Associations between Virulence Factors of Shiga Toxin-Producing Escherichia coli and Disease in Humans

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Journal of Clinical Microbiology, March 1999, p. 497-503, Vol. 37, No. 3
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

Associations between Virulence Factors of Shiga Toxin-Producing Escherichia coli and Disease in Humans

Patrick Boerlin,¹^,²^,³^,^* Scott A. McEwen,¹ Franziska Boerlin-Petzold,² Jeffrey B. Wilson,¹ Roger P. Johnson,²^,⁴ and Carlton L. Gyles²

Department of Population Medicine¹ and Department of Pathobiology,² Ontario Veterinary College, University of Guelph, and Health of Animals Laboratory, Health Canada,⁴ Guelph, Ontario, Canada, and Institute for Veterinary Bacteriology, University of Bern, Bern, Switzerland³

Received 13 July 1998/Returned for modification 9 October 1998/Accepted 19 November 1998

Associations between known or putative virulence factors of Shiga toxin-producing Escherichia coli and disease in humans wereinvestigated. Univariate analysis and multivariate logistic regressionanalysis of a set of 237 isolates from 118 serotypes showed significantassociations between the presence of genes for intimin (eae) andShiga toxin 2 (stx₂) and isolates from serotypes reported in humans.Similar associations were found with isolates from serotypes reportedin hemorrhagic colitis and hemolytic-uremic syndrome. The enterohemorrhagicE. coli (EHEC) hemolysin gene was significantly associated withisolates from serotypes found in severe diseases in univariateanalysis but not in multivariate logistic regression models. Astrong association between the intimin and EHEC-hemolysin genesmay explain the lack of statistical significance of EHEC hemolysinin these multivariate models, but a true lack of biological significanceof the hemolysin in humans or in disease cannot be excluded. Thisresult warrants further investigations of this topic. Multivariateanalysis revealed an interaction between the eae and stx₂ genes,thus supporting the hypothesis of the synergism between the adhesinintimin and Shiga toxin 2. A strong statistical association wasobserved between the stx₂ gene and severity of disease for a setof 112 human isolates from eight major serotypes. A comparisonof 77 isolates of bovine origin and 91 human isolates belongingto six major serotypes showed significant associations of thegenes for Shiga toxin 1 and EspP protease with bovine isolatesand an increased adherence on HEp-2 cell cultures for human isolates,particularly from diarrheic patients and healthypersons.

^* Corresponding author. Mailing address: Institut für Veterinär-Bakteriologie der Universität Bern, Länggassstrasse 122,CH-3012 Bern, Switzerland. Phone: (41) 31-631 2368. Fax: (41)31-631 2634. E-mail: patrick.boerlin{at}vbi.unibe.ch.

Journal of Clinical Microbiology, March 1999, p. 497-503, Vol. 37, No. 3
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

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