Gastrointestinal Bacteria Reference Unit, UK Health Security Agency, Colindale, London, UK.
NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.
J Med Microbiol. 2024 Nov;73(11). doi: 10.1099/jmm.0.001928.
Shiga toxin-producing (STEC) are zoonotic, gastrointestinal pathogens characterized by the presence of the Shiga toxin () gene. Historically, STEC O157:H7 clonal complex (CC) 11 has been the most clinically significant serotype; however, recently there has been an increase in non-O157 STEC serotypes, including STEC O103:H2 belonging to CC17. STEC O103:H2 is an STEC serotype frequently isolated in England, although little is known about the epidemiology, clinical significance, associated public health burden or evolutionary context of this strain. Surveillance data and whole-genome sequencing data were analysed to determine the microbiological characteristics and public health burden of CC17, including the clinically significant serotype O103:H2, in England and Wales. Isolates of belonging to CC17 (=425) submitted to the Gastrointestinal Bacteria Reference Unit from 2014 to 2022 were whole genome sequenced, integrated with enhanced surveillance questionnaire data and analysed retrospectively. Overall, diagnoses of CC17 infection increased every year since 2014. Most cases were female (58.5%), with the highest proportion of cases belonging to the 0-4 age group (=83/424, 19.6%). Clinical presentation data identified diarrhoea (92.1%), abdominal pain (72.4%) and blood in stool (55.3%) as the most frequent symptoms, while 20.4% cases were admitted to hospital and 1.3% developed haemolytic uraemic syndrome. The five most common established serotypes were O103:H2 (64.5%), O123:H2 (11.1%), O151:H2 (6.6%), O71:H2 (3.3%) and O4:H2 (2.6%). The majority of CC17 isolates (78.6%) had the virulence gene combination. Nine outbreak clusters of STEC infections that were mainly geographically dispersed and temporally related were identified and associated with foodborne transmission. Nationwide implementation of PCR to detect non-O157 STEC and improvements to algorithms for the follow-up of PCR-positive faecal specimens is recommended. Enhanced surveillance is necessary to assess the incidence of CC17 infection and overall burden of this CC within the UK population.
产志贺毒素（STEC）是一种人畜共患的胃肠道病原体，其特征是存在志贺毒素（Stx）基因。历史上，STEC O157：H7 克隆复合体（CC）11 是最具临床意义的血清型；然而，最近非 O157 STEC 血清型的数量有所增加，包括属于 CC17 的 STEC O103：H2。STEC O103：H2 是英国经常分离到的一种 STEC 血清型，尽管人们对该菌株的流行病学、临床意义、相关公共卫生负担或进化背景知之甚少。对英格兰和威尔士的 CC17（包括临床重要血清型 O103：H2）的微生物学特征和公共卫生负担进行了监测数据和全基因组测序数据的分析。2014 年至 2022 年，从胃肠道细菌参考单位提交的属于 CC17（=425）的 菌株进行了全基因组测序，与增强的监测问卷数据相结合，并进行了回顾性分析。总体而言，自 2014 年以来，CC17 感染的诊断每年都在增加。大多数病例为女性（58.5%），年龄组比例最高的是 0-4 岁组（=83/424，19.6%）。临床症状数据显示，腹泻（92.1%）、腹痛（72.4%）和粪便带血（55.3%）是最常见的症状，而 20.4%的病例住院，1.3%发展为溶血性尿毒综合征。五种最常见的定型血清型为 O103：H2（64.5%）、O123：H2（11.1%）、O151：H2（6.6%）、O71：H2（3.3%）和 O4：H2（2.6%）。大多数 CC17 分离株（78.6%）具有 毒力基因组合。确定了 9 个主要在地理上分散和时间上相关的 STEC 感染暴发群，与食源性传播有关。建议在全国范围内实施 PCR 检测非 O157 STEC，并改进针对 PCR 阳性粪便标本的后续检测算法。需要加强监测，以评估 CC17 感染的发生率和该 CC 在英国人群中的总体负担。
