Enterohaemorrhagic E. coli Hybrid Pathotype O80:H2 an emerging clone in France E. Loukiadis 1 , P. Mariani-Kurkdjian 2 , S. Ganet 1 , P. Fach 3 , M.Bruyand 4 , S. Bonacorsi 2 11th annual workshop of the NRL for E. coli in the EU Rome, 11 November 2016 1. VetAgro Sup Campus Vétérinaire de Lyon, Laboratoire LMAP/LNR STEC, Lyon, France 2. CNR associé Escherichia coli, Service de Microbiologie, AP-HP, Hôpital Robert-Debré, Service de Microbiologie, Université Paris Diderot, IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, France 3. ANSES, Plateforme Identity Path, Maisons-Alfort, France 4. Santé Publique France, St Maurice, France
20
Embed
Enterohaemorrhagic E. coli Hybrid PathotypeO80:H2 an ... · VetAgro Sup Campus Vétérinaire de Lyon, Laboratoire LMAP/LNR STEC, Lyon, France 2. CNR associé Escherichia coli , Service
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Enterohaemorrhagic E. coli Hybrid Pathotype O80:H2
an emerging clone in France
E. Loukiadis1, P. Mariani-Kurkdjian2, S. Ganet1, P. Fach3, M.Bruyand4, S. Bonacorsi2
11th annual workshop of the NRL for E. coli in the EU
Rome, 11 November 2016
1. VetAgro Sup Campus Vétérinaire de Lyon, Laboratoire LMAP/LNR STEC, Lyon, France
2. CNR associé Escherichia coli, Service de Microbiologie, AP-HP, Hôpital Robert-Debré, Service de Microbiologie,
Université Paris Diderot, IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, France
3. ANSES, Plateforme Identity Path, Maisons-Alfort, France
4. Santé Publique France, St Maurice, France
Introduction
• In 2012, we isolated an atypical EHEC from HUS patient’s blood culture
• This strain belongs to the rare serotype O80:H2 and harbors EHEC and ExPEC
Pediatric HUS related to EHEC O80 in France, 2005-2016
Geographical repartition
Soycal, EID, 2016
Regional 10 year cumulative incidence rate of HUS
CLINICAL AND BIOLOGICAL CHARACTERISTICS
• HUS preceeded by diarrhea in 46 (79%) instances, 16 bloody (27,5%)
Median duration of diarrhea: 5 days (Q1: 3; Q3: 9)
Median blood creatinine: 89 µmol/L (Q1: 43; Q3:268)
Haemoglobinemia: median 6 g/dL (Q1: 5; Q3: 8)
Blood platelet count: median 37000 /mm3 (Q1: 23000; Q3: 63000)
• Blood transfusion required in 58% (n=34)
• 33 % acute dialysis support (n=19), 23 % long term renal sequelae(n=13)
• 17% neurological complications (n=10)
• 3,4 % died (n=2)
• 3 Unusual HUS:
- 1 relapse complicated by bacteremia
- 1 died after myocardial complication with pancreatic abscess
- 1 died (septic choc with intestinal necrosis and peritonitis)Soycal, EID, 2016
Genetic characterization of O80:H2 strains
EHEC virulence profile
• stx2 : 100% (no stx1)
�subtypes: 62% stx2c 2d,
22% stx2a
9% stx2d
7% stx2a 2d
• eae : 100%
� rare variant eae ξ: 100%
• ehx: 87%
Soycal, EID, 2016
Genetic characterization of O80:H2 strains
ExPEC (pS88) virulence profile
• > 4 genes : 100% : sitA, cia, hlyF, ompT
• iss, iroN (salmochelin) : 98%
• cva: 96%
• iucC (aerobactin) and etscC : 61%
Peigne et al, Infect Immun, 2009
O80:H2 : hybrid pathotypeSoycal, EID, 2016
RepPCR typing
O80
O1
57
O1
04
O1
21
O
11
1
Soycal, EID, 2016
H H BP
BH
- Amoxicillin : 93% R
- Cotrimoxazole : 74 % R
- Nalidixic acid : 89% R
Antimicrobial resistance
Azithromycin MIC90 : 4 mg/L.
57 % multidrug R
None ESBL
Soycal, EID, 2016
Epidemiological information on O80 pediatric HUS
• 5 HUS cases related to an outbreak in 2005 linked to raw milk
cheese consumption
• 2 HUS cases among a family (twin sister)
• Diarrhea among the relatives in 15 (28%) instances
• Risk exposures reported by 54 cases
- Raw milk consumption: 4 (7%)
- Cheese made with raw milk: 12 (22%)
- Ground beef: 18 (33%)
- Contact with farm animals: 12 (22%)
Not conclusive
Soycal, EID, 2016
O80:H2 STEC strainshave been isolated in food
• France (in 2012 and 2014)Cow-origin foodstuffs (not epidemiologically related)
?
• O80:H2 strains have also been isolated from animals (stx-)From a cow (Spain) (Blanco et al., JCM, 2004)
From a pig (Spain, the pig-origin strain was actually isolated in Slovakia) (Vu-Khac H et al., 2007)
O80:H2 STEC strainshave been isolated in food
• Food O80:H2 STEC isolates
→ « Chance » discovery (not screened in routine)
Which prevalence in food?
1st official monitoring plan in 2017in raw minced beef
Hybrid pathotype O80:H2has been isolated in food
Same virulence profile as human ones
EHEC-associated genesIncluding: stx2a
eae ξehxA
+ExPEC-associated genesUp to 7 pS88-encoded genes : sitA, cia, hlyF, ompTiss, iroN, cva,
O80:H2 : an hybrid pathotype
Hybrid pathotype O80:H2has been isolated in food
Same virulence profile as human ones
EHEC-associated genesIncluding: stx2a
eae ξehxA
+ExPEC-associated genesUp to 7 pS88-encoded genes : sitA, cia, hlyF, ompTiss, iroN, cva,
O80:H2 : an hybrid pathotype
Same antibioresistance profile as human ones
Resistant to amoxicillin, kanamycin, and nalidixic ac id
Soycal, EID, 2016! The 2 animal AEEC strains from the Spanish collection have a differentprofile (ehxA and pS88 negative) and are not multidrug resistant
N= 290 (2010-2012)
(146 human and 123 animal strains + 9 reference
strains + 9 « non pathogenic » E. coli)
French O80:H2 STEC strains belong to the ST301 (CC165)Wirth et al. , 2006
Hybrid pathotype O80:H2has been isolated in food
Cow-origin O80:H2 strains belong to the sameclonal group as humans ones
Same genetic profile than human ones
Soycal, EID, 2016O80:H2
RepPCR typing
Bv STECBv AEEC
Pig
AEEC
Confirmed by PFGE analysisOngoing WGS analysis of STEC
CONCLUSION
• Ongoing surveillance of this emerging atypical strain in France
• Therapeutic challenge: role of antibiotics?
• O80:H2 in others European countries ?
• Reservoir and source of infection for STEC O80:H2?
AcknowledgmentsThe French Society of Pediatrics and the French Ministry of Agriculture for its support of this study.J Blanco, NRL E. coli, SpainDr. Soysal ,Assistance Publique–Hôpitaux de Paris (AP-HP), FranceM Gouali, French NRC, Institut Pasteur, FranceAll the NCR and NRL teams