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Following infection with certain strains of Shiga toxin-producing bacteria, particularly Shigella dysenteriae serotype 1 and enterohaemorrhagic Escherichia coli (EHEC), patients are at elevated risk for developing life-threatening extraintestinal complications such as acute renal failure. Hence, these bacteria represent a public health concern in both developed and developing countries. Shiga toxins (Stxs) expressed by EHEC are highly cytotoxic class II ribosome-inactivating proteins and primary virulence factors responsible for major clinical signs of Stx-mediated pathogenesis, including bloody diarrhea, hemolytic uremic syndrome (HUS), and neurological complications. Ruminant animals are thought to serve as critical environmental reservoirs of Shiga toxin-producing Escherichia coli (STEC), but other emerging or arising reservoirs of the toxin-producing bacteria have been overlooked. Here, we summarize recent findings about reservoirs of STEC and review outbreaks of these bacteria both within and outside the United States. A better understanding of environmental transmission to humans will facilitate the development of novel strategies for preventing zoonotic EHEC infection.
Kim et al. (Thu,) studied this question.