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Escherichia coli O104:H4

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Escherichia coli O104:H4

Escherichia coli O104:H4 is an enteroaggregative strain of the bacterium Escherichia coli, and the cause of the 2011 Escherichia coli O104:H4 outbreak.[1] The "O" in the serological classification identifies the cell wall lipopolysaccharide antigen, and the "H" identifies the flagella antigen.

Analysis of genomic sequences obtained by BGI Shenzhen show that the O104:H4 outbreak strain is an enteroaggregative E. coli (EAEC or EAggEC) type that has acquired Shiga toxin genes, presumably by horizontal gene transfer.[2][3][4] Genome assembly and copy number analysis both confirmed that two copies of the Shiga toxin stx2 prophage gene cluster are a distinctive characteristic of the genome of the O104:H4 outbreak strain.[5][6] The O104:H4 strain is characterized by the following genetic markers:[6][7]

  • Shiga toxin stx2 positive,
  • terE positive (tellurite resistance gene cluster),
  • eae negative (intimin adherence gene),
  • β-lactamases ampC, ampD, ampE, ampG, ampH are present.

The European Commission (EC) integrated approach to food safety[8] defines a case of Shiga-like toxin producing E. coli (STEC) diarrhea caused by O104:H4 by an acute onset of diarrhea or bloody diarrhea together with the detection of the Shiga toxin 2 (Stx2) or the Shiga gene stx2.[9] Prior to the 2011 outbreak, only one case identified as O104:H4 had been observed, in a woman in South Korea in 2005.[10]


  • Pathophysiology 1
  • Infection 2
  • Treatment 3
  • Prevention 4
  • References 5


E. coli O104 is a shiga toxin–producing E. coli (STEC). The toxins are what causes illness and the associated symptoms. The method of how these toxins cause illness is sticking to the intestinal cells and aggravating the cells along the intestinal wall.[11][12] This in turn can cause bloody stools to occur. Another effect that can come from this bacteria is Hemolytic Uremic Syndrome (HUS), which is a condition characterized by destruction of red blood cells, that over a long period of time can cause kidney failure.[13]Some common symptoms of HUS are vomiting, bloody diarrhea, and blood in the urine.[12]


A common mode of E. coli O104:H4 infection involves ingestion of fecally contaminated food; the disease can thus be considered a foodborne illness. Most recently in 2011, there was an outbreak of the E. Coli O104:H4 strain in Germany that caused the death of several people, and landed hundreds of citizens in hospital.[14][15][12] The infection was traced back to foenugreek sprouts grown from contaminated seeds imported from Egypt.


To diagnose infection with STEC, a patient's stool (feces) can be tested in a laboratory for the presence of Stx2 (Shiga toxin). Testing methods used include direct detection of the toxin by immunoassay, or detection of the stx2 gene or other virulence-factor genes by PCR. If infection with STEC is confirmed, the E. coli strain may be serotyped to determine whether O104:H4 is present.[11]

E. coli O104:H4 is difficult to treat as it is resistant to many antibiotics, although it is susceptible to carbapenems.[14]


Spread of E. coli is prevented simply by thorough hand-washing with soap, washing and hygienically preparing food, and properly heating/cooking food, so that bacteria are destroyed.[16] The German outbreak was traced to faecal contamination of Egyptian fenugreek seeds which were sprouted then used as a salad garnish.


  1. ^ Mellman, Alexander; Harmsen, D; Cummings, CA et al. (July 20, 2011). "Prospective genomic characterization of the German enterohemorrhagic Escherichia coli O104:H4 outbreak by rapid next generation sequencing technology".  
  2. ^ in Germany and Reveals New Super-Toxic Strain"E. coli"BGI Sequences Genome of the Deadly .  
  3. ^ David Tribe (2011-06-02). "BGI Sequencing news: German EHEC strain is a chimera created by horizontal gene transfer".  
  4. ^ Maev Kennedy and agencies (2011-06-02). outbreak: WHO says bacterium is a new strain"E. coli". London: Retrieved 2011-06-04. 
  5. ^ (STpEAEC)"Escherichia coli O104 genome and attributed the strain as a category of Shiga toxin-producing enteroaggregative E. coli"BGI releases the complete map of the Germany .  
  6. ^ a b EHEC O104:H4"E. coli"Copy number analysis of German outbreak strain .  
  7. ^ "Characterization of EHEC O104:H4".  
  8. ^ "The EU integrated approach to food safety". 
  9. ^ "Case Definition for diarrhoea and haemolytic uremic syndrome caused by O104:H4".  
  10. ^ Bae, WK; Lee, YK; Cho, MS et al. (June 30, 2006). O104:H4"Escherichia coli"A case of haemolytic uremic syndrome caused by . Yonsei Medical Journal 47 (3): 473–479.  
  11. ^ a b Frank, C; Werber, D; Cramer, JP et al. (October 26, 2011). "Epidemic profile of Shiga-toxin–producing Escherichia coli O104:H4 outbreak in Germany.". New England Journal of Medicine 365: 1771–1780.  
  12. ^ a b c Reinberg, Steven. "German E. Coli Strain Especially Lethal - Infectious Diseases: Causes, Types, Prevention, Treatment and Facts on" MedicineNet Inc, 22 June 2011. Web. 08 Nov. 2011. .
  13. ^ European Food Safety Authority. "Shiga Toxin-producing E. Coli (STEC) O104:H4 2011 Outbreaks in Europe:." EFSA Journal. European Food Safety Authority, 3 Nov. 2011. Web. 08 Nov. 2011. .
  14. ^ a b Gorman, Christine. "E. Coli on the March: Scientific American." Science News, Articles and Information | Scientific American. Scientific American, 7 Aug. 2011. Web. 08 Nov. 2011. .
  15. ^ "July 8, 2011: Outbreak of Shiga Toxin-producing E. Coli O104 (STEC O104:H4) Infections Associated with Travel to Germany | E. Coli." Centers for Disease Control and Prevention. Center for Disease Control and Prevention, 8 July 2011. Web. 08 Nov. 2011. .
  16. ^ "CDC - Escherichia coli O157:H7, General Information - NCZVED." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 8 July 201. Web. 08 Nov. 2011.
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