Molecular Characterization of the Enterohemolysin Gene (<i>ehxA</i>) in Clinical Shiga-Toxin-Producing <i>Escherichia coli</i> Isolates
Shiga toxin (Stx)-producing <i>Escherichia coli</i> (STEC) is an important foodborne pathogen with the ability to cause bloody diarrhea (BD) and hemolytic uremic syndrome (HUS). Little is known about enterohemolysin-encoded by <i>ehxA</i>. Here we investigated the prevalence...
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doaj-5bc2371b201743fc82dd6589894a61a12021-01-20T00:02:27ZengMDPI AGToxins2072-66512021-01-0113717110.3390/toxins13010071Molecular Characterization of the Enterohemolysin Gene (<i>ehxA</i>) in Clinical Shiga-Toxin-Producing <i>Escherichia coli</i> IsolatesYing Hua0Ji Zhang1Cecilia Jernberg2Milan Chromek3Sverker Hansson4Anne Frykman5Yanwen Xiong6Chengsong Wan7Andreas Matussek8Xiangning Bai9Department of Microbiology, School of Public Health, Southern Medical University, Guangzhou 510515, ChinaMolecular Epidemiology and Public Health Laboratory, School of Veterinary Sciences, Massey University, Palmerston North 4100, New ZealandThe Public Health Agency of Sweden, 171 82 Solna, SwedenDivision of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, 141 86 Stockholm, SwedenQueen Silvia Children’s Hospital, Sahlgrenska University Hospital, 413 45 Gothenburg, SwedenQueen Silvia Children’s Hospital, Sahlgrenska University Hospital, 413 45 Gothenburg, SwedenState Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, ChinaDepartment of Microbiology, School of Public Health, Southern Medical University, Guangzhou 510515, ChinaDepartment of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, 141 52 Stockholm, SwedenState Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, ChinaShiga toxin (Stx)-producing <i>Escherichia coli</i> (STEC) is an important foodborne pathogen with the ability to cause bloody diarrhea (BD) and hemolytic uremic syndrome (HUS). Little is known about enterohemolysin-encoded by <i>ehxA</i>. Here we investigated the prevalence and diversity of <i>ehxA</i> in 239 STEC isolates from human clinical samples. In total, 199 out of 239 isolates (83.26%) were <i>ehxA</i> positive, and <i>ehxA</i> was significantly overrepresented in isolates carrying <i>stx</i><sub>2a</sub> + <i>stx</i><sub>2c</sub> (<i>p</i> < 0.001) and <i>eae</i> (<i>p</i> < 0.001). The presence of <i>ehxA</i> was significantly associated with BD and serotype O157:H7. Five <i>ehxA</i> subtypes were identified, among which, <i>ehxA</i> subtypes B, C, and F were overrepresented in <i>eae</i>-positive isolates. All O157:H7 isolates carried <i>ehxA</i> subtype B, which was related to BD and HUS. Three <i>ehxA</i> groups were observed in the phylogenetic analysis, namely, group Ⅰ (<i>ehxA</i> subtype A), group Ⅱ (<i>ehxA</i> subtype B, C, and F), and group Ⅲ (<i>ehxA</i> subtype D). Most BD- and HUS-associated isolates were clustered into <i>ehxA</i> group Ⅱ, while <i>ehxA</i> group Ⅰ was associated with non-bloody stool and individuals ≥10 years of age. The presence of <i>ehxA</i> + <i>eae</i> and <i>ehxA</i> + <i>eae + stx</i><sub>2</sub> was significantly associated with HUS and O157:H7 isolates. In summary, this study showed a high prevalence and the considerable genetic diversity of <i>ehxA</i> among clinical STEC isolates. The <i>ehxA</i> genotypes (subtype B and phylogenetic group Ⅱ) could be used as risk predictors, as they were associated with severe clinical symptoms, such as BD and HUS. Furthermore, <i>ehxA</i>, together with <i>stx</i> and <i>eae,</i> can be used as a risk predictor for HUS in STEC infections.https://www.mdpi.com/2072-6651/13/1/71Shiga-toxin-producing <i>Escherichia coli</i>enterohemolysin<i>ehxA</i>gene diversityhemolytic uremic syndromeclinical significance |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ying Hua Ji Zhang Cecilia Jernberg Milan Chromek Sverker Hansson Anne Frykman Yanwen Xiong Chengsong Wan Andreas Matussek Xiangning Bai |
spellingShingle |
Ying Hua Ji Zhang Cecilia Jernberg Milan Chromek Sverker Hansson Anne Frykman Yanwen Xiong Chengsong Wan Andreas Matussek Xiangning Bai Molecular Characterization of the Enterohemolysin Gene (<i>ehxA</i>) in Clinical Shiga-Toxin-Producing <i>Escherichia coli</i> Isolates Toxins Shiga-toxin-producing <i>Escherichia coli</i> enterohemolysin <i>ehxA</i> gene diversity hemolytic uremic syndrome clinical significance |
author_facet |
Ying Hua Ji Zhang Cecilia Jernberg Milan Chromek Sverker Hansson Anne Frykman Yanwen Xiong Chengsong Wan Andreas Matussek Xiangning Bai |
author_sort |
Ying Hua |
title |
Molecular Characterization of the Enterohemolysin Gene (<i>ehxA</i>) in Clinical Shiga-Toxin-Producing <i>Escherichia coli</i> Isolates |
title_short |
Molecular Characterization of the Enterohemolysin Gene (<i>ehxA</i>) in Clinical Shiga-Toxin-Producing <i>Escherichia coli</i> Isolates |
title_full |
Molecular Characterization of the Enterohemolysin Gene (<i>ehxA</i>) in Clinical Shiga-Toxin-Producing <i>Escherichia coli</i> Isolates |
title_fullStr |
Molecular Characterization of the Enterohemolysin Gene (<i>ehxA</i>) in Clinical Shiga-Toxin-Producing <i>Escherichia coli</i> Isolates |
title_full_unstemmed |
Molecular Characterization of the Enterohemolysin Gene (<i>ehxA</i>) in Clinical Shiga-Toxin-Producing <i>Escherichia coli</i> Isolates |
title_sort |
molecular characterization of the enterohemolysin gene (<i>ehxa</i>) in clinical shiga-toxin-producing <i>escherichia coli</i> isolates |
publisher |
MDPI AG |
series |
Toxins |
issn |
2072-6651 |
publishDate |
2021-01-01 |
description |
Shiga toxin (Stx)-producing <i>Escherichia coli</i> (STEC) is an important foodborne pathogen with the ability to cause bloody diarrhea (BD) and hemolytic uremic syndrome (HUS). Little is known about enterohemolysin-encoded by <i>ehxA</i>. Here we investigated the prevalence and diversity of <i>ehxA</i> in 239 STEC isolates from human clinical samples. In total, 199 out of 239 isolates (83.26%) were <i>ehxA</i> positive, and <i>ehxA</i> was significantly overrepresented in isolates carrying <i>stx</i><sub>2a</sub> + <i>stx</i><sub>2c</sub> (<i>p</i> < 0.001) and <i>eae</i> (<i>p</i> < 0.001). The presence of <i>ehxA</i> was significantly associated with BD and serotype O157:H7. Five <i>ehxA</i> subtypes were identified, among which, <i>ehxA</i> subtypes B, C, and F were overrepresented in <i>eae</i>-positive isolates. All O157:H7 isolates carried <i>ehxA</i> subtype B, which was related to BD and HUS. Three <i>ehxA</i> groups were observed in the phylogenetic analysis, namely, group Ⅰ (<i>ehxA</i> subtype A), group Ⅱ (<i>ehxA</i> subtype B, C, and F), and group Ⅲ (<i>ehxA</i> subtype D). Most BD- and HUS-associated isolates were clustered into <i>ehxA</i> group Ⅱ, while <i>ehxA</i> group Ⅰ was associated with non-bloody stool and individuals ≥10 years of age. The presence of <i>ehxA</i> + <i>eae</i> and <i>ehxA</i> + <i>eae + stx</i><sub>2</sub> was significantly associated with HUS and O157:H7 isolates. In summary, this study showed a high prevalence and the considerable genetic diversity of <i>ehxA</i> among clinical STEC isolates. The <i>ehxA</i> genotypes (subtype B and phylogenetic group Ⅱ) could be used as risk predictors, as they were associated with severe clinical symptoms, such as BD and HUS. Furthermore, <i>ehxA</i>, together with <i>stx</i> and <i>eae,</i> can be used as a risk predictor for HUS in STEC infections. |
topic |
Shiga-toxin-producing <i>Escherichia coli</i> enterohemolysin <i>ehxA</i> gene diversity hemolytic uremic syndrome clinical significance |
url |
https://www.mdpi.com/2072-6651/13/1/71 |
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