Escherichia coli O157:H7

E. coli O157:H7 infection often causes severe, acute hemorrhagic diarrhea (although nonhemorrhagic diarrhea is also possible) and abdominal cramps. Usually little or no fever is present, and the illness resolves in 5 to 10 days.{{cite journal | vauthors = Ciccarelli S, Stolfi I, Caramia G | title = Management strategies in the treatment of neonatal and pediatric gastroenteritis | journal = Infection and Drug Resistance | volume = 6 | pages = 133–61 | date = October 2013 | pmid = 24194646 | pmc = 3815002 | doi = 10.2147/IDR.S12718 | doi-access = free }} It can also sometimes be asymptomatic.{{cite journal | vauthors = Roos V, Ulett GC, Schembri MA, Klemm P | title = The asymptomatic bacteriuria Escherichia coli strain 83972 outcompetes uropathogenic E. coli strains in human urine | journal = Infection and Immunity | volume = 74 | issue = 1 | pages = 615–24 | date = January 2006 | pmid = 16369018 | pmc = 1346649 | doi = 10.1128/IAI.74.1.615-624.2006 }}

In some people, particularly children under five years of age, persons whose immunologies are otherwise compromised, and the elderly, the infection can cause hemolytic–uremic syndrome (HUS), in which the red blood cells are destroyed and the kidneys fail. About 2–7% of infections lead to this complication. In the United States, HUS is the principal cause of acute kidney failure in children, and most cases of HUS are caused by E. coli O157:H7.{{cn|date=January 2023}}

Image:E. Coli 0157.jpg

Like the other strains of the E. coli, O157:H7 is gram-negative and oxidase-negative. Unlike many other strains, it does not ferment sorbitol, which provides a basis for clinical laboratory differentiation of the strain. Strains of E. coli that express Shiga and Shiga-like toxins gained that ability via infection with a prophage containing the structural gene coding for the toxin, and nonproducing strains may become infected and produce shiga-like toxins after incubation with shiga toxin positive strains. The prophage responsible seems to have infected the strain's ancestors fairly recently, as viral particles have been observed to replicate in the host if it is stressed in some way (e.g. antibiotics).{{cite journal | vauthors = O'Brien AD, Newland JW, Miller SF, Holmes RK, Smith HW, Formal SB | title = Shiga-like toxin-converting phages from Escherichia coli strains that cause hemorrhagic colitis or infantile diarrhea | journal = Science | volume = 226 | issue = 4675 | pages = 694–96 | date = November 1984 | pmid = 6387911 | doi = 10.1126/science.6387911 | bibcode = 1984Sci...226..694O }}{{cite journal | vauthors = Strockbine NA, Marques LR, Newland JW, Smith HW, Holmes RK, O'Brien AD | title = Two toxin-converting phages from Escherichia coli O157:H7 strain 933 encode antigenically distinct toxins with similar biologic activities | journal = Infection and Immunity | volume = 53 | issue = 1 | pages = 135–40 | date = July 1986 | pmid = 3522426 | pmc = 260087 | doi = 10.1128/IAI.53.1.135-140.1986}}

All clinical isolates of E. coli O157:H7 possess the plasmid pO157.{{cite journal | vauthors = Lim JY, Yoon J, Hovde CJ | title = A brief overview of Escherichia coli O157:H7 and its plasmid O157 | journal = Journal of Microbiology and Biotechnology | volume = 20 | issue = 1 | pages = 5–14 | date = January 2010 | pmid = 20134227 | pmc = 3645889 | doi = 10.4014/jmb.0908.08007}} The periplasmic catalase is encoded on pO157 and may enhance the virulence of the bacterium by providing additional oxidative protection when infecting the host.{{cite journal | vauthors = Brunder W, Schmidt H, Karch H | title = KatP, a novel catalase-peroxidase encoded by the large plasmid of enterohaemorrhagic Escherichia coli O157:H7 | journal = Microbiology | volume = 142 ( Pt 11) | issue = 11 | pages = 3305–15 | date = November 1996 | pmid = 8969527 | doi = 10.1099/13500872-142-11-3305 | doi-access = free }} E. coli O157:H7 non-hemorrhagic strains are converted to hemorrhagic strains by lysogenic conversion after bacteriophage infection of non-hemorrhagic cells.{{cn|date=January 2023}}

While it is relatively uncommon, the E. coli serotype O157:H7 can naturally be found in the intestinal contents of some cattle, goats, and even sheep.{{cn|date=August 2022}} The digestive tract of cattle lack the Shiga toxin receptor globotriaosylceramide, and thus, these can be asymptomatic carriers of the bacterium.{{cite journal | vauthors = Pruimboom-Brees IM, Morgan TW, Ackermann MR, Nystrom ED, Samuel JE, Cornick NA, Moon HW | title = Cattle lack vascular receptors for Escherichia coli O157:H7 Shiga toxins | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 97 | issue = 19 | pages = 10325–29 | date = September 2000 | pmid = 10973498 | pmc = 27023 | doi = 10.1073/pnas.190329997 | bibcode = 2000PNAS...9710325P | doi-access = free }} The prevalence of E. coli O157:H7 in North American feedlot cattle herds ranges from 0 to 60%.{{cite journal | vauthors = Jeon SJ, Elzo M, DiLorenzo N, Lamb GC, Jeong KC | title = Evaluation of animal genetic and physiological factors that affect the prevalence of Escherichia coli O157 in cattle | journal = PLOS ONE | volume = 8 | issue = 2 | pages = e55728 | year = 2013 | pmid = 23405204 | pmc = 3566006 | doi = 10.1371/journal.pone.0055728 | bibcode = 2013PLoSO...855728J | doi-access = free }}

Some cattle may also be so-called "super-shedders" of the bacterium. Super-shedders may be defined as cattle exhibiting rectoanal junction colonization and excreting >10^{3 to 4} CFU g⁻¹ feces. Super-shedders have been found to constitute a small proportion of the cattle in a feedlot (<10%) but they may account for >90% of all E. coli O157:H7 excreted.{{cite journal | vauthors = Chase-Topping M, Gally D, Low C, Matthews L, Woolhouse M | title = Super-shedding and the link between human infection and livestock carriage of Escherichia coli O157 | journal = Nature Reviews. Microbiology | volume = 6 | issue = 12 | pages = 904–12 | date = December 2008 | pmid = 19008890 | pmc = 5844465 | doi = 10.1038/nrmicro2029 }}

Infection with E. coli O157:H7 can come from ingestion of contaminated food or water, or oral contact with contaminated surfaces. Examples of this can be undercooked ground beef but also leafy vegetables and raw milk. Fields often become contaminated with the bacterium through irrigation processes or contaminated water naturally entering the soil.{{Cite news|url=https://www.cnn.com/2018/05/02/health/e-coli-lettuce-explainer/index.html|title=Why deadly E. coli loves leafy greens|last=Scutti|first=Susan |work=CNN|access-date=2018-09-20}} It is highly virulent, with a low infectious dose: an inoculation of fewer than 10 to 100 colony-forming units (CFU) of E. coli O157:H7 is sufficient to cause infection, compared to over a million CFU for other pathogenic E. coli strains.J.D. Greig, E.C.D. Todd, C. Bartleson, and B. Michaels. March 25, 2010. "[http://www.fsis.usda.gov/PDF/Atlanta2010/Slides_FSEC_JGreig_Doses.pdf Infective Doses and Pathen Carriage] {{Webarchive|url=https://web.archive.org/web/20101016000915/http://www.fsis.usda.gov/PDF/Atlanta2010/Slides_FSEC_JGreig_Doses.pdf |date=2010-10-16 }}", pp. 19–20, USDA 2010 Food Safety Education Conference.

A stool culture can detect the bacterium. The sample is cultured on sorbitol-MacConkey (SMAC) agar, or the variant cefixime potassium tellurite sorbitol-MacConkey agar (CT-SMAC{{Cite web |url=http://www.solabia.com/solabia/produitsDiagnostic.nsf/0/27DFE62DDA44AF3AC12574C7003A6377/$file/TDS_BK147_v5.pdf |title=MACCONKEY SORBITOL AGAR (CT-SMAC) |access-date=2010-12-11 |archive-url=https://web.archive.org/web/20110716102617/http://www.solabia.com/solabia/produitsDiagnostic.nsf/0/27DFE62DDA44AF3AC12574C7003A6377/$file/TDS_BK147_v5.pdf |archive-date=2011-07-16 |url-status=dead }}). On SMAC agar, O157:H7 colonies appear clear due to their inability to ferment sorbitol, while the colonies of the usual sorbitol-fermenting serotypes of E. coli appear red. Sorbitol non-fermenting colonies are tested for the somatic O157 antigen before being confirmed as E. coli O157:H7. Like all cultures, diagnosis is time-consuming with this method; swifter diagnosis is possible using quick E. coli DNA extraction method{{Cite web |url=http://www.fortiusbio.com/Food_Pathogen_E-coli_DNA_Extraction_Strip_Card.html |title=Quick E. coli DNA extraction filter paper card |access-date=2014-07-11 |archive-url=https://web.archive.org/web/20140717100350/http://www.fortiusbio.com/Food_Pathogen_E-coli_DNA_Extraction_Strip_Card.html |archive-date=2014-07-17 |url-status=dead }} plus polymerase chain reaction techniques. Newer technologies using fluorescent and antibody detection are also under development.{{cn|date=January 2023}}

Avoiding the consumption of, or contact with, unpasteurized dairy products, undercooked beef, uncleaned vegetables, and non disinfected water reduces the risk of an E. coli infection. Proper hand washing with water that has been treated with adequate levels of chlorine or other effective disinfectants after using the lavatory or changing a diaper, especially among children or those with diarrhea, reduces the risk of transmission.{{Cite web|url=https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02019|title=Viruses, Bacteria, and Parasites in the Digestive Tract - Health Encyclopedia - University of Rochester Medical Center|website=www.urmc.rochester.edu|access-date=2020-01-17}}{{Cite web |title=Preventing Foodborne Illness: Escherichia coli O157:H7 |url=https://wonder.cdc.gov/wonder/prevguid/p0000417/p0000417.asp#head009000000000000 |access-date=2023-11-28 |website=wonder.cdc.gov |archive-date=2023-09-23 |archive-url=https://web.archive.org/web/20230923134113/https://wonder.cdc.gov/wonder/prevguid/p0000417/p0000417.asp#head009000000000000 |url-status=dead }}

E. coli O157:H7 infection is a nationally reportable disease in the US, Great Britain, and Germany. It is also reportable in most states of Australia including Queensland.{{Cite web|url=https://academic.oup.com/cid/article-abstract/69/3/428/5146342?redirectedFrom=fulltext|title=Journal}}

While fluid replacement and blood pressure support may be necessary to prevent death from dehydration, most patients recover without treatment in 5–10 days. There is no evidence that antibiotics improve the course of disease, and treatment with antibiotics may precipitate hemolytic–uremic syndrome (HUS).{{cite journal | vauthors = Walterspiel JN, Ashkenazi S, Morrow AL, Cleary TG | title = Effect of subinhibitory concentrations of antibiotics on extracellular Shiga-like toxin I | journal = Infection | volume = 20 | issue = 1 | pages = 25–29 | year = 1992 | pmid = 1563808 | doi = 10.1007/BF01704889 | s2cid = 39513818 }} The antibiotics are thought to trigger prophage induction, and the prophages released by the dying bacteria infect other susceptible bacteria, converting them into toxin-producing forms. Antidiarrheal agents, such as loperamide (imodium), should also be avoided as they may prolong the duration of the infection.{{cn|date=January 2023}}

Certain novel treatment strategies, such as the use of anti-induction strategies to prevent toxin production{{cite journal | vauthors = Keen EC | title = Paradigms of pathogenesis: targeting the mobile genetic elements of disease | journal = Frontiers in Cellular and Infection Microbiology | volume = 2 | pages = 161 | date = December 2012 | pmid = 23248780 | pmc = 3522046 | doi = 10.3389/fcimb.2012.00161 | doi-access = free }} and the use of anti-Shiga toxin antibodies,{{cite journal | vauthors = Tzipori S, Sheoran A, Akiyoshi D, Donohue-Rolfe A, Trachtman H | title = Antibody therapy in the management of shiga toxin-induced hemolytic uremic syndrome | journal = Clinical Microbiology Reviews | volume = 17 | issue = 4 | pages = 926–41, table of contents | date = October 2004 | pmid = 15489355 | pmc = 523565 | doi = 10.1128/CMR.17.4.926-941.2004 }} have also been proposed.

The common ancestor of Escherichia coli O157:H7 was found to have originated in the Netherlands around 1890 as estimated by molecular biologists. It is thought that international spread was through animal movements, like Holstein Friesian cattle.{{Cite journal |last1=Franz |first1=Eelco |last2=Rotariu |first2=Ovidiu |last3=Lopes |first3=Bruno S |last4=MacRae |first4=Marion |last5=Bono |first5=James L |last6=Laing |first6=Chad |last7=Gannon |first7=Victor |last8=Söderlund |first8=Robert |last9=van Hoek |first9=Angela H A M |last10=Friesema |first10=Ingrid |last11=French |first11=Nigel P |last12=George |first12=Tessy |last13=Biggs |first13=Patrick J |last14=Jaros |first14=Patricia |last15=Rivas |first15=Marta |date=2018-10-29 |title=Phylogeographic Analysis Reveals Multiple International transmission Events Have Driven the Global Emergence of Escherichia coli O157:H7 |url=https://academic.oup.com/cid/article/69/3/428/5146342 |journal=Clinical Infectious Diseases |volume=69 |issue=3 |pages=428–437 |doi=10.1093/cid/ciy919 |pmid=30371758 |issn=1058-4838|hdl=2164/13183 |hdl-access=free }} E.coli O157:H7 is thought to have moved from Europe to Australia around 1937, to the United States in 1941, to Canada in 1960, and from Australia to New Zealand in 1966.

The first recorded observation of human E. coli O157:H7 infection was in 1975, in association with a sporadic case of hemorrhagic colitis, but it was not identified as pathogenic then.{{cite journal |last1=Riley |first1=Lee W. |last2=Remis |first2=Robert S. |last3=Helgerson |first3=Steven D. |last4=McGee |first4=Harry B. |last5=Wells |first5=Joy G. |last6=Davis |first6=Betty R. |last7=Hebert |first7=Richard J. |last8=Olcott |first8=Ellen S. |last9=Johnson |first9=Linda M. |last10=Hargrett |first10=Nancy T. |last11=Blake |first11=Paul A. |last12=Cohen |first12=Mitchell L. |date=March 24, 1983 |title=Hemorrhagic Colitis Associated with a Rare Escherichia coli Serotype |url=https://www.nejm.org/doi/full/10.1056/nejm198303243081203 |journal=The New England Journal of Medicine |volume=308 |issue=12 |pages=681–685 |publisher=Massachusetts Medical Society |doi=10.1056/NEJM198303243081203 |pmid=6338386 |access-date=March 15, 2024}} It was first recognized as a human pathogen following a 1982 hemorrhagic colitis outbreak in Oregon and Michigan, in which at least 47 people were sickened by eating beef hamburger patties from a fast food chain that were found to be contaminated with it.{{cite web |url=https://www.hopkinsmedicine.org/health/conditions-and-diseases/escherichia-coli-o157-h7 |title=Escherichia coli O157:H7 |author= |date=September 26, 2020 |website=Johns Hopkins Medicine |publisher=Johns Hopkins University |access-date=March 15, 2024 |quote=In 1982, E. coli O157:H7 was initially identified as the cause of bloody diarrhea from eating undercooked or raw hamburger meat that was contaminated with the bacteria.}}{{cite report |title=Multistate Outbreak of Escherichia coli O157:H7 Infections Associated with Eating Ground Beef --- United States, June--July 2002 |date=July 26, 2002 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5129a1.htm |publisher=The United States Centers for Disease Control and Prevention (CDC) |quote=E. coli O157:H7 was first described as a cause of human illness and associated with undercooked ground beef in 1982 (1).}}

The United States Department of Agriculture banned the sale of ground beef contaminated with the O157:H7 strain in 1994.{{cite news |title=Ban on E. Coli in Ground Beef Is to Extend to 6 More Strains |url=https://www.nytimes.com/2011/09/13/business/federal-officials-extend-e-coli-ban.html?scp=2&sq=Jack%20in%20the%20Box&st=cse |newspaper=The New York Times |date=September 12, 2011 |access-date=2011-10-08 }}

The pathogen results in an estimated 2,100 hospitalizations annually in the United States. The illness is often misdiagnosed; therefore, expensive and invasive diagnostic procedures may be performed. Patients who develop HUS often require prolonged hospitalization, dialysis, and long-term followup.{{Cite journal|last1=Berkenpas|first1=E.|last2=Millard|first2=P.|last3=Pereira da Cunha|first3=M.|date=2005-12-13|title=Detection of Escherichia coli O157:H7 with langasite pure shear horizontal surface acoustic wave sensors|journal=Biosensors and Bioelectronics|language=en|volume=21|issue=12|pages=2255–2262|doi=10.1016/j.bios.2005.11.005|pmid=16356708}}

• 1993 Jack in the Box E. coli outbreak
• 1996 Odwalla E. coli outbreak
• 2011 Germany E. coli O104:H4 outbreak
• 2024 McDonald's E. coli outbreak
• Escherichia coli O104:H4
• Escherichia coli O121
• Food-induced purpura
• List of foodborne illness outbreaks
• Walkerton E. coli outbreak

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• [https://web.archive.org/web/20080928115921/http://www.ecoli-uk.com/ Haemolytic Uraemic Syndrome Help (HUSH) – a UK based charity]
• [https://web.archive.org/web/20120319172413/http://www.aboutkidshealth.ca/En/News/NewsAndFeatures/Pages/E-coli-Protecting-Family.aspx E. coli: Protecting yourself and your family from a sometimes deadly bacterium]
• [https://web.archive.org/web/20110727165934/http://patricbrc.org/portal/portal/patric/Taxon?cType=taxon&cId=83334 Escherichia coli O157:H7] genomes and related information at [http://patricbrc.org/ PATRIC], a Bioinformatics Resource Center funded by [https://www.niaid.nih.gov/ NIAID]
• For more information about reducing your risk of foodborne illness, visit the US Department of Agriculture's [http://www.fsis.usda.gov Food Safety and Inspection Service] website or [http://fightbac.org The Partnership for Food Safety Education | Fight BAC!]
• [https://briandeer.com/e-coli-o157.htm briandeer.com], report from The Sunday Times on a UK outbreak, May 17, 1998
• [https://web.archive.org/web/20070302044727/http://cbs5.com/topstories/local_story_257194412.html CBS5 report on September 2006 outbreak]

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