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Escherichia coli Enterohemorrhagic ( Ehec ) VROOTOXIN PRODUCERS, are certain strains of the intestinal bacteria Escherichia coli (E. coli) Cause of diseases. The suffix Enterohemorrhagic ( whole of the ancient Greek ankle BEAUTIFUL – Intestiny and hemorrhagic Hemorrhage) indicates that EHEC can lead to diarrheal diseases with blood (whole whole colitis).

Pathogen biological agent [ To edit ]

Topographic images of colonies of E. coli O157: H7 (a) 43895OW (not producers of cute ) and (b) 43895or (producers of cute ) About agar (48 h bei 28 ° C).

E. coli It is a very widespread gram -negative bacterium. Several non -pathogenic strains are part of the normal flora of the human intestine. However, there are certain serological strains that can cause intestinal diseases in humans. Apart from EHEC, which was documented for the first time in 1977, there are others E. coli pathogens: E. coli Enteropathogen (EPEC), E. coli Toxin entertainment (ETEC) and E. coli enteroinvasiva (EIEC), E. coli enteroagregativa (EAEC) [ first ] Asi as E. Difusadherent coli (DAEC).

The bacteria E. coli Enterohemorrhagic (EHEC) have several peculiarities that increase their pathogenic potential: first they can adhere to the epithelium cells of the intestine wall thanks to an envelope protein (adhesine). Secondly, thanks to a phage infection they have a gene for the production of a toxin, which resembles the necrosis neurotoxin of the bacteria Shigella dysentery , which is called toxin II of Shiga type or also Vero toxin. Finally, EHEC crops also produce a encoded plasmid hemolysis (blood cell destructive toxin). Among the three O157, O103 and O26 serotypes, almost 60% of biological agents are distributed. The letter “or” (not the zero figure) refers to the lipopolysaccharides that act as antigens against the surface of the outer membranes of the bacteria cell. For virulence, the presence of QSEC sensor protein is also essential.

The bacteria E. coli Enterohemorrhagic are E. coli toxins producers similar to Shiga (Stec) about E. coli toxin producers Vero (VTEC). However, only EHEC is called pathogenic crops.

Transmission [ To edit ]

The biological agent and infectious diseases that cause occur throughout the world. The main reserve of the agent are ruminants, mainly cows, but also sheep and goats, whose intestines are frequent, but without deriving in diseases.

The transmission of the agent can occur in very varied forms, but mainly through direct or indirect oral ingestion of fecal remains. [ 2 ] The agent can be transmitted to food, especially to raw meat or milk. An infection is also possible through water to drink or for feces contaminated. Water for consumption contaminated with animal waste in 2000 in the Canadian town of Walkerton caused more than 2000 patients and 18 deaths. [ 3 ] In addition, it is also possible a spread from man to man or from animal to man through contact. [ 4 ] Flies can also spread the EHEC. [ 5 ] With less than 100 bacteria it is sufficient for contagion to occur. [ 2 ] ​

Epidemiology [ To edit ]

Confirmed cases of EHEC/STEC and HUS per year and category in Germany according to the reference definition of the Robert Koch Institute; May 25, 2011 data [ 6 ] ​

Outside Germany there were important outbreaks of diseases caused by EHEC, especially the O157 serotype: H7: as happened in the United States in 1982 when many people became ill after the ingestion of sausages that did not heat up enough, [ 7 ] In Japan in 1996 when more than 9,000 schoolchildren became ill to the ingestion of germinated seeds of radish and in 2006 from California in 26 nation states. [ 8 ] ​

In 2009, a total of 836 cases of EHEC without Hus infection were documented in Germany according to the Robert Koch Institute, 44% of them children under 5 years. [ 9 ] ​

Increase in cases due to the aggressive mutant of 2011 [ To edit ]

In May 2011 there was an outbreak of the bacteria E. coli Enterohemorrhagic, specifically of serotype O104: H4, which produced the death of at least 23 people in Germany and more than a thousand infected.

The outbreak caused a food crisis in Europe that was mistakenly called Cruise of the cucumber , after an erroneous accusation by the German authorities against Spanish cucumbers as the cause of the epidemic. The analyzes imposed by the European Commission showed that there was no contamination by E. coli in Spanish cruxy crops in Almería, Granada and Malaga, and that the bacteria found in the samples of imported cucumber were of a type of E. coli different from The epidemic bacteria. [ ten ] ​ [ 11 ] ​

Course of the disease, complications [ To edit ]

The infection can run with the absence of symptoms. In other cases, after an incubation time of 3 or 4 days (although cases of up to 10 days are known [ twelfth ] ), A gastroenteritis is manifested, which can be developed in an entire colitis. Toxins destroy the cells of the intestine wall and blood vessels, especially in the brain and kidneys. [ 13 ] Together with Shiga toxins there are other EHEC virulence factors such as the protein encoded in Lee, EHEC hemolysis, the CDT ( cytolethal distending toxin ), FE proteases and protein serin that acquire iron, so that in varied clinical paintings caused by EHEC are considered multifactor processes. [ 13 ] ​

A severe complication of EHEC intestinal infection is hemolytic uremic syndrome (Hus or Suh), which can occur with or without neurological complications. Suh cases are due in approx. 85% of cases to an EHEC/STEC infection, although it may also be due to Shigella or other pathological biological agents. Recent studies have shown that thrombotic thrombocytopenic purple (PTT), which was also considered an option in this context, is due to a different clinical picture, and therefore is no longer included in official statistics.

The excretion of bacteria usually occurs in a period that varies between 5 and 20 days, although especially among children it may take several months. During this period the spread of other people is possible.

Diagnosis [ To edit ]

The diagnosis is produced by means of the polymerase chain reaction (RCP) with first ones that bind to specific DNA sections of EHEC and thus enable the replica of a typical gene for EHEC to DNA polymierase. RCP results can be checked against typical EHEC DNA. Additionally, the existence of Shiga I and II toxin produced by the biological agent can be demonstrated. How methods can be used [ 14 ] O Mass spectrometry methods. [ 15 ] Together with classic chromatographic or mass spectrometry coupling techniques, cursed analytics are increasingly used. [ 16 ] ​

ITESM Biotechnology Student CCM sterilizing material in a autoclave for planting E. coli by serial dilution.

A combat of this biological agent with antibiotics is not successful, since the excretion of bacteria can be postponed [ 17 ] ​ [ 18 ] Or the course of the disease can be aggravated with a greater formation of toxins. [ 19 ] ​ [ 20 ] The treatment depends on the symptoms by replacing the loss of water and electrolytes, which occurs in the case of severe colitis. No medicines are prescribed that hinder the intestinal movement, such as the Loperamide, so as not to avoid the excretion of the toxins and the agent. [ 21 ] Suh complication has to be treated with intensive medicine, for example with blood transfusions, the stimulation of urine excretion through diuretics, hemophiltations dialysis and plasma exchange. [ 20 ] ​ [ 18 ] Patients in hospitals are isolated from other patients. [ 22 ] ​

Since 2009 there are some reports on the use of Eculizumab monoclonal antibodies among children with SUH, which did not react to plasmapheresis treatment, as well as an atypical suh after a kidney transplant. [ 23 ] ​ [ 24 ] ​ [ 25 ] Following these reports, an experimentally use of Eculizumab in some Germany clinics since May 28, 2011 in critical cases of SUH, which did not show improvements with a plasmaféresis treatment. The success factor of this measure cannot be evaluated, according to Rolf Stahl, of the Hamburg-EPPENDORF University Clinic, up to 3-4 weeks after the beginning of the therapy. [ 26 ] ​

See also [ To edit ]

References [ To edit ]

  1. ↑ Infectiology of the gastrointestinal tract p. 224 ff . Berlín, Heidelberg: Springer. 2006. ISBN 9783540413592 . Online: Escherichia coli enterohemorrágica In Google books
  2. ↑ a b RKI guide for doctors: Diseases by Enterohemorrhagische Escherichia Coli (EHEC), version of January 2008 . Retrieved on May 29, 2011.
  3. ↑ Peter Schindler, Bavarian State Office for Health and Food Safety: Faecal contamination in drinking water . In: Post in the flight seminar: Water – reservoir of life. Current Questions about water supply and hygiene , March 2004, Environmental protection/faecalies
  4. ↑ ‘ Infections by enterohemorrhagic Escherichia coli (Ehec) . In: RKI: Epidemiological Bulletin 31/1999 » . Filed from the original March 2, 2011 . Retrieved on June 9, 2011 .
  5. ↑ https://web.archive.org/web/2010815194202/http://www.mosq-trap.net/fly-colletector/index-dateien/rfl07ub_foerster_wz.pdf
  6. ↑ Robert Koch Institute: Survstat, http://www3.rki.de/survstat Archived el 27 de Abril de 2015 en Wayback Machine., Data level: May 27, 2011
  7. ↑ EHEC epidemic in 1982 in the USA by infected Hamburgers [first]
  8. ↑ EHEC epidemia in 1996 in Japan and 2006 in the USA [2]
  9. ↑ Robert Koch Institute: Infection Sepidemiological Yearbook for 2009 (broken link available on the Internet Archive; see the record , the first version and the last ). , Berlin, 2010, S. 68–69.
  10. ↑ «News 20minutos.es Explanation of the crux crisis» . Filed from the original June 8, 2011 . Retrieved on June 11, 2011 .
  11. ↑ “Archive copy” . Filed from the original January 12, 2012 . Retrieved on June 11, 2011 .
  12. ↑ RKI guide for doctors: Diseases by Enterohemorrhagische Escherichia Coli (EHEC), version of January 2008 . Retrieved on May 29, 2011.
  13. ↑ a b Epidemiology and pathogenesis of infections with enterohemorrhagic Escherichia coli . Berliner and Munich veterinary weekly 122 (11/12). 2009. pp. 417-424. doi: 10.2376/0005-9366-122-417 .
  14. ↑ Clotilde LM, Bernard C 4th, Hartman GL, Lau DK, Carter JM: Microbead-based immunoassay for simultaneous detection of Shiga toxins and isolation of Escherichia coli O157 in foods. , J Food Prot. 2011 Mar;74(3):373-9, PMID 21375872
  15. ↑ KONDO F, Saito H, Hayashi R, onda H, Kobayashi S, Matsumoto M, SUZUKI M, Ito Y, OKA H, NAKANISHI T, SHIMIZU A: Identification of Shiga toxins in Shiga toxin-producing Escherichia coli using immunoprecipitation and high-performance liquid chromatography-electrospray ionization mass spectrometry. , Analyst. 2003 Nov; 128 (11): 1360-4, PMID 14700230
  16. ↑ Fagerquist CK, Sultan O.: Induction and identification of disulfide-intact and disulfide-reduced β-subunit of Shiga toxin 2 from Escherichia coli O157:H7 using MALDI-TOF-TOF-MS/MS and top-down proteomics. , Analyst. 2011 Apr 21;136(8):1739-46, PMID 21336382
  17. ↑ «Medical Center for Quality in Medicine: S1 guideline EHEC / HUS (as of June 1, 2011)» (pdf) . Accessed June 2, 2011 . (broken link available on the Internet Archive; see the record , the first version and the last ).
  18. ↑ a b Practical Gastroenterology, S. 359 F . Munich: Elsevier, Urban & Fischerverlag. 2008. ISBN 9783437233715 . Online: Escherichia coli enterohemorrágica In Google books
  19. ↑ Wolfgang F. Caspary, Manfred Kist, Jürgen Stein (2006). Infectiology of the gastrointestinal tract, p. 232 . Berlin, Heidelberg: Springer. ISBN 9783540413592 . Online: Escherichia coli enterohemorrágica In Google books
  20. ↑ a b The infectiology, p. 1032 f . Berlin, Heidelberg: Springer. 2003. ISBN 9783540000754 . Online: Escherichia coli enterohemorrágica In Google books
  21. ↑ Internal emergencies: Safe through the acute situation and the subsequent 48 hours, p.321 . Stuttgart: Georg Thieme Verlag. 2003. ISBN 9783135106076 . Online: Escherichia coli enterohemorrágica In Google books
  22. ↑ «RKI: hygiene measures in stationary patients with hemolytic-uremian syndrome (HUS) or bloody diarrhea by enterohemorrhagic Escherichia coli (EHEC)» . Filed from the original May 31, 2011 . Retrieved on May 28, 2011 .
  23. ↑ «Complement Blockade in Severe Shiga-Toxin–Associated HUS» (HTML) . May 2011 . Retrieved on May 27, 2011 .
  24. ↑ «Eculizumab for Congenital Atypical Hemolytic–Uremic Syndrome» (HTML) . January the 2009 . Retrieved on May 28, 2011 .
  25. ↑ «Efficacy of eculizumab in the treatment of recurrent atypical hemolytic-uremic syndrome after renal transplantation» (HTML) . April 2010 . Retrieved on May 30, 2011 .
  26. ↑ «Press release dated May 28, 2011: Uke currently cares for 64 patients who have developed HU syndrome » . Filed from the original February 18, 2015 . Consulted on March 10, 2018 .

Bibliography [ To edit ]

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external links [ To edit ]