Published Date: 2010-08-31 12:00:05
Subject: PRO/AH/EDR> E. coli VTEC non-O157 - USA (07): O26, ground beef, alert, recall
Archive Number: 20100831.3097
E. COLI VTEC NON-O157 - USA (07): O26, GROUND BEEF, ALERT, RECALL
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Sat 28 Aug 2010
Source: CNN [edited]
Cargill Meat Solutions Corp. has recalled about 8500 pounds of ground
beef that may be contaminated with E. coli, the U.S. Department of
Agriculture announced Sat 28 Aug 2010. The move came after 3 people,
2 in Maine and 1 in New York, were identified as becoming ill from a
strain of _E. coli_, the government said.
None of the 3 required hospitalization, said Cargill Inc. spokesman
The USDA says it believes certain BJ's Wholesale Club stores in
Connecticut, Maine, Maryland, Massachusetts, New Hampshire, New
Jersey, New York and Virginia received the products. The recalled
ground beef was shipped on 11 Jun 2010 to distribution centers, where
it was repackaged into consumer-size packages and sold under different
retail brand names. The USDA did not identify the brands.
The recalled beef bears the USDA establishment number "EST. 9400," a
product code of "W69032" and a "use/freeze by" date of 1 Jul 2010.
The USDA's Food Safety and Inspection Services, which said it became
aware of the problem on 5 Aug 2010, "determined that there is an
association between the ground beef products subject to recall and the
cluster of illnesses in the states of Maine and New York."
Saturday's statement identified the strain as _E. coli_ 026, which can
cause bloody diarrhea, dehydration and, in severe cases, kidney failure.
The government "strongly encourages consumers to check their freezers
and immediately discard any product subject to this recall."
The government lists the recall as Class 1, meaning "there is a
reasonable probability that the use of the product will cause serious,
adverse health consequences or death."
ProMED-mail Rapporteur Brent Barrett
This outbreak once again underscores the relevance of non-O157 strains
of verotoxin-producing _E. coli_. Other _E. coli_ serogroups that have
been associated with VTEC (verotoxin-producing _E. coli_) disease
include motile ones such as O26:H11 and O104:H21 and non-motile ones
such as O111:NM (or H-). Such non-O157 isolates can be obtained from
sheep and cattle and, although they cause as many as 30 percent of
outbreaks of VTEC (1), appear to be somewhat less (or at least more
variably) virulent in a variety of in vivo and in vitro assays (2-4).
In analyzing the genetic and phenotypic profiles of non-O157 groups,
it has been found that they belong to their own lineages and have
unique profiles of virulence traits different from O157 (5). The
serogroups appearing to be most prominent are O26, O111, O128, and
O103 (6), the former serotype being the implicated strain in this
If a laboratory is using sorbitol-MacConkey (sMAC) plates to identify
VTEC by virtue of O157's inability to ferment sorbitol, the non-O157
strains will be missed. In a 3-year pediatric study from the
University of Washington, USA (7), 1851 stool samples were processed
for sorbitol fermentation as well as toxin production by EIA (enzyme
immunoassay), and 28 strains of O157 were found along with O103 (4
strains), O118 (2 strains), O111 (2 strains), and 3 other strains.
Clinically, the O157 infections had a higher frequency of bloody
stools, fecal leukocytes, and abdominal pain with shorter symptom
duration. Five (18 percent) of O157 infections developed HUS; none of
the non-O157 strains did. Since toxin assay did not identify all O157
strains found on sMAC plates, the investigators did not advocate
performing toxin assay alone. Non-O157 can produce hemolytic-uremic
syndrome, as demonstrated by a cluster of O121 cases associated with a
lake in Connecticut, USA (8).
Since toxin assays are not uniformly performed in many areas, and most
cases do not produce HUS, it is likely that cases due to non-O157
strains are being missed. How frequent this phenomenon will become
over time is unclear.
Because of the higher risk of morbidity and mortality in VTEC
infections treated with antimicrobials (9), antimicrobials should not
used for known acute cases.
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verotoxin-producing _Escherichia coli_. Exp Biol Med 2003; 228(4):
331-2; available at
2. Blanco J, Blanco M, Blanco JE, et al: Verotoxin-producing
_Escherichia coli_ in Spain: prevalence, serotypes, and virulence
genes of O157:H7 and non-O157 VTEC in ruminants, raw beef products,
and humans. Exp Biol Med 2003; 228: 345-51; available at
3. Law D, Kelly J: Use of heme and hemoglobin by _Escherichia coli_
O157 and other Shiga-toxin-producing _E. coli_ serogroups. Infect
Immun 1995; 63(20): 700-2; available at
4. Tzipori S, Wachsmuth KI, Smithers J, Jackson C: Studies in
gnotobiotic piglets on non-O157:H7 _Escherichia coli_ serotypes
isolated from patients with hemorrhagic colitis. Gastroenterology
1988; 94(3): 590-7; abstract available at
5. Schmidt H, Geitz C, Tarr PI, et al: Non-O157:H7 pathogenic
Shiga-toxin producing _Escherichia coli_: phenotypic and genetic
profiling of virulence traits and evidence for clonality. J Infect Dis
1999; 179(1): 115-23; available at
6. Bettelheim KA: Role of non-O157 VTEC. Symp Ser Soc Appl Microbiol
2000; (29): 38S-50S; abstract available at
7. Klein EJ, Stapp JR, Calusen CR, et al: Shiga toxin-producing
_Escherichia coli_ in children with diarrhea: a prospective
point-of-care study. J Pediatr 2002; 141(2): 172-7; available at
8. McCarthy TA, Barrett NL, Hadler JL, et al: Hemolytic-uremic
syndrome and _Escherichia coli_ O121 at a lake in Connecticut, 1999.
Pediatrics 2001; 108(4): E59; available at
9. Iijima K, Kamioka I, Nozu K: Management of diarrhea-associated
hemolytic uremic syndrome in children. Clin Exp Nephrol 2008; 12(1):
16-9; abstract available at
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