Aim: Enterohemorrhagic Escherichia coli (EHEC) is the cause of diarrhea, bloody diarrhea, and haemolytic uremic syndrome (HUS) worldwide. The role of EHEC in the etiology of HUS in the Czech Republic has recently been described, but the prevalence, characteristics, and epidemiology of EHEC causing diarrhea have not been fully known. Therefore, this study analyzed the serotypes, stx genotypes, and virulence factors in EHEC strains isolated in 1965-2013 from patients with diarrhea or bloody diarrhea and their family contacts. In addition, we characterized diagnostically relevant phenotypes of EHEC strains, their antimicrobial susceptibility, seasonal trends, and distribution by administrative region.
Material and methods: Serogrouped E. coli isolates from patients were referred to the National Reference Laboratory (NRL) for E. coli and Shigella for the detection of Stx. Specimens of both human and non-human origin were referred to the NRL for epidemiological investigation. Serotyping was performed by conventional and molecular methods, PCR was applied to stx genotyping and identification of non-stx virulence factors, and standard methods were used for phenotypic analysis and antimicrobial susceptibility testing. The epidemiological link between the human and animal isolates was confirmed using pulsed-field gel electrophoresis (PFGE).
Results: Of 50 EHEC strains, 24 were recovered from patients with diarrhea without blood, 19 from patients with bloody diarrhea, six from family contacts, and one from an epidemiologically linked animal. EHEC cases were reported during the whole year, with peaks in May through October, most often in the Central Bohemian and Hradec Králové Regions. EHEC outbreaks occurred in three families: in one of them sheep-to-human transmission of EHEC was detected. The EHEC strains were assigned to five serotypes, with more than half of them being non-sorbitol fermenting (NSF) O157:H7/NM[fliCH7] and a third being strains O26:H11/NM[fliCH11]; serotypes O111:NM[fliCH8], O118:NM[fliCH25], and O104:H4, similarly to sorbitol-fermenting (SF) strains O157:NM[fliCH7], were rare. Of seven stx genotypes identified, all were present in NSF EHEC O157, two in each of EHEC O26 and O111, and one in each of EHEC O118, O104, and SF O157. All but one strain were Stx producers. Genes encoding other virulence factors including toxins (EHEC-hlyA, cdt-V, and espP) and adhesins (eae, efa1, iha, lpf, and sfpA) were detected in all strains and their occurrence was serotype specific. The most common of these genes were eae encoding adhesin intimin and EHEC-hlyA encoding EHEC hemolysin. All EHEC strains but SF O157 harboured terE encoding tellurite resistance. All strains except NSF EHEC O157 and EHEC O118 fermented sorbitol and produced ß-D-glucuronidase. Most (89.8%) EHEC strains were susceptible to all 12 antimicrobials tested.
Conclusion: EHEC strains cause diarrhea and bloody diarrhea in the Czech Republic. Nevertheless, only a systematic screening of the stool from patients with diarrhea can make it possible to elucidate their actual role in the etiology of diarrheal diseases (as well as HUS) in the Czech Republic and to consider the data in the European context. EHEC cases are reported to the European Centre for Disease Prevention and Control (ECDC) within the Food and Waterborne Diseases Surveillance Network.