virulence
genes of O157:H7 and non-O157 VTEC in ruminants, raw beef products,
and humans. Exp Biol Med 2003; 228: 345-51; available at
3. Law D, Kelly J: Use of heme and hemoglobin by _Escherichia coli_
O157 and other Shiga-toxin-producing _E. coli_ serogroups. Infect
Immun 1995; 63(20): 700-2; available at
4. Tzipori S, Wachsmuth KI, Smithers J, Jackson C: Studies in
gnotobiotic piglets on non-O157:H7 _Escherichia coli_ serotypes
isolated from patients with hemorrhagic colitis. Gastroenterology
1988; 94(3): 590-7; abstract available at
5. Schmidt H, Geitz C, Tarr PI, et al: Non-O157:H7 pathogenic
Shiga-toxin producing _Escherichia coli_: phenotypic and genetic
profiling of virulence traits and evidence for clonality. J Infect
Dis 1999; 179(1): 115-23; available at
6. Bettelheim KA: Role of non-O157 VTEC. Symp Ser Soc Appl Microbiol
2000; (29): 38S-50S; abstract available at
7. Klein EJ, Stapp JR, Calusen CR, et al: Shiga toxin-producing
_Escherichia coli_ in children with diarrhea: a prospective
point-of-care study. J Pediatr 2002; 141(2): 172-7; available at
8. McCarthy TA, Barrett NL, Hadler JL, et al: Hemolytic-uremic
syndrome and _Escherichia coli_ O121 at a lake in Connecticut, 1999.
Pediatrics 2001; 108(4): E59; available at
9. Iijima K, Kamioka I, Nozu K: Management of diarrhea-associated
hemolytic uremic syndrome in children. Clin Exp Nephrol 2008; 12(1):
16-9; abstract available at
[see also:
2010
----
E. coli VTEC non-O157 - USA (07): O26, ground beef, alert, recall 20100831.3097
E. coli VTEC non-O157 - USA (06): O145, lettuce 20100528.1777
E. coli VTEC non-O157 - USA (05): O145, lettuce 20100525.1738
E. coli VTEC non-O157 - USA (04): O145, lettuce 20100517.1618
E. coli VTEC non-O157 - USA (03): O145, lettuce, recall 20100507.1483
E. coli VTEC non-O157 - USA (02): (OH, MI, NY) O145 20100505.1460
E. coli VTEC non-O157 - USA: (MI, OH) 20100427.1358
2008
----
E. coli VTEC non-O157, restaurant - USA (04): (OK), O111 20081201.3779
E. coli VTEC non-O157, restaurant - USA: (OK), O111 20080902.2748
E. coli VTEC non-O157, past. ice cream, 2007 - Belgium: Antwerp 20080218.0655
2007
----
E. coli VTEC non-O157, beef sausage - Denmark 20070602.1784
E. coli VTEC non-O157, 2000-2005 - USA (CT) 20070118.0240
2006
----
E. coli VTEC non-O157, lettuce - USA (UT)(02): background 20060905.2523
E. coli VTEC non-O157, lettuce - USA (UT) 20060904.2521
E. coli VTEC non-O157 - Norway (03) 20060416.1133
E. coli VTEC non-O157 - Norway 20060329.0947
E. coli VTEC non-O157, minced beef - Norway 20060304.0680
2005
----
E. coli O145, fatal - Slovenia 20050916.2739
2003
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E. coli, VTEC non-O157 - UK (Scotland): correction 20030828.2166
E. coli, VTEC non-O157 - UK (Scotland) 20030825.2144
2001
----
E. coli O26 - South Korea 20010509.0896
1999
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E. coli O111, diarrhea - USA (Texas) 19990707.1134
1997
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E. coli, non-0157 - Belgium 19970610.1215]
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