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Journal of Clinical Microbiology, January 2004, p. 311-319, Vol. 42, No. 1
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.1.311-319.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Serotypes, Virulence Genes, and Intimin Types of Shiga Toxin (Verotoxin)-Producing Escherichia coli Isolates from Human Patients: Prevalence in Lugo, Spain, from 1992 through 1999

J. E. Blanco,1 M. Blanco,1 M. P. Alonso,1,2 A. Mora,1 G. Dahbi,1 M. A. Coira,2 and J. Blanco1*

Laboratorio de Referencia de E. coli (LREC), Departamento de Microbioloxía e Parasitoloxía, Facultade de Veterinaria, Universidade de Santiago de Compostela (USC), 27002 Lugo,1 Unidade de Microbioloxía Clínica, Complexo Hospitalario Xeral-Calde, 27004 Lugo, Spain2

Received 15 September 2003/ Returned for modification 24 September 2003/ Accepted 1 October 2003

We have analyzed the prevalence of Shiga toxin-producing Escherichia coli (STEC) in stool specimens of patients with diarrhea or other gastrointestinal alterations from the Xeral-Calde Hospital of Lugo City (Spain). STEC strains were detected in 126 (2.5%) of 5,054 cases investigated, with a progressive increase in the incidence from 0% in 1992 to 4.4% in 1999. STEC O157:H7 was isolated in 24 cases (0.5%), whereas non-O157 STEC strains were isolated from 87 patients (1.7%). STEC strains were (after Salmonella and Campylobacter strains) the third most frequently recovered enteropathogenic bacteria. A total of 126 human STEC isolates were characterized in this study. PCR showed that 43 (34%) isolates carried stx1 genes, 45 (36%) possessed stx2 genes and 38 (30%) carried both stx1 and stx2. A total of 88 (70%) isolates carried an ehxA enterohemolysin gene, and 70 (56%) isolates possessed an eae intimin gene (27 isolates with type {gamma}1, 20 with type ß1, 8 with type {zeta}, 5 with type {gamma}2, and 3 with type {varepsilon}). STEC isolates belonged to 41 O serogroups and 66 O:H serotypes, including 21 serotypes associated with hemolytic uremic syndrome and 30 new serotypes not previously reported among human STEC strains in other studies. Although the 126 STEC isolates belonged to 81 different seropathotypes (associations between serotypes and virulence genes), only four accounted for 31% of isolates. Seropathotype O157:H7 stx1 stx2 eae-{gamma}1 ehxA was the most common (13 isolates) followed by O157:H7 stx2 eae-{gamma}1 ehxA (11 isolates), O26:H11 stx1 eae-ß1 ehxA (11 isolates), and O111:H- stx1 stx2 eae-{gamma}2 ehxA (4 isolates). Our results suggest that STEC strains are a significant cause of human infections in Spain and confirm that in continental Europe, infections caused by STEC non-O157 strains are more common than those caused by O157:H7 isolates. The high prevalence of STEC strains (both O157:H7 and non-O157 strains) in human patients, and their association with serious complications, strongly supports the utilization of protocols for detection of all serotypes of STEC in Spanish clinical microbiology laboratories.

* Corresponding author. Mailing address: Laboratorio de Referencia de E. coli (LREC), Departamento de Microbioloxía e Parasitoloxía, Facultade de Veterinaria, Universidade de Santiago de Compostela (USC), 27002 Lugo, Spain. Phone and fax: 34-982-285936. E-mail: jba{at}lugo.usc.es.

Journal of Clinical Microbiology, January 2004, p. 311-319, Vol. 42, No. 1
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.1.311-319.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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