Zoonosis from the ground
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1 Zoonosis from the ground Alex W. Friedrich Medical Microbiology University Medical Center Groningen
2 Reported hospitalisation and case-fatality rates due to zoonoses in confirmed human cases in the EU, 2011 Zoonotic Diseases Causative agent Confirmed human cases Reported hospitalised cases Hospitalisation rate (%) Reported deaths Case fatality rate (%) Campylobacteriosis Campylobacter spp. 220,209 8, Salmonellosis Salmonella spp. 95,548 4, STEC infections Shiga toxinproducing E. coli 9, Yersiniosis Yersinia spp. 7, Listeriosis Echinococcosis L. monocytogenes Echinococcus spp. 1, Brucellosis Brucella spp Trichinellosis Trichinella spp Rabies Rabies EFSA Journal 2013;11(4):3129
3 STEC reports in the Netherlands Data: Ingrid Friesema, RIVM
4 Infections due to E. coli Urinary tract infections 5 mm Neonatal encephalitis Enteropathogenic E. coli 1000x Other opportunistic infections x
5 Enteropathogenic E. coli Enterotoxigenic E. coli (ETEC) Enteropathogenic E. coli (EPEC) Shiga toxin-producing (STEC) /Enterohaemorrhagic E. coli (EHEC)/ VTEC Enteroaggregative E. coli (EAEC) - children in 3rd world, in HIV patients, chron. Diarrhea. Malnutrition, highly antibiotic resistant Enteroinvasive E. coli (EIEC) STEC 0methods.pdf
6 EHEC O157:H7 outbreak in Canada 7 died, 2000 with diarrhea cause: contaminated water 6
7 Clinical importance and danger to public health HUS (most frequent cause for acute renal failure) No specific therapy No specific prevention (e.g. vaccination) Complex diagnostics
8 (Zoonotic) STEC Infection sources
9 HUS-association of molecular markers in EHEC diagnostics PCR results Percentage of pos. E. coli PCR on pat with isolates sfpa rfbo157 eae stx HUS % SF O157:HNM % NSF O157:H % non O157 EHEC % STEC % EPEC
10 The Stx2 family e Stx2e d g Stx2g Stx2d act Stx2d Stx2 c Stx2c Stx2f f = HUS associated Friedrich et al J Infect Dis; Friedrich et al J. Clin. Microbiol. Friedrich et al 2009 Clin Inf Dis
11 EHEC: major concern of food born outbreak Common O-serogroups reported to cause foodborne illness are O157:H7/HNM O26, O45 O103, O104:H4 O111, O121 and O145 All eae +, except Asscociation with raw fruits & vegetables?
12 EHEC on fruits and veg Heaton and Jones, J Appl Microbiol 2007
13 EHEC O104:H4 outbreak In Germany >5922 cases >850 HUS 53 patients died E. coli O104:H4 HUSEC41/ESBL ID: O104:H4 Stx2 positive Stx1 negative Eae negative ESBL positive EHEC-Ausbruch in Norddeutschland Frank et al N Engl J Med
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15 Mission uncompleted Primary source fennugreek et al. outbreak source Reservoir??? 2nd source?
16 Why Sprouts?? Seeds and beans need warm and humid conditions to sprout and grow These sprouting conditions are also ideal for the growth of bacteria such as E. coli
17 Tenacity of EHEC Heaton and Jones, J Appl Microbiol 2007
18 Prevention of Gastrointestinal Zoonotic diseases Keep cleaning Food safety Animal Contact?
19 In and not on plants
20 Stx-negative variants of EHEC O157 Outbreak no. Year Disease No. of isolates stx-positive stx-negative Total HUS /96 HUS HUS D D D Clin. Infect. Dis. 2007
21 Groningen STEC-ID-net Running multicenter study in NL patients from GP with Diarrhea/BD/HUS Identify prevalence of STEC- EHEC/HUSEC Capacity building of STEC-diagnostics Create an expert network Microbiological risk assessment for Public Health Create Dutch HUSEC collection Rotterdam John Rossen,Mirjam Kooistra, CERTE UMCG
22 Data analyzed: Mirjam Mooistra, UMCG/Certe STEC-ID net: direct PCR-detection April 2013 t/m Augustus 2013 Included patients: n= 9582 (Groningen n=6358; Rotterdam n=3224) Target(s) Groningen Rotterdam n % n % stx stx1,eae stx stx2,eae stx1,stx stx1,stx2,eae eae TOTAAL Totaal STEC-prevalence 0,8% 0,4% 0,7% EHEC-prevalence 1,1% 1,4 1,2% Direct-PCR stx1/stx2/eae % % % after Pre-enrichment: % % %?
23 Structure analysis of stx-gene O P Q SRRz Prophage stxa 2 B SR Rz stx 2var Antibiotics in pre-hus-phase increase risk for HUS 2011 outbreak: Antibiotics after HUS improved clinical outcome
24 stx-genes: common in nature
25 Are we prepared? STEC of important zoonotic impact also via vegetables Stx-genes not enough to determine STEC/EHEC Risk analysis of STEC/EHEC needed for public health, infection control and food safety Need for national research network on STEC/EHEC for outbreak preparation
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