Origins of the E. coli Strain Causing an Outbreak of Hemolytic–Uremic Syndrome in Germany

The authors sequenced the genome of an isolate of the E. coli strain causing the outbreak of bloody diarrhea and the hemolytic–uremic syndrome (HUS) in Germany. This genome differed from those of other O104:H4 enteroaggregative E. coli known to cause diarrhea but not HUS. In early May 2011, an outbreak of diarrhea with associated hemolytic–uremic syndrome began in northern Germany; cases have subsequently been reported in 15 other countries. As of July 22, a total of 3167 cases of non–hemolytic–uremic syndrome Shiga-toxin–producing Escherichia coli (16 deaths) and 908 cases of hemolytic–uremic syndrome (34 deaths) have been reported, according to the German Protection against Infection Act. Several groups reported that the outbreak was caused by a Shiga-toxin–producing E. coli strain belonging to serotype O104:H4, with virulence features that are common to the enteroaggregative E. coli pathotype. 1 – 3 This unusual E. coli serotype has previously been . . .