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Open Access Highly Accessed Review

O157:H7 and O104:H4 Vero/Shiga toxin-producing Escherichia coli outbreaks: respective role of cattle and humans

Denis Piérard1, Henri De Greve23, Freddy Haesebrouck4 and Jacques Mainil5*

Author Affiliations

1 National Reference Center for Verotoxin/Shiga toxin producing E.coli, Department Microbiology and Infection Control, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium

2 Structural & Molecular Microbiology, Department of Structural Biology, VIB, Brussels, Belgium

3 Structural Biology Brussels, Vrije Universiteit Brussel, B-1050 Brussels, Belgium

4 Department of Pathology, Bacteriology and Avian Diseases, Faculty of Veterinary Medicine, Ghent University, B-9820 Merelbeke, Belgium

5 Bacteriology, Department of Infectious Diseases, Faculty of Veterinary Medicine, University of Liège, B-4000 Liège, Belgium

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Veterinary Research 2012, 43:13  doi:10.1186/1297-9716-43-13

Published: 13 February 2012

Abstract

An enteroaggregative Verotoxin (Vtx)-producing Escherichia coli strain of serotype O104:H4 has recently been associated with an outbreak of haemolytic-uremic syndrome and bloody diarrhoea in humans mainly in Germany, but also in 14 other European countries, USA and Canada. This O104:H4 E. coli strain has often been described as an enterohaemorrhagic E. coli (EHEC), i.e. a Vtx-producing E. coli with attaching and effacing properties. Although both EHEC and the German O104:H4 E. coli strains indeed produce Vtx, they nevertheless differ in several other virulence traits, as well as in epidemiological characteristics. For instance, the primary sources and vehicles of typical EHEC infections in humans are ruminants, whereas no animal reservoir has been identified for enteroaggregative E. coli (EAggEC). The present article is introduced by a brief overview of the main characteristics of Vtx-producing E. coli and EAggEC. Thereafter, the O104:H4 E. coli outbreak is compared to typical EHEC outbreaks and the virulence factors and host specificity of EHEC and EAggEC are discussed. Finally, a renewed nomenclature of Vtx-producing E. coli is proposed to avoid more confusion in communication during future outbreaks and to replace the acronym EHEC that only refers to a clinical condition.