Biological Sciences
E Coli
E. coli, short for Escherichia coli, is a type of bacteria commonly found in the intestines of humans and animals. While most strains are harmless, some can cause illness, such as diarrhea and urinary tract infections. E. coli is also widely used in biological research and biotechnology due to its well-studied genetics and ease of manipulation.
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eBook - PDFE. Coli Infections
Importance of Early Diagnosis and Efficient Treatment
- Luis Rodrigo(Author)
- 2020(Publication Date)
- IntechOpen(Publisher)
2. What is Escherichia coli ( E. coli )? • Escherichia coli are gram-negative bacilli of the family Enterobacteriaceae . • E. coli is commonly found in the lower intestine of warm-blooded organisms. • E. coli is the most common human and animal pathogens as it is responsible for a broad spectrum of diseases. • There are many different types (strains) of E. coli which cause a number of ill-nesses. Virulence types of E. coli include enterotoxigenic (ETEC), enteroinvasive (EIEC), enteropathogenic (EPEC), and enterohemorrhagic E. coli (EHEC) [15]. 3. History In 1982, Riley LW et al. and colleagues were the first to recognize the EHEC sero-type O157:H7 as a human pathogen associated with outbreaks of bloody diarrhea in Oregon and Michigan, USA [16]. Since then, E. coli O157:H7 has become one of the most important foodborne pathogens. 4. Symptoms and mode of transmission Virulent strains of Escherichia coli are responsible for most diarrheal infections, meningitis, septicemia, and urinary tract infections in children worldwide. A person who is infected with E. coli O157 can pass it on to other people if there is a situation of insufficient hygiene or handwashing. Small children can still pass the infection on for a couple of weeks after they have recovered from any illness. 5 Fast Detection of Pathogenic Escherichia coli from Chicken Meats DOI: http://dx.doi.org/10.5772/intechopen.91437 On the basis of World Health Organization report, the most important symptoms and mode of transmission of Escherichia coli are represented in the diagram ( Figure 1 ). 5. Immunosensor conception 5.1 Working electrodes Interdigitated microelectrodes were provided by the Microelectronics Institute of Barcelona, National Microelectronics Centre (IMB-CNM), Spain. The different steps of the fabrication of the gold interdigitated electrodes were extensively char-acterized as described in Ref. [17]. The electrode consists in 3 mm × 3 mm square Figure 1.
- Dongyou Liu(Author)
- 2014(Publication Date)
- CRC Press(Publisher)
coli and on which food-stuff, water, or facilities should be surveyed to improve food safety measures. 30.2 CLASSIFICATION AND MORPHOLOGY E. coli (obsolete synonym: Bacillus coli communis [Escherich 1885]) is one of the six species in the genus Escherichia that includes E. adecarboxylata , E. blattae , E. coli , E. ferguso-nii , E. hermannii , and E. vulneris . Named after Theodor Escherich (the person who first discovered this bacterium), the genus Escherichia is classified taxonomically in the fam-ily Enterobacteriaceae (consisting of Gram-negative bacteria that are motile via peritrichous flagella, grow well at 37°C, are oxidase negative and catalase positive, and reduce nitrates), order Enterobacteriales (rod-shaped facultatively anaero-bic Gram-negative bacteria), class Gammaproteobacteria (facultatively anaerobic Gram-negative bacteria), phylum Proteobacteria (Gram-negative bacteria with an outer mem-brane composed primarily of lipopolysaccharides), and domain Bacteria. Of the six Escherichia species, E. coli is the most fre-quently isolated and the best understood and characterized living organism. As Gram-negative, rod-shaped, and non-spore-forming bacilli, E. coli cells are about 2 μ m in length and 0.5 μ m in diameter. It is a facultative anaerobe, capable of reducing nitrates to nitrites, and produces acid and gas when growing fermentatively on glucose or other carbohy-drates. Most strains are oxidase, citrate, urease, and hydro-gen sulfide negative. They are positive for indole production and the methyl red test and can be differentiated from the closely related Shigella and Salmonella by its ability to fer-ment lactose. 6 30.3 BIOLOGY AND EPIDEMIOLOGY Members of E. coli are common inhabitants of the lower intestinal tract of humans and other vertebrates, where they often represent the most abundant facultative anaerobes. In fact, healthy humans typically carry more than a billion E.
- Carlton L. Gyles, John F. Prescott, J. Glenn Songer, Charles O. Thoen(Authors)
- 2008(Publication Date)
- Wiley-Blackwell(Publisher)
16 Escherichia coli C. L. Gyles and J. M. Fairbrother Escherichia coli is a gram-negative, fermentative, rod-shaped bacterium that grows readily on simple bacteriologic media, including MacConkey agar, on which it forms large red colonies. Other features that are helpful in its identification include a posi- tive indole reaction, negative tests for production of urease and hydrogen sulfide, and failure to utilize citrate as the sole carbon source. Although vastly outnumbered by anaerobic bacteria, E. coli is the major facultatively anaerobic organism in the intestinal tract of most animal species and is typi- cally present at 10 7 to 10 9 organisms per gram in feces. E. coli is usually the dominant organism recovered on aerobic culture of feces, but pet birds appear to be an exception as E. coli are recovered from only a low percentage of healthy pet birds (Glunder 2002) The sterile intestinal tracts of newborn animals quickly become contaminated with bacteria from the dam and the environment. E. coli rapidly becomes established in the intestine and remains as a part of the normal flora throughout the life of the animal. The concentration of E. coli is low in the upper small intestine but it increases progressively, with the max- imum concentration in the large intestine. The vast majority of E. coli in the normal flora are nonpatho- genic, but Shiga toxin-producing E. coli (STEC) in the normal flora of cattle and other ruminants may be highly pathogenic for humans. In most E. coli dis- eases, pathogenicity is associated with virulence genes encoded by plasmids, bacteriophages, or path- ogenicity islands (PAI). These genes include the plasmid-encoded genes for enterotoxins and fimbriae or pili, the phage-encoded genes for Shiga toxins (Stx), and the PAI-encoded genes for the attaching and effacing (AE) lesion in enteropathogenic E. coli (EPEC) and enterohemorrhagic E. coli (EHEC) as well as the pap, hly, and cnf1 genes in uropathogenic E.
eBook - ePub- Dongyou Liu(Author)
- 2018(Publication Date)
- CRC Press(Publisher)
30 Escherichia Marta Rivas, Elizabeth Miliwebsky, Beatriz D’Astek, and Luis PianciolaContents 30.1Introduction 30.2Classification 30.3Life Cycle 30.4Epidemiology30.1Introduction30.5Enteropathogenic E. coli30.5.1Epidemiology 30.5.2Clinical Features 30.5.3Pathogenesis 30.5.4Diagnosis 30.5.5Treatment 30.5.6Prevention30.6Shiga Toxin-Producing E. coli30.6.1Epidemiology 30.6.2Clinical Features 30.6.3Pathogenesis 30.6.4Diagnosis 30.6.5Treatment 30.6.6Prevention30.7Enteroaggregative E. coli30.7.1Epidemiology 30.7.2Clinical Features 30.7.3Pathogenesis 30.7.4Diagnosis 30.7.5Treatment 30.7.6Prevention30.8Enterotoxigenic E. coli30.8.1Epidemiology 30.8.2Clinical Features 30.8.3Pathogenesis 30.8.4Diagnosis 30.8.5Treatment 30.8.6Prevention30.9Enteroinvasive E. coli30.9.1Epidemiology 30.9.2Clinical Features 30.9.3Pathogenesis 30.9.4Diagnosis 30.9.5Treatment 30.9.6Prevention 30.10Conclusion and Future Perspectives ReferencesThe genus Escherichia is a member of the family Enterobacteriaceae ,1 and the species Escherichia coli as part of this genus, is widely distributed in nature. It was first described in 1885 by the German pediatrician Theodore von Escherich, who called it Bacterium coli .2 The taxonomical name of Escherichia coli was later adopted to honor its discoverer.30.2ClassificationEscherichia coli is a gram-negative, oxidase-negative, rod-shaped, facultative anaerobic bacillus with both fermentative and respiratory metabolisms, nonmotile or motile by peritrichous flagella. It is a major inhabitant of the large intestine of both humans and warm-blooded animals, and as part of the commensal microflora, maintains the physiological health of the host. Colonization begins at birth, but maturation of the microflora is a continuous process lasting for several years, and E. coli is one of the first facultative organisms to colonize the human gut.3 It is estimated that 1%–4% of all cultivable bacteria of the colon are E. coli bacteria, and up to 1010 CFU/g of feces can be detected.4
eBook - ePub- Marianne D. Miliotis, Jeffrey W. Bier(Authors)
- 2003(Publication Date)
- CRC Press(Publisher)
The epidemiology of microbial foodborne diseases has changed over the last 10 years. This is due not only to an increase in susceptibility of the human population to diseases or changes in lifestyles, including more adventurous eating, more convenience foods, and less time devoted to food preparation, but also to the emergence of newly recognized foodborne pathogens (Keskimäki et al., 1998). The gastrointestinal tract is an easy target for different pathogens that are ingested with food, and this is the principal reason why bowel infections are among the most common human infectious diseases.Escherichia coli is just one of many bacteria that can cause diarrhea. The association between E. coli and intestinal infections was suspected by Escherich in 1885, when the bacteria were first identified. It was not until 1945, however, that Bray and other researchers demonstrated its involvement in gastroenteritis. E. coli associated with enteric diarrheal disease includes strains of many different serotypes, categorized into five major groups according to their virulence mechanisms: enteropathogenic (EPEC), enterotoxigenic (ETEC), enteroinvasive (EIEC), enterohemorrhagic (EHEC), and enteroaggregative (EAEC). Other strains, namely diffusely adherent E. coli (DAEC), are less well established as pathogens (Giron et al., 1991; Nataro and Kaper, 1998).II. CHARACTERISTICS
E. coli belongs to the Enterobacteriaceae family. It is a short gram-negative, non–spore-forming, usually with flagellae that are peritrichous, and fimbriate bacillus. A capsule or microcapsule is often present. E. coli is the main facultative anaerobe in the large intestine. This bacteria colonizes the gastrointestinal tract during the first hours of life. The function of E. coli as part of intestinal flora has been linked to nutrition as a source of vitamins. Although regarded as part of the flora of the human intestinal tract, several highly adapted E. coli
eBook - ePub- Ronald G. Labbé, Santos García, Ronald G. Labbé, Santos García(Authors)
- 2013(Publication Date)
- Wiley-Blackwell(Publisher)
Escherichia coli Peter Feng U.S. Food and Drug Administration, College Park, Maryland, USA14.1 Introduction
Escherichia coli is a normal inhabitant of the digestive tract of animals, including humans. It serves many beneficial functions in the body by synthesizing useful vitamins and by competing and suppressing the growth of pathogenic bacteria that may be present or ingested with food and water. With the exception of anaerobic bacteria, E. coli is one of the dominant enteric species in the human feces; therefore, it has been used as an indicator of fecal contamination for close to a century. The concept of indicators is based on the premise that if E. coli is detected in food and water, it is evidence that the product has been fecal contaminated and that pathogens may also be present. However, as E. coli can be found in environmental sources, the use of E. coli as a fecal indicator has been challenged as being unreliable; but as no suitable substitute has been proposed, it continues to be used as an indicator of insanitation worldwide.E. coli is a member of the family Enterobacteriaceae and the genus is composed of Gram negative, aerobic, facultatively anaerobic, non-sporeforming rods. They have the ability to ferment a variety of sugars, but the fermentation of lactose with production of acid and gas is characteristic, as it is for other members of thE Coliform group. E. coli can be further classed into biotypes based on the IMViC tests (indole, methyl red, Voges-Proskauer, and citrate), where biotype I and II have + + - - and - + - - reactions, respectively. Since the majority of E. coli are indole positive, biotype I are much more prevalent. Other biochemical traits include ß-glucuronidase activity, but absence of urease, phenylalanine deaminase and H2 S production. Serological typing of E. coli
eBook - ePub- Y Motarjemi, M. Adams(Authors)
- 2006(Publication Date)
- Woodhead Publishing(Publisher)
10Emerging pathogenic E. coli
G. Duffy, Ashtown Food Research Centre, Teagasc, Ireland10.1 Introduction
Escherichia coli are facultatively anaerobic, non spore forming, Gram negative rods within the family Enterobacteriacea. They form part of the natural gastro-intestinal flora of man and warm-blooded animals. Although most E. coli are harmless commensal organisms, there are many pathogenic strains which can cause a variety of illness in man and animals. There are six recognised groups of pathogenic E. coli . Each group has different virulence traits and mechanisms of pathogenicity, many of which are host specific.10.1.1 Enteropathogenic E. coli (EPEC)
EPEC were the first group of E. coli recognised as a causative agent of diarrhoeal illness in humans (Bray, 1945 ). Symptoms in general appear about 12-36 h after ingestion and include vomiting and diarrhoea. Stools are rarely bloody. In infants the disease can be severe lasting longer than two weeks. The pathogenic mechanisms of this group of organism are linked to their ability to adhere to and invade epithelial cells inducing characteristic attaching and effacing lesions (Donnenberg et al. , 1989). The major O groups within this group which are linked to human illness include O55, O86, O111, O119, O126, O127, O128 and O142 (Williams et al. , 1997). Through volunteer feeding studies the infectious dose of EPEC in healthy adults has been estimated to be 106 organisms. Food and water have been implicated as vectors of this pathogen and cases are most common in underdeveloped countries where sanitation and water quality may be poor.10.1.2 Enterotoxigenic E. coli (ETEC)
ETEC were first recognised as a causative agent of diarrhoea in the 1960s and 1970s, (Smith and Gyles, 1970 ). The illness they cause usually occurs between 12 and 36 h after ingestion and symptoms can range from mild diarrhoea to a severe cholera-like illness with diarrhoea characterised by watery stools accompanied by vomiting and severe stomach pains. Symptoms normally persist for two to three days. In humans, ETEC can colonise the small intestine and produce heat stable (ST) and heat labile (LT) toxins (Smith and Gyles, 1970 ). Serotypes which cause illness in humans include O6, O8, O15, O25, O78, O148, O159 and O167. Fimbrial colonisation factors/antigens (CFAs) play an important role in pathogenicity and they display a high degree of host specificity, thus strains which are pathogenic in animals generally do not cause illness in humans and vice versa (De Graff and Gasstra, 1997 ). The infective dose of ETEC for adults has been estimated to be at least 108 cells; but the young, the elderly and the infirm may be susceptible to lower levels. ETEC is thought to be a common cause of traveller’s diarrhoea resulting from consumption of contaminated water or food, and has been linked with gastroenteritis outbreaks on cruise ships. For instance, an investigation of recent outbreaks of ETEC on three cruise ships indicated that all were associated with consuming beverages with ice cubes on board the ship (Daniels et al.
eBook - PDF- Barbudde, S.B., R.Ramesh N.P.Singh, Barbudde, S.B., R.Ramesh & N.P.Singh(Authors)
- 2020(Publication Date)
- NEW INDIA PUBLISHING AGENCY (NIPA)(Publisher)
Chapter-13 ______________________________ DIVERSITY AMONG EMERGING ENTEROHEMORRHAGIC ESCHERICHIA COLI. D. B. Rawool 1 , S. B. Barbuddhe 2 , S. V. S. Malik 1 1 Indian Veterinary Research Institute, Izatnagar 243 122, Uttar Pradesh, India 2 ICAR Research Complex for Goa, Old Goa, Goa 403 402, India G lobally, 2 billion children under the age of five suffer from diarrhoea, of which, more than 50% of the cases being in South Asia and sub-Saharan Africa, where the disease is more likely to be fatal (UNICEF-WHO, 2009). It has been also estimated that the great majority of acute diarrhoeal illnesses in children over the age of two years is attributable to bacterial pathogens (Carpenter, 1980). Amongst the various enteric bacterial pathogens, diarrheagenic strains of Escherichia coli are considerably responsible for causing bacterial diarrhea (Nataro and Kaper, 1998). E. coli , is well known predominant facultative anaerobic flora of gastro intestinal track of humans and animals. The organism was first described by the German pediatrician Dr. Theodor Escherich and named as Bacterium coli commune , since it had been isolated from the feces of a healthy infant (Escherich, 1885, Sussman, 1985). Even today, it has been speculated that E. coli happens to be the most abundant facultative anaerobic species of the normal human enteric microbiota (Bettelheim, et al ., 2003). Generally, E. coli lives in harmony with the host, wherein the host provides a nourishing environment for bacteria and the bacteria in turn offer essential nutrients to the intestinal epithelium and promote healthy immune responses in the host. Besides this, certain E. coli strains might also serve as an important factor for inhibition of the growth of other pathogenic enteropathogens (Kruis, 2004). However, most of the E. coli remains harmless, however, in case of debilitated or immunosuppressed host, or when gastrointestinal barriers are violated, these normal “nonpathogenic” strains of E.
eBook - PDF- Garg, Sudhi Ranjan(Authors)
- 2021(Publication Date)
- Daya Publishing House(Publisher)
8 Escherichia coli Infections D.K. Sinha, Bhoj Raj Singh, Younis Farooq and Sandeep Kumar Centre for Animal Disease Research and Diagnosis, Indian Veterinary Research Institute, Izatnagar – 243 122 The disease investigation reports from Central Disease Diagnosis Laboratory (CDDL), Indian Veterinary Research Institute, Izatnagar, reveal that out of 400 bacterial strains isolated from sick or morbid animals in the year 2011-12, more than 20 per cent consisted of E. coli isolates only, more common than any other bacteria. There are several pathotypes of E. coli including enterotoxigenic E. coli (ETEC), entheropathogenic E. coli (EPEC), enterohaemorrhagic E. coli (EHEC), uropathogenic E. coli (UPEC), enteroaggregative E. coli (EAgEC) and verotoxigenic E. coli (ETEC) associated with infections in human beings and animals that have zoonotic potential. Often, the E. coli infections are self limiting and with little chance of mortality except in very young and aged individuals. However, some E. coli that produce verotoxin (VT), shigatoxin (ST) or shiga like toxin (SLT) have the potential to cause severe disease as bloody diarrhoea and haemolytic uremic syndrome (HUS) in humans. HUS is characterized by haemolytic anaemia (due to abnormal breakdown of RBCs) and thrombocytopenia (reduction of platelets) leading to severe bloody diarrhoea. HUS is associated with severe acute renal failure, often requiring intensive care. E. coli is also involved in various disorders in animals like white scour/colibacillosis in This ebook is exclusively for this university only. Cannot be resold/distributed. neonatal calves, gas oedema in piglets, mastitis in milch cattle, naval ill, foal diarrhoea in horses and colisepticaemia and enteritis in poultry causing heavy economic losses in the livestock and poultry sector. Apart from domestic animals, zoo and wild animals also suffer from colibacillosis, particularly during water scarcity and flood seasons (Malik et al. 2000).
eBook - ePub- Eduardo A. Groisman(Author)
- 2001(Publication Date)
- Academic Press(Publisher)
CHAPTER 9Pathogenic Escherichia coli
JOSÉ L. PUENTE and B. BRETT FINLAYI. IntroductionII. Enterotoxigenic E. coli (ETEC)A. Disease B. Virulence Factors C. Virulence Gene RegulationIII. Enteroinvasive E. coli (EIEC)A. Disease B. Virulence Factors C. Virulence Gene RegulationIV. Enteropathogenic E. coli (EPEC)A. Disease B. Virulence Factors C. Virulence Gene RegulationV. Enterohemorrhagic E. coli (EHEC)A. Disease B. Virulence Factors C. Virulence Gene RegulationVI. Enteroaggregative E. coli (EAEC)A. Disease B. Virulence FactorsVII. Diffusely Adhering E. coli (DAEC)A. Disease B. Virulence FactorsVIII. Uropathogenic E. coliA. Disease B. Virulence FactorsIX. E. coli That Cause Sepsis and MeningitisA. Disease B. Virulence FactorsX. Conclusions ReferencesI. Introduction
Escherichia coli is the most extensively studied microorganism. It has been a model system for the study of bacterial metabolism, the cell division process, cell wall biosynthesis, chemotaxis, bacterial genetics, and the physiological role of enteric bacteria as part of the normal fecal flora [1 ]. Despite the vast knowledge that has been accumulated over the years, the recent release of its full genomic composition has made it obvious that there are still many things to learn about this microorganism [2 ]. Analysis of the E. coli K-12 genome sequence also shows that about 2% of its DNA consists of mobile genetic elements, including phages, plasmids, and transposons [2 ]. These elements are responsible for the continuous evolution of the bacterial genomic repertoire, providing significant diversity in E. coli strains. In this regard, pathogenic E. coli appears to have evolved from nonpathogenic strains by acquiring new virulence factors by the horizontal transfer of accessory DNA, which is often organized in clusters (pathogenicity islands) in the chromosome or on plasmids [3 ]. The high genetic diversity of the E. coli genome is also reflected by the large variation in DNA content between different strains [4 –6 ] and by the distribution or genomic location (insertion site) of different virulence determinants [7 , 8 ]. In this context, it seems that most pathogenic E. coli strains do not have a single evolutionary origin, but instead have emerged as a result of different events of DNA transfer, and that even strains capable of causing the same disease do not constitute a monophyletic group [9
eBook - PDF- Wilhelm Tham, Marie Louise Danielsson-Tham, Wilhelm Tham, Marie Louise Danielsson-Tham(Authors)
- 2013(Publication Date)
- CRC Press(Publisher)
Diarrheagenic E. coli with Emphasis on Shiga Toxin-producing E. coli † Peter Gerner-Smidt # Introduction Escherichia coli is one of the microorganisms most frequently encountered in human clinical specimens and specimens from animals, food and water. Most strains of E. coli are low pathogenic or not pathogenic at all. Since they are part of the normal intestinal flora in humans and animals, their presence in food and water is an indication of faecal contamination. However, a number of strains are human pathogens and E. coli is a common cause of extraintestinal infections such as urinary tract infections and septicemia. During the past 50 years E. coli has increasingly been recognized as a cause of infectious gastroenteritis. At least six pathogroups of such diarrheagenic E. coli (DEC) have been described (Kaper et al. 2004): enteropathogenic E. coli (EPEC), which is associated with infantile diarrhea; enterotoxigenic E. coli (ETEC), which is a frequent cause of watery diarrhea in travelers CHAPTER 7 # Enteric Diseases Laboratory Branch, Centers for Disease Control & Prevention, MS-CO-3, 1600 Clifton Rd, 30333, Atlanta GA, USA. Email: [email protected] † Disclaimer: The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy. Diarrheagenic E. coli with Diarrheagenic E. coli with E E mphasis on Shiga mphasis on Shiga T T oxin-producing E. coli oxin-producing E. coli 89 89 to third world countries; enteroinvasive E. coli (EIEC) , which is related to Shigella and cause diarrhea in some third world countries; in fact, Shigella may be considered a variant of EIEC since this genus cannot be differentiated genetically from E. coli (Lukjancenko et al. 2010, Parsot 2005) ; entero aggregative E. coli (EAEC), which have also been described as a cause of diarrhea in third world countries; diffusely adherent E.
eBook - PDFEscherichia coli
Recent Advances on Physiology, Pathogenesis and Biotechnological Applications
- Amidou Samie(Author)
- 2017(Publication Date)
- IntechOpen(Publisher)
For an in‐ depth understanding of pathogen behavior in the human GI tract, these models should be used in combination with new technologies such as ‐omics or quantitative imaging technologies. Author details Charlène Roussel 1,2 † , Charlotte Cordonnier 1,3 † , Valérie Livrelli 3,4 , Tom Van de Wiele 2 and Stéphanie Blanquet‐Diot 1 * *Address all correspondence to: [email protected] 1 CIDAM, Conception, Engineering and Development of Food and Drug, Faculty of Pharmacy, University of Auvergne, Clermont‐Ferrand, France 2 Cmet, Center for Microbial Ecology and Technology, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium 3 M2iSH, Microbes, Intestine, Inflammation and Host Susceptibility, UMR INSERM/University of Auvergne, Faculty of Pharmacy, University of Auvergne, Clermont‐Ferrand, France 4 Bacteriology Department, CHU Clermont‐Ferrand, France † Co‐first authors Escherichia coli - Recent Advances on Physiology, Pathogenesis and Biotechnological Applications 16 Escherichia coli - Recent Advances on Physiology, Pathogenesis and Biotechnological Applications References [1] Clements A, Young JC, Constantinou N, Frankel G. Infection strategies of enteric patho‐ genic Escherichia coli. Gut Microbes. 2012; 3 (2):71‐87. DOI: 10.4161/gmic.19182 [2] Qadri F, Svennerholm A‐M, Faruque ASG, Sack RB. Enterotoxigenic Escherichia coli in devel ‐ oping countries: Epidemiology, microbiology, clinical features, treatment, and prevention. Clinical Microbiology Reviews. 2005; 18 (3):465‐483. DOI: 10.1128/CMR.18.3.465‐483.2005 [3] Majowicz SE, Scallan E, Jones‐Bitton A, Sargeant JM, Stapleton J, Angulo FJ, Yeung DH, Kirk MD. Global incidence of human Shiga toxin–producing Escherichia coli infections and deaths: A systematic review and knowledge synthesis. Foodborne Pathogens and Disease. 2014; 11 (6):447‐455. DOI: 10.1089/fpd.2013.1704 [4] Liu LJH, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al.
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