| Autor: |
Usein CR; Cantacuzino National Institute of Research, Bucharest, Romania.; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania., Ciontea AS; Cantacuzino National Institute of Research, Bucharest, Romania., Militaru CM; Cantacuzino National Institute of Research, Bucharest, Romania., Condei M; Cantacuzino National Institute of Research, Bucharest, Romania., Dinu S; Cantacuzino National Institute of Research, Bucharest, Romania., Oprea M; Cantacuzino National Institute of Research, Bucharest, Romania., Cristea D; Cantacuzino National Institute of Research, Bucharest, Romania., Michelacci V; Food Safety, Nutrition and Veterinary Public Health Department, Istituto Superiore di Sanità, Rome, Italy., Scavia G; Food Safety, Nutrition and Veterinary Public Health Department, Istituto Superiore di Sanità, Rome, Italy., Zota LC; National Center for Surveillance and Control of Communicable Diseases, National Institute of Public Health, Bucharest, Romania., Zaharia A; National Center for Surveillance and Control of Communicable Diseases, National Institute of Public Health, Bucharest, Romania., Morabito S; Food Safety, Nutrition and Veterinary Public Health Department, Istituto Superiore di Sanità, Rome, Italy. |
| Abstrakt: |
IntroductionAt the beginning of 2016, an increase in paediatric haemolytic uremic syndrome (HUS) cases was observed in Romania. The microbiological investigations allowed isolation of Shiga toxin-producing Escherichia coli (STEC) O26 as the causative agent from most cases. Methods: An enhanced national surveillance of HUS and severe diarrhoea was established across the country following the identification of the first cases and was carried out until August 2016. A total of 15 strains were isolated from 10 HUS and five diarrhoea cases. Strains were characterised by virulence markers (i.e. stx type/subtype, eae , ehxA genes), phylogroup, genetic relatedness and clonality using PCR-based assays, PFGE and multilocus sequence typing (MLST). The first six strains were further characterised by whole genome sequencing (WGS). Results: Five PCR-defined genotypes were distinguished. All strains from HUS cases harboured stx2a and eae , with or without stx1a , while strains from diarrhoea cases carried exclusively stx1a and eae genes. PFGE resolved strains into multiple pulsotypes, compatible with a certain geographic segregation of the cases, and strains were assigned to phylogroup B1 and sequence type (ST) 21. WGS confirmed the results of conventional molecular methods, brought evidence of O26:H11 serotype, and complemented the virulence profiles. Discussion/conclusion: This first description of STEC O26 strains from cases in Romania showed that the isolates belonged to a diverse population. The virulence content of most strains highlighted a high risk for severe outcome in infected patients. Improving the national surveillance strategy for STEC infections in Romania needs to be further considered. |
