Hemolytic Uremic Syndrome Outbreak in Adults and Shiga Toxin–Producing Escherichia coli Negative for Locus of Enterocyte Effacement, France, 2025
Justine de Larminat, Kevin La, Philippe Bidet, André Birgy, Sandrine Liguori, Pierre Phlipaux, Celine Courroux, Florence Crombé, Jorge Blanco, Paul Coppo, Antoine Dossier, Laurence Armand-Lefevre, François Xavier Weill, Carolina Silva Nodari, Gabrielle Jones, Aurelie Cointe, and Stéphane Bonacorsi
Author affiliation: Escherichia coli National Reference Center, Robert-Debré University Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France (J. de Larminat, K. La, P. Bidet, A. Birgy, S. Liguori, P. Phlipaux, C. Courroux, A. Cointe, S. Bonacorsi); Infection, Antimicrobien, Modélisation, Évolution, INSERM, Université Paris Cité, Paris (J. de Larminat, K. La, P. Bidet, A. Birgy, L. Armand-Lefevre, A. Cointe, S. Bonacorsi); Universitair Ziekenhuis Brussel, Brussels, Belgium (F. Crombé); Vrije Universiteit Brussel–Campus Jette, Brussels (F. Crombé); University of Santiago de Compostela, Lugo, Spain (J. Blanco); Hôpital Saint-Antoine, Paris (P. Coppo); Sorbonne Université, Paris (P. Coppo); Hôpital Bichat–Claude-Bernard, APHP, Paris (A. Dossier, L. Armand-Lefevre); Université Paris Diderot UFR de Médecine Site Xavier-Bichat, Paris (L. Armand-Lefevre); Institut Pasteur, Université Paris Cité, Paris (F.X. Weill, C. Silva Nodari); Santé Publique France, Saint-Maurice, France (G. Jones)
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Figure 5
Figure 5. Quadruplex PCR results from study of hemolytic uremic syndrome outbreak in adults and Shiga toxin–producing Escherichia coli negative for locus of enterocyte effacement, France, 2025. We performed quadruplex PCR on fecal extracts targeting 2 chromosomic genes: O77 g (wzy) (609-bp) and neuS K92 (247-bp), and 2 loci on the 134 kb plasmid: elt (163-bp) and the phytase-tpx region (285-bp). Wells 1 to 4, fecal samples (stx2+ but culture negative) positive for both chromosomal and plasmid targets (P+) defining probable cases. Well 5, fecal samples positive only for chromosomal targets defining possible case. Well 6, fecal specimen from patient with isolate CNREC-004–43, which had lost its 134kb plasmid probably in vivo. Well 7, specimen from patient with isolate CNREC-004-49, showing plasmid target signals absent in the corresponding isolate DNA, suggesting partial plasmid loss in vitro (Figure 3). Wells 8–10, fecal extracts from patients with outbreak isolates harboring the complete 134kb plasmid (CNREC-004-17, -33 and -50). Well 11, negative control.
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