A systematic review of ETEC epidemiology focusing on colonization factor and toxin expression

Introduction

Vaccine development for enterotoxigenic Escherichia coli (ETEC) is dependent on in-depth understanding of toxin and colonization factor (CF) distribution. We sought to describe ETEC epidemiology across regions and populations, focusing on CF and toxin prevalence.

Methods

We conducted a systematic review of the published literature, including studies reporting data on ETEC CF and toxin distributions among those with ETEC infection. Point estimates and confidence intervals were calculated using random effects models.

Results

Data on 17,205 ETEC isolates were abstracted from 136 included studies. Approximately half of the studies (49%) involved endemic populations, and an additional 17% involved only travel populations. Globally, 60% of isolates expressed LT either alone (27%) or in combination with ST (33%). CFA/I-expressing strains were common in all regions (17%), as were ETEC expressing CFA/II (9%) and IV (18%). Marked variation in toxins and CFs across regions and populations was observed.

Discussion/conclusions

These results demonstrate the relative importance of specific CFs in achieving target product profiles for a future ETEC vaccine. However, heterogeneity across time, population, and region, confounded by variability in CF and toxin detection methodologies, obfuscates rational estimates for valency requirements.     

Comparative evaluation of a vaccine candidate expressing enterotoxigenic Escherichia coli (ETEC) adhesins for colibacillosis with a commercial vaccine using a pig model

In this study, a comparative evaluation of a novel live vaccine candidate expressing enterotoxigenic Escherichia coli (ETEC) fimbriae and a commercial ETEC vaccine was carried out in suckling to weaned piglets. The E. coli K88ab, K88ac, K99, FasA and F41 fimbrial genes were individually inserted into an expression/secretion plasmid, pBP244. These plasmids were subsequently transfected into attenuated Salmonella, which were used as the vaccine candidate. Eighteen pregnant sows and 107 of their piglets were used in this comparative study. All the vaccinated groups of sows and piglets exhibited significantly increased antibody levels relative to specific antigens when compared with those in the unimmunized control. The experimental piglets with the vaccine candidate did not experience diarrhea following challenge with the virulent ETEC strains. However, diarrhea was observed in 36.8% of the piglets in the group immunized with the commercial vaccine and in 50% of the control group after challenge with the ETEC strains. These findings indicate that immunization of sows with the candidate vaccine can effectively protect their young pigs against colibacillosis.     

浙江省舟山市269例海岛渔民病毒性肝炎型别分析

为探讨海岛渔民病毒性肝炎的病毒种类及其与临床的关系，对269例海岛渔民肝炎患者的型别进行了分析。研究对象为浙江省舟山市人民医院2001年1月至2004年12月住院的269例渔民病毒性肝炎患者，均为男性，年龄18～65岁，平均32．5岁。诊断标准根据2000年9月中华医学会传染病与寄生虫病学分会、肝病学分会联合修订的病毒性肝炎防治方案。患者人院后常规进行甲、乙、丙、丁、戊、庚型肝炎血清标志物检测，采用酶联免疫吸附法，HCV—RNA，HBV—DNA（采用PCR）。     

Contamination of potable water by enterotoxigenic Escherichia coli: qPCR based culture-free detection and quantification

Tourists visiting to endemic zones may acquire Enterotoxigenic Escherichia coli (ETEC) infection resulting into diarrhea due to consumption of contaminated potable waters. In this study, a qPCR assay (SYBR Green), targeting LT1 and ST1 genes was designed to quantify ETEC in potable waters derived from civic water supply. The assay could detect lowest 1 CFU/PCR targeting LT1/ST1 gene from ten-fold diluted culture of the reference strain (E. coli MTCC 723) and is ten-fold more sensitive than the conventional PCR. The quantification of the ETEC in potable waters collected from civic supply of a major city of the northern India exhibiting high flow of tourists reveals that all the sites that ran along sewage line were contaminated by the ETEC. Contamination was due to percolation of sewage. The assay could be used for the regular monitoring of potable water in places exhibiting heavy flow of tourists to prevent ETEC induced diarrhea.     

Immunization with recombinant Lactobacillus casei strains producing K99, K88 fimbrial protein protects mice against enterotoxigenic Escherichia coli

To exploit a safe and effective vaccine for the prevention against K99 or K88 infections of enterotoxigenic Escherichia coli (ETEC), we have developed a mucosal delivery vehicle based on Lactobacillus casei CICC 6105 using poly-γ-glutamate synthetase A (PgsA) as an anchoring matrix. To evaluate the immunization effect of the recombinant strains (harboring plasmids pLA-K99-K88-LTB, pLA-K99, and pLA-K88), anti-ETEC K99 or K88 antibody responses, T-cell proliferation, and cytokines by intracellular staining (ICS) were investigated after specific pathogen-free (SPF) C57BL/6 mice orally inoculated with these recombinant strains. After oral vaccination into C57BL/6 mice, all recombinant strains were proved to be immunogenic and able to elicit high levels of mucosal immunoglobulin A (IgA) titers in bronchoalveolar lavage fluids, intestinal fluids and prominent systemic immunoglobulin G and IgG subclasses (IgG1, IgG2b, and IgG2a) responses in sera. Using the T-cell proliferation assay, the stimulation index (SI) of groups immunized with pLA-K99/L. casei and pLA-K88/L. casei reached to 2.73 and 2.64, respectively, versus 2.56 in a group immunized with pLA-K99-K88-LTB/L. casei. A detailed analysis of the cell-mediated immune responses by ICS showed the number of specific CD8(+) T cells expressing cytokines (IFN-γ, TNF-α, and IL-2) and granule-associated proteins (CD107a) was higher than that of specific CD4(+) T cells secreted by immune spleen cells upon restimulation in vitro with peptides. Next, the results showed that DCs activated in vitro with recombinant L. casei enhance specific T-cell proliferation and promote T cells to produce both Th1 and Th2 cytokines. More than 80% of the vaccinated mice were protected after challenge with a lethal dose of standard strains C83912 and C83902. These results demonstrate that recombinant L. casei can induce specific humoral and mucosal antibodies and cellular immune response against protective antigens upon oral administration.     

Carriage of diarrhoeagenic Escherichia coli by older children and adults in Accra, Ghana

Diarrhoeagenic Escherichia coli (DEC) were sought in stool specimens from 72 adults and children aged over 3 years, who presented with diarrhoea at a hospital in Accra, Ghana, and 72 matched controls. Only diffusely-adherent E. coli were significantly associated with disease in these older individuals (P = 0.029). We additionally tested 53 specimens from infants among whom DEC were collectively associated with disease (P = 0.012). Enteropathogenic, enterotoxigenic and enteroaggregative E. coli, the most commonly isolated pathotypes from infants with diarrhoea, were frequently recovered from healthy adults. Asymptomatic carriage of DEC by older individuals in Accra may place young children at risk for diarrhoea.     

Vaccination with EtpA glycoprotein or flagellin protects against colonization with enterotoxigenic Escherichia coli in a murine model

Enterotoxigenic Escherichia coli (ETEC) remain a leading cause diarrheal illness, prompting a search for vaccine targets that led to the recent discovery of EtpA, a secreted adhesin of ETEC that acts by bridging flagella and host cells. In a murine model, immunization with recombinant EtpA glycoprotein inhibited colonization by two EtpA-producing human ETEC strains, H10407 and E24377A. In addition, vaccination with recombinant flagellin (serotype H11) generated antibodies that specifically recognized the tips of flagella from E24377A expressing a heterologous flagellar serotype (H28) and afforded significant protection against colonization. EtpA and/or flagellin could be valuable subunit antigens in the formulation of a broadly protective ETEC vaccine.     

肠毒素大肠埃希菌载体活菌疫苗的安全性和免疫性研究

目的 研究肠毒素大肠埃希菌活菌载体疫苗FE3、FE16的安全性和免疫原性。方法 通过肠毒素大肠埃希菌肠毒素毒力试验、新西兰大白兔免疫试验、小鼠口服和鼻饲途径免疫试验，检测载体疫苗的毒性、免疫原性和免疫效果。结果 毒力试验中所有检测均为阴性；免疫4次后大白兔血清对福氏2a型茵的凝集效价均不低于1：640，对肠毒素大肠埃希菌菌毛抗原的凝集效价均不低于1：1280；通过口服和鼻饲方式免疫小鼠后，血清中IgG显著升高，同时能够在粪便中检测到分泌型IgA，而灭活苗免疫未能检测到分泌型IgA。结论 活菌载体疫苗株FE3和FE16具有良好的安全性和免疫原性，同时能够刺激机体产生体液免疫和黏膜免疫反应。     

Escherichia coli enterovirulent phenotypes in Zambians with AIDS-related diarrhoea

Persistent diarrhoea is a major cause of morbidity and mortality in AIDS patients, and consequently an important public health problem in sub-Saharan Africa. Although intestinal protozoa and bacteria are detected in many of these patients, a substantial proportion of disease remains unexplained even after intensive investigation. HEp-2 cell adherent Escherichia coli have been described in AIDS patients with persistent diarrhoea, but their contribution to the overall burden of disease is not yet defined. We studied HEp-2 cell adherence of E. coli isolates from 116 adult Zambian AIDS patients and 153 healthy controls obtained in 1993 or 1998-99. Enteroaggregative, enteropathogenic, and diffusely adherent phenotypes were observed in E. coli isolates from both AIDS patients and controls, but cytotoxic phenotypes were only isolated from the AIDS patients. There was no evidence of seasonality in the frequency of isolation, and there was no evidence of long-term carriage. Light and electron microscopy of distal duodenal biopsies did not reveal any bacteria closely associated with the brush border. Isolates were less susceptible to amoxycillin, tetracycline, and sulfonamides than to newer antibiotics. Enterovirulent E. coli appear to contribute to intestinal disease in AIDS patients in Zambia but asymptomatic carriage is common. Antibiotic trials should be carried out.     

Enterotoxigenic Escherichia coli associated diarrhoea among infants aged less than six months in Calcutta, India

The role of enterotoxigenic Escherichia coli (ETEC) as etiologic agents of diarrhoea in infants aged less than six months was assessed in a hospital based study in Calcutta, India. Of the 218 cases examined, ETEC strains were isolated from 26 (11.9%) cases. Among these, in 17 cases ETEC was the sole infecting pathogen (p = 0.0085). Of the 26 isolates (each isolate representing a case), 24 were distributed among seven different O:K:H serotypes and two different colonization factor antigens (CFAs) I and II. Two of the remaining isolation were untypable, non-haemagglutinating, and were nonhydrophobic as measured by the salt aggregation test (SAT). Of the 26 ETEC strains detected, 15 (57.7%) produced heat-labile toxin (LT) only, 8 (30.8%) liberated heat-stable toxin (ST) only, and the remaining 3 (11.5%) produced both LT and ST. No ETEC strain was isolated from the 102 age-matched controls included in this study. All the ETEC isolates were multiple drug resistant. The study showed that the diarrhoea due to ETEC was of brief duration, mostly within the range of 3 to 7 days.     

三对引物同时PCR分型检测产毒素大肠杆菌的方法及在分子流行病学研究中的应用

在产毒素大肠杆菌肠毒素基因内设计合成三对引物，建立了三对引物同时ＰＣＲ检测ＥＴＥＣ的方法，一次ＰＣＲ即可扩增出６２７ｂｐ（ＬＴｈ）、２４０ｂｐ（ＳＴ Ｉａ）和１６９ｂｐ（ＳＴ Ｉｂ）三种肠毒素基因片段，可同时分型检测出ＬＴｈ，ＳＴ Ｉａ、ＳＴ Ｉｂ、ＬＴｈ－ＳＴ Ｉａ、ＬＴｈ－ＳＴ Ｉｂ五种基因型的ＥＴＥＣ，与非ＥＴＥＣ对照菌无交叉反应，最小检出量为１０ｃｆｕ，显示了很高的特异性和敏感性。将建立的     

Live attenuated enterotoxigenic Escherichia coli (ETEC) vaccine with dmLT adjuvant protects human volunteers against virulent experimental ETEC challenge

Background

There is no licensed vaccine against enterotoxigenic Escherichia coli (ETEC), a major cause of diarrhea-associated morbidity and mortality among infants and children in low-income countries and travelers. The results of this vaccination/challenge study demonstrate strong protection by an attenuated ETEC vaccine candidate, ACE527, when co-administered with a mucosal adjuvant, the double-mutant heat-labile toxin (dmLT) of ETEC.

Vaccination of attenuated EIS-producing Salmonella induces protective immunity against enterohemorrhagic Escherichia coli in mice

There is an urgent need for vaccine against enterohemorrhagic Escherichia coli (EHEC), which causes a wide range of life-threatening diseases in human and animals. E. coli secreted protein A (EspA), intimin and shiga toxin (Stx) are important pathogenic factors and protective antigens of EHEC. In our previous study, we found that recombinant trivalent protein EIS, which is composed of EspA (E), the 300 amino acids of the carboxyl terminus of intimin (I) and the B subunit of Stx2 (S), was able to efficiently elicit protective immunity against EHEC. The application of live attenuated Salmonella as a carrier for vaccine against mucosal pathogens provided unparalleled merits. Therefore, in this study we constructed live attenuated EIS-producing Salmonella vaccine and tested it as vaccine in mice model. We found that the vaccination of EIS-producing recombinant Salmonella was able to induce significant increases of EspA, intimin and Stx2 specific IgG in serum and secretory IgA in feces. Antigen specific T cell proliferation was also observed in the mice immunized with recombinant EIS-producing Salmonella. In addition, this immunity was able to protect mice from a challenge of a lethal dose of EHEC, even after a period of 70 days. Moreover, the EIS-producing Salmonella induced immunity can be boosted by a single subcutaneous injection of purified EIS protein, even after an interval of 70 days. This EIS-producing Salmonella vaccine provides an alternative approach for the prevention of EHEC infection.     

Alternatives to carbapenems in ESBL-producing Escherichia coli infections

Objectives

The authors had for objective to assess the activity of a wide panel of antibiotics on extended-spectrum-β-lactamase producing Escherichia coli isolates (ESBL-Ec), because of the sharp increase of their frequency, leading to an increased use of carbapenems.

Material and methods

We selected 100 ESBL-Ec in which ESBLs were identified by PCR and sequencing, between 2009 and 2010. We determined the MICs of amoxicillin-clavulanate, piperacillin-tazobactam, temocillin, mecillinam, cefoxitin, cefotaxime, ceftazidime, aztreonam, tigecycline, nitrofurantoin, and fosfomycin using reference methods. The susceptibility profiles were defined according to EUCAST 2012 recommendations.

Results

Fosfomycin, nitrofurantoin, and pivmecillinam were active against more than 90% of isolates and remain excellent choices for the oral treatment of urinary tract infections (UTIs). Temocillin and piperacillin-tazobactam are also good candidates for the treatment of pyelonephritis or bloodstream infections. Only 27, 23, and 8% of isolates were susceptible to ceftazidime, cefepime, and cefotaxime, respectively.

Conclusion

Our study results prove that in many cases, there are non-carbapenem alternatives for the treatment of ESBL-Ec infections.     

Antimicrobial-resistant invasive Escherichia coli, Spain

Surveillance System. A network of 32 Spanish hospitals, serving approximately 9.6 million persons, submitted antimicrobial-susceptibility data on 7,098 invasive Escherichia coli species (2001-2003). Resistance to ampicillin, cotrimoxazole, ciprofloxacin, gentamicin, and tobramycin was found at rates of 59.9%, 32.6%, 19.3%, 6.8%, and 5.3%, respectively. Resistance to multiple drugs increased from 13.8% in 2001 to 20.6% in 2003 (p <0.0001). Antimicrobial consumption data were obtained from the Spanish National Health System. In spite of decreased cephalosporin and beta-lactam use, overall extended-spectrum beta-lactamase production increased from 1.6% (2001) to 4.1% (2003) (p <0.0001), mainly due to the rising prevalence of cefotaximases. Resistance to ciprofloxacin significantly increased, mostly in community-onset infections, which coincided with a rise in community quinolone use. Cotrimoxazole resistance remained stable at approximately 30%, even though its use was dramatically reduced.     

Escherichia coli O104:H4 infections and international travel

We analyzed travel-associated clinical isolates of Escherichia coli O104:H4, including 1 from the 2011 German outbreak and 1 from a patient who returned from the Philippines in 2010, by genome sequencing and optical mapping. Despite extensive genomic similarity between these strains, key differences included the distribution of toxin and antimicrobial drug-resistance determinants.     

Emergence of Escherichia coli isolates producing conjugative plasmid-mediated DHA-1 beta-lactamase in a Korean university hospital

Seven isolates of cefoxitin-resistant Escherichia coli with an inducible phenotype were detected between November 2002 and July 2003 in a Korean hospital. Conjugations were tested by the filter mating method using azide-resistant E. coli J53 as the recipient. All isolates and their transconjugants were tested for broth microdilution minimum inhibitory concentrations, isoelectric focusing (IEF), polymerase chain reaction (PCR) for SHV, TEM, CTX-M and DHA-derived beta-lactamases, and DNA sequencing. XbaI-digested genomic DNA bands of the seven isolates were separated by pulsed-field gel electrophoresis (PFGE). IEF, PCR and sequence analysis revealed that all isolates possessed a blaTEM-1-like and a blaDHA-1 gene. Two isolates also carried the blaCTX-M-14 gene. Transfer of the resistance by conjugation experiments of all seven isolates was successful, suggesting that the blaDHA-1-containing plasmids in the E. coli isolates were self-transmissible. The isolates were recovered from patients in wards or an intensive care unit, all of which had been exposed to beta-lactams before isolation of the DHA-1 producers. Five patterns among the seven isolates were demonstrated by PFGE; sporadic infections with E. coli possessing an inducible beta-lactam resistance phenotype were found. DHA-1 encoded by conjugative plasmids conferred the resistance phenotype. The spread of the DHA-1 producers was due to both clonal spread and horizontal transfer of the resistance gene.     

Contamination of potable water distribution systems by multiantimicrobial-resistant enterohemorrhagic Escherichia coli

BACKGROUND: The contamination of processed or unprocessed drinking water by fecal coliform bacteria has been reported worldwide. Despite a high incidence of waterborne diseases, entero-hemorrhagic Escherichia coli (EHEC) is an underacknowledged pathogen of concern to public health in India. Although the presence of EHEC is recorded in surface water resources of India, drinking water sources are yet to be investigated. OBJECTIVES: The goal of this study was to analyze potable water samples for the presence of virulence determinants of EHEC and to determine the sensitivity of the virulence determinants to antimicrobials. METHODS: We enumerated coliform bacteria in potable water samples collected from six locations in Lucknow, a major city in northern India, using the most probable number method. E. coli (n = 81), randomly isolated by membrane-filtration technique from four sites, were identified by biochemical characterization. E. coli were not detected in samples from two other sites. We screened 15 randomly selected isolates from each site for virulence determinants of EHEC using polymerase chain reaction (PCR). The isolates positive for virulence determinants (n = 18) were screened for sensitivity to 15 antimicrobials by the disk diffusion method. RESULTS: Both stx1 and stx2 genes were present in 33.3% of isolates, whereas others possessed either stx1 (11.1%) or stx2 (55.6%). eaeA, hlyA, and chuA genes were present in 100, 23.3, and 16.7% of isolates, respectively. Resistance to multiple antimicrobials was observed in potential EHEC. CONCLUSIONS: The occurrence of multiantimicrobial-resistant EHEC in potable water is an important health concern because of the risk of waterborne outbreaks.