Family Outbreak of Shiga Toxin–producing E. coli O123:H–, France, 2009 | CDC EID

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Volume 16, Number 9–September 2010
Letter
Family Outbreak of Shiga Toxin–producing Escherichia coli O123:H–, France, 2009
Lisa A. King, Ingrid Filliol-Toutain, Patricia Mariani-Kurkidjian, Véronique Vaillant, Christine Vernozy-Rozand, Sarah Ganet, Nathalie Pihier, Patrick Niaudet, and Henriette de Valk
Author affiliations: Institut de Veille Sanitaire, Saint Maurice, France (L.A. King, V. Vaillant, H. de Valk); Institut Pasteur, Paris, France (I. Filliol-Toutain); Hôpital Robert Debré, Paris (P. Mariani-Kurhidjian); VetAgro Sup Campus Vétérinaire de Lyon, Marcy l'Etoile, France (C. Vernozy-Roxand, S. Gantet); Direction Générale de l'Alimentation, Paris (N. Pihier); and Hôpital Necker Enfants Malades, Paris (P. Niaudet)

To the Editor: Shiga toxin–producing Escherichia coli (STEC) is a major cause of foodborne disease in industrialized countries. We present results of the investigation of a family outbreak in France caused by a rare STEC serotype.

Surveillance of STEC infections in France since 1996 has been based on national surveillance of STEC-related pediatric hemolytic uremic syndrome (HUS) (1). On February 11, 2009, two cases of diarrhea were reported to a surveillance coordinator: 1 in a child with HUS and the other in that child's sibling.

The 2 siblings, 2 and 6 years of age, had diarrhea beginning on February 4 and 5, 2009. Bloody diarrhea developed in the younger child, and HUS was diagnosed on February 9. The older child had nonbloody diarrhea for 3 days and abdominal pain. Questioning of the patients' parents identified no recent history of travel, contact with farm animals, or outdoor bathing. A food history indicated that the 2 patients had shared an undercooked ground beef burger 4–5 days before symptom onset. The patients' parents also ate burgers from the same package (box); they did not report any gastrointestinal symptoms.

Fecal specimens of the patients were tested for STEC by direct PCR for STEC genes (stx); after which culture and identification of stx1, stx2, eae, and ehxA (hlyA) virulence genes; and serotyping with a panel of 22 serum samples were conducted as described (1,2). Molecular serotyping was subsequently conducted on nonagglutinating strains by using the rfb–restriction fragment length polymorphism technique for O antigen (3) and sequencing of the fliC gene for H antigen (4).

A trace-back investigation was conducted for the implicated beef burgers, which were obtained from a box of 10, frozen, 100-g ground beef burgers purchased in late January 2009. The remaining beef burger in the box from which the patients had eaten a beef burger was obtained from the family's freezer for microbiologic testing. Stored production samples from the implicated batch underwent microbiologic testing.

After broth enrichment, ground beef samples were tested by PCR for stx and eae virulence genes and O antigens of serotypes O157, O26, O145, O103, and O111 (2,5,6). Subsequently, strains isolated from stx-positive and eae-positive enrichment broths were biochemically tested and underwent serotyping and PCR identification of virulence genes. Genetic relatedness of clinical and ground beef STEC strains was studied by using pulsed-field gel electrophoresis with Xbal as described (7).

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Family Outbreak of Shiga Toxin–producing E. coli O123:H–, France, 2009 | CDC EID