Verocytotoxin-producing Escherichia coli (VTEC)

doi:10.1016/j.vetmic.2009.04.011

Veterinary Microbiology

Volume 140, Issues 3–4, 27 January 2010, Pages 360-370

https://doi.org/10.1016/j.vetmic.2009.04.011 Get rights and content

Abstract

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.

Section snippets

Introduction and historical perspective

Verocytotoxin (VT)-producing Escherichia coli (VTEC), also known as Shiga toxin-producing E. coli (STEC), are zoonotic agents which cause a potentially fatal human illness whose clinical spectrum includes diarrhoea, haemorrhagic colitis, and the haemolytic uraemic syndrome (HUS). VTEC are of serious public health concern because of their association with large outbreaks and with HUS, which is the leading cause of acute renal failure in children. Although many VTEC serotype have been associated

The infectious agent

Most members of the species E. coli are commensals in the gastrointestinal tracts of animals and humans. However there are pathogenic groups that cause enteric disease in animals and/or humans that include VTEC, enterotoxigenic E. coli, enteroinvasive E. coli, enteropathogenic E. coli serotypes, and enteroaggregative E. coli (Nataro and Kaper, 1998).

Over 380 different VTEC OH serotypes have now been isolated from humans with gastrointestinal disease and many of these serotypes as well as others

Clinical illness and epidemiology in humans

VTEC cause sporadic infection and outbreaks in humans, with the majority of reported outbreaks of VTEC infection associated with VTEC serotype O157:H7, and with sporadic cases occurring more frequently than outbreak cases (Griffin and Tauxe, 1991). The peak age-related frequency of VTEC-associated diarrhoea and HUS is in young children (Griffin and Tauxe, 1991), although the elderly also are at increased risk. The number of outbreak and sporadic cases of VTEC O157 and non-O157 VTEC typically

VTEC in cattle

A growing number of non-O157 VTEC serotypes have been isolated from animals, and many of these serotypes have been associated with human disease (Beutin et al., 1998, World Health Organization, 1999). The majority of VTEC strains implicated in human disease, including E. coli O157:H7, do not appear to be associated with clinical disease in cattle (Mohammed et al., 1985, Naylor et al., 2005a). E. coli O157 is common in cattle; prevalence estimates in North American beef cattle range from 10% to

Rapid screening methods

Several rapid screening methods are now available including the polymerase chain reaction (PCR) (Nataro and Kaper, 1998) to detect VTEC-specific DNA sequences and various immunospecific methods to detect VT antigen in faeces, either directly or after broth-culture enrichment, or in bacterial culture filtrates (Nataro and Kaper, 1998).

Laboratory culture

Laboratory diagnosis of VTEC infection involves the use of a selective and differential medium, such as sorbitol MacConkey agar (March and Ratnam, 1986), to

Therapy in humans

Most patients with uncomplicated VTEC infection recover fully with general supportive measures (Griffin et al., 1988, Karmali, 1989). Tarr et al. (2005) recommend that patients with confirmed VTEC infection and bloody diarrhoea should be initially admitted to hospital to observe for any signs of progression to HUS and also to limit spread of the infection to the community. There are no specific therapies for HUS and patients should, as far as possible, be managed by specialists with experience

Prevention and control

Optimum control of VTEC needs to involve all stages of food production, from farm to fork. Quantitative risk assessments and simulation models are available which describe stages in the farm-to-fork continuum that contribute to an increased risk of foodborne illness and allow potential control measures to be assessed (Cassin et al., 1998, Jordan et al., 1999, Ebel et al., 2004).

Future perspectives

Evaluating the public health impact of interventions at various stages of the farm to fork continuum is complicated by difficulties in traceability of product from farm to consumers, under-reporting of disease, and difficulties in confirming source identification due to the potential time lag between contamination and recognition of a case or outbreak. Currently VTEC infection in animals is not a reportable or ‘named’ disease in agricultural regulations word-wide. This may change in some

Conflict of interest

None.

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ReviewVerocytotoxin-producing Escherichia coli (VTEC)

Abstract

Section snippets

Introduction and historical perspective

The infectious agent

Clinical illness and epidemiology in humans

VTEC in cattle

Rapid screening methods

Laboratory culture

Therapy in humans

Prevention and control

Future perspectives

Conflict of interest

Curr. Opin. Microbiol.

Int. J. Food Microbiol.

Lancet

J. Food Prot.

J. Food Prot.

Vet. J.

J. Food Prot.

J. Dairy Sci.

Prev. Vet. Med.

Diagn. Microbiol. Infect. Dis.

Lancet i

J. Food Prot.

Meat Sci.

J. Food Prot.

Res. Microbiol.

Int. J. Med. Microbiol.

J. Food Prot.

J. Food Prot.

J. Food Prot.

Vaccine

J. Food Prot.

J. Food Prot.

Safety and immunogenicity of Escherichia coli O157 O-specific polysaccharide conjugate vaccine in 2–5-year-old children

J. Infect. Dis.

Phage-typing scheme for Escherichia coli O157:H7

J. Infect. Dis.

Fecal carriage of Escherichia coli O157:H7 and carcass contamination in cattle at slaughter in northern Italy

Int. Microbiol.

Emerging foodborne diseases

Emerg. Infect. Dis.

Preliminary foodnet data on the incidence of infection with pathogens transmitted commonly through food—10 states

Morb. Mort. Wkly Rep.

Enzyme-linked immunosorbent assays for detecting antibodies to Shiga-like toxin I, Shiga-like toxin II, and Escherichia coli O157:H7 lipopolysaccharide in human serum

Curr. Microbiol.

Influence of apple cultivars on inactivation of different strains of Escherichia coli O157:H7 in apple cider by UV irradiation

Appl. Environ. Microbiol.

Human infections with Shiga toxin-producing Escherichia coli other than serogroup O157 in Germany

Emerg. Infect. Dis.

Localization of intravenously administered verocytotoxins (shiga-like toxins) 1 and 2 in rabbits immunized with homologous and heterologous toxoids and toxin subunits

Infect. Immun.

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. (Maywood.)

The complete DNA sequence and analysis of the large virulence plasmid of Escherichia coli O157:H7

Nucleic Acids Res.

What are we doing about Escherichia coli O157:H7 in cattle?

J. Anim. Sci.

Effectiveness of public health interventions in food safety: a systematic review

Can. J. Public Health

A severe outbreak of Escherichia coli O157:H7-associated haemorrhagic colitis in a nursing home

N. Engl. J. Med.

A continuing assessment of risk factors for the development of Escherichia coli O157:H7-associated hemolytic uremic syndrome

Clin. Nephrol.

Comparison of shiga-toxigenic Escherichia coli prevalences among dairy, feedlot, and cow-calf herds in Washington State

Appl. Environ. Microbiol.

Type III secretion systems and disease

Clin. Microbiol. Rev.

Incidence and tracking of Escherichia coli O157:H7 in a major produce production region in California

PLoS. ONE.

Molecular analysis as an aid to assess the public health risk of non-O157 Shiga toxin-producing Escherichia coli strains

Appl. Environ. Microbiol.

Dissecting virulence: systematic and functional analyses of a pathogenicity island

Proc. Natl. Acad. Sci. U.S.A.

Isolation of Escherichia coli O157:H7 from retail fresh meats and poultry

Appl. Environ. Microbiol.

Prevention and decontamination of Escherichia coli O157:H7 on raw beef carcasses in commercial beef abattoirs

J. Rapid Methods Automation Microbiol.

Correlation of enterohaemorrhagic Escherichia coli O157 prevalence in feces, hides, and carcasses of beef cattle during processing

Review
Verocytotoxin-producing Escherichia coli (VTEC)