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Article

Molecular Characterization of the Enterohemolysin Gene (ehxA) in Clinical Shiga Toxin-Producing Escherichia coli Isolates

1
Department of Microbiology, School of Public Health, Southern Medical University, Guangzhou 510515, China
2
Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, 141 52 Stockholm, Sweden
3
Molecular Epidemiology and Public Health Laboratory, School of Veterinary Sciences, Massey University, Palmerston North 4100, New Zealand
4
The Public Health Agency of Sweden, 171 82 Solna, Sweden
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Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, 141 86 Stockholm, Sweden
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Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
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Department of Pediatrics, Department of Pediatrics, Sahlgrenska Academy, Sahlgrenska Academy, University of Gothenburg, 416 85 Gothenburg, Sweden
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State 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, China
9
Laboratory Medicine, Jönköping Region County, Department of Clinical and Experimental Medicine, Linköping University, 551 85 Jönköping, Sweden
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Oslo University Hospital, 0372 Oslo, Norway
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Division of Laboratory Medicine, Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway
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Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, 141 86 Stockholm, Sweden
*
Authors to whom correspondence should be addressed.
Received: 15 December 2020 / Revised: 11 January 2021 / Accepted: 15 January 2021 / Published: 19 January 2021
Shiga toxin (Stx)-producing Escherichia coli (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 ehxA. Here we investigated the prevalence and diversity of ehxA in 239 STEC isolates from human clinical samples. In total, 199 out of 239 isolates (83.26%) were ehxA positive, and ehxA was significantly overrepresented in isolates carrying stx2a + stx2c (p < 0.001) and eae (p < 0.001). The presence of ehxA was significantly associated with BD and serotype O157:H7. Five ehxA subtypes were identified, among which, ehxA subtypes B, C, and F were overrepresented in eae-positive isolates. All O157:H7 isolates carried ehxA subtype B, which was related to BD and HUS. Three ehxA groups were observed in the phylogenetic analysis, namely, group Ⅰ (ehxA subtype A), group Ⅱ (ehxA subtype B, C, and F), and group Ⅲ (ehxA subtype D). Most BD- and HUS-associated isolates were clustered into ehxA group Ⅱ, while ehxA group Ⅰ was associated with non-bloody stool and individuals ≥10 years of age. The presence of ehxA + eae and ehxA + eae + stx2 was significantly associated with HUS and O157:H7 isolates. In summary, this study showed a high prevalence and the considerable genetic diversity of ehxA among clinical STEC isolates. The ehxA 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, ehxA, together with stx and eae, can be used as a risk predictor for HUS in STEC infections. View Full-Text
Keywords: Shiga toxin-producing Escherichia coli; enterohemolysin; ehxA; gene diversity; hemolytic uremic syndrome; clinical significance Shiga toxin-producing Escherichia coli; enterohemolysin; ehxA; gene diversity; hemolytic uremic syndrome; clinical significance
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MDPI and ACS Style

Hua, Y.; Zhang, J.; Jernberg, C.; Chromek, M.; Hansson, S.; Frykman, A.; Xiong, Y.; Wan, C.; Matussek, A.; Bai, X. Molecular Characterization of the Enterohemolysin Gene (ehxA) in Clinical Shiga Toxin-Producing Escherichia coli Isolates. Toxins 2021, 13, 71. https://0-doi-org.brum.beds.ac.uk/10.3390/toxins13010071

AMA Style

Hua Y, Zhang J, Jernberg C, Chromek M, Hansson S, Frykman A, Xiong Y, Wan C, Matussek A, Bai X. Molecular Characterization of the Enterohemolysin Gene (ehxA) in Clinical Shiga Toxin-Producing Escherichia coli Isolates. Toxins. 2021; 13(1):71. https://0-doi-org.brum.beds.ac.uk/10.3390/toxins13010071

Chicago/Turabian Style

Hua, Ying, Ji Zhang, Cecilia Jernberg, Milan Chromek, Sverker Hansson, Anne Frykman, Yanwen Xiong, Chengsong Wan, Andreas Matussek, and Xiangning Bai. 2021. "Molecular Characterization of the Enterohemolysin Gene (ehxA) in Clinical Shiga Toxin-Producing Escherichia coli Isolates" Toxins 13, no. 1: 71. https://0-doi-org.brum.beds.ac.uk/10.3390/toxins13010071

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