National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK.
NIHR HPRU in Gastrointestinal Infections at University of Liverpool, Liverpool, UK.
J Med Microbiol. 2023 Jun;72(6). doi: 10.1099/jmm.0.001707.
Shiga toxin-producing (STEC) belong to a diverse group of gastrointestinal pathogens defined by the presence of Shiga toxin genes () of which there are at least ten subtypes (Stx1a-Stx1d and Stx2a-Stx2g). Initially thought to be associated with mild symptoms, more recently STEC encoding have been isolated from cases of haemolytic uraemic syndrome (HUS) and the clinical significance and public health burden require further investigation. We analysed clinical outcomes and genome-sequencing data linked to patients infected with STEC encoding- in England to assess the risk to public health. One hundred and twelve (=58 isolates encoded ; =54 isolates belonging to CC122 or CC722 that had but were negative for ) isolated from patients' faecal specimens between 2015 and 2022 were genome sequenced and linked to epidemiological and clinical outcome data. All isolates were investigated for the presence of virulence genes and a maximum-likelihood phylogeny of isolates belonging to CC122 and CC722 was constructed. There were 52 cases infected with STEC harbouring between 2015 and 2022, with the majority identified in 2022. Most cases resided in the North of England (=39/52, 75 %), were female (=31, 59.6 %) and/or aged five and under (=29, 55.8 %). Clinical outcome data were available for 40/52 cases (76.9 %) and 7/40(17.5 %) were diagnosed with STEC-HUS. In the two most common clonal complexes, CC122 and CC722, the presence of the -encoding prophage correlated with the presence of additional virulence genes, and , located on an 85kbp IncFIB plasmid. Certain serotypes of harbouring cause severe clinical outcomes, including STEC-HUS. Public health advice and possible interventions are limited, as little is known about the animal and environmental reservoirs and transmission routes. We recommend more comprehensive and standardized collection of microbiological and epidemiological data, and routine sharing of sequencing data between public health agencies worldwide.
产志贺毒素大肠杆菌（STEC）属于一组多样化的胃肠道病原体，其特征是存在志贺毒素基因（），其中至少有十种亚型（Stx1a-Stx1d 和 Stx2a-Stx2g）。最初认为它们与轻度症状有关，但最近已从溶血性尿毒综合征（HUS）病例中分离出编码的 STEC，其临床意义和公共卫生负担需要进一步研究。我们分析了与英格兰感染产志贺毒素大肠杆菌的患者相关的临床结果和基因组测序数据，以评估对公共健康的风险。2015 年至 2022 年间，从患者粪便标本中分离出 112 株（58 株编码；54 株属于 CC122 或 CC722，携带但为 阴性），对其进行了基因组测序，并与流行病学和临床结果数据相关联。所有分离株均被检测了毒力基因的存在，并构建了属于 CC122 和 CC722 的分离株最大似然系统发育树。2015 年至 2022 年间共发生 52 例感染产志贺毒素大肠杆菌的病例，其中大部分发生在 2022 年。大多数病例位于英格兰北部（=39/52，75%），为女性（=31，59.6%）和/或年龄在 5 岁及以下（=29，55.8%）。临床结果数据可用于 40/52 例（76.9%），其中 7/40（17.5%）诊断为 STEC-HUS。在两个最常见的克隆复合体 CC122 和 CC722 中，携带编码噬菌体的存在与额外的毒力基因，和位于 85kbp IncFIB 质粒上的 ，相关。携带 编码噬菌体的某些血清型可引起严重的临床后果，包括 STEC-HUS。由于对动物和环境宿主以及传播途径知之甚少，因此公共卫生建议和可能的干预措施有限。我们建议更全面和标准化地收集微生物学和流行病学数据，并在全球公共卫生机构之间常规共享测序数据。
