Escherichia coli O104:H4

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Escherichia coli O104:H4 is an enteroaggregative strain of the bacterium Escherichia coli, and the cause of the 2011 Escherichia coli O104:H4 outbreak.[1] The "O" in the serological classification identifies the cell wall lipopolysaccharide antigen, and the "H" identifies the flagella antigen.

Analysis of genomic sequences obtained by BGI Shenzhen show that the O104:H4 outbreak strain is an enteroaggregative E. coli (EAEC or EAggEC) type that has acquired Shiga toxin genes, presumably by horizontal gene transfer.[2][3][4] Genome assembly and copy number analysis both confirmed that two copies of the Shiga toxin stx2 prophage gene cluster are a distinctive characteristic of the genome of the O104:H4 outbreak strain.[5][6] The O104:H4 strain is characterized by the following genetic markers:[6][7]

  • Shiga toxin stx2 positive,
  • terE positive (tellurite resistance gene cluster),
  • eae negative (intimin adherence gene),
  • β-lactamases ampC, ampD, ampE, ampG, ampH are present.

The European Commission (EC) integrated approach to food safety[8] defines a case of Shiga-like toxin producing E. coli (STEC) diarrhea caused by O104:H4 by an acute onset of diarrhea or bloody diarrhea together with the detection of the Shiga toxin 2 (Stx2) or the Shiga gene stx2.[9] Prior to the 2011 outbreak, only one case identified as O104:H4 had been observed, in a woman in South Korea in 2005.[10]


E. coli O104 is a shiga toxin–producing E. coli (STEC). The toxins are what causes illness and the associated symptoms. The method of how these toxins cause illness is sticking to the intestinal cells and aggravating the cells along the intestinal wall.[11][12] This in turn usually can cause bloody stools to occur. Another effect that can come from this bacteria is Hemolytic Uremic Syndrome (HUS), which is a condition characterized by destruction of red blood cells, that over a long period of time can cause kidney failure.[13]Some common symptoms of HUS are vomiting, bloody diarrhea, and blood in the urine.[12]


A common mode of E. coli O104:H4 infection involves ingestion of fecally contaminated food; the disease can thus be considered a foodborne illness. Most recently in 2011, there was an outbreak of the E. Coli O104:H4 strain in Germany that caused the death of several people, and landed hundreds of citizens in hospital.[14][15][12] The infection was traced back to some sprouts that had been contaminated.


The first step to treating someone that appears to have E. coli O104:H4 symptoms are to test their stools. The stool test is then sent a lab to see if it has any remnants of STEC (Shiga-toxin–producing E. coli) can be found; if STEC is found it is a good chance that E. coli O104:H4 or another form of STEC is present. With the help of lab tests a doctor can diagnose a patient so they can properly be treated. One thing that makes E. coli O104:H4 very difficult to treat is that it is resistant to most antibiotics except carbapenems; in fact, E. coli O104:H4 is resistant to at least 14 different types of antibiotics.[14]


Prevention of spreading E. coli or other pathogens can be done simply by rinsing hands with soap, washing food, and properly heating/cooking food, to make sure the bacteria are destroyed, since E. coli is a very resilient pathogen.[16]


  1. ^ Mellmann, A.; Harmsen, D.; Cummings, C. A.; Zentz, E. B.; Leopold, S. R.; et al., Alain (2011). "Prospective genomic characterization of the German enterohemorrhagic Escherichia coli O104:H4 outbreak by rapid next generation sequencing technology". In Ahmed, Niyaz. PLoS ONE 6 (7): e22751. doi:10.1371/journal.pone.0022751. 
  2. ^ "BGI Sequences Genome of the Deadly E. coli in Germany and Reveals New Super-Toxic Strain". BGI. 2011-06-02. Retrieved 2011-06-02. 
  3. ^ David Tribe (2011-06-02). "BGI Sequencing news: German EHEC strain is a chimera created by horizontal gene transfer". Biology Fortified. Retrieved 2011-06-02. 
  4. ^ Maev Kennedy and agencies (2011-06-02). "E. coli outbreak: WHO says bacterium is a new strain". London: Retrieved 2011-06-04. 
  5. ^ "BGI releases the complete map of the Germany E. coli O104 genome and attributed the strain as a category of Shiga toxin-producing enteroaggregative Escherichia coli (STpEAEC)". BGI. 2011-06-16. Retrieved 2011-06-20. 
  6. ^ a b "Copy number analysis of German outbreak strain E. coli EHEC O104:H4". Johannes Kepler University of Linz. 2011-06-11. Retrieved 2011-06-15. 
  7. ^ "Characterization of EHEC O104:H4". Robert Koch Institute. 2011-06-03. Retrieved 2011-06-15. 
  8. ^ "The EU integrated approach to food safety". 
  9. ^ "Case Definition for diarrhoea and haemolytic uremic syndrome caused by O104:H4". European Commission. 2011-06-03. Retrieved 2011-06-16. 
  10. ^ Bae WK, Lee YK, Cho MS, Ma SK, Kim SW, Kim NH, et al.. A case of haemolytic uremic syndrome caused by Escherichia coli O104:H4. Yonsei Medical Journal. 2006 Jun 30;47(3):473–9. doi:10.3349/ymj.2006.47.3.437. PMID 16807997.
  11. ^ Frank, Christina, and Et Al. "Epidemic profile of Shiga-toxin–producing Escherichia coli O104:H4 outbreak in Germany." New England Journal of Medicine. Robert Koch Institute, 26 Oct. 2011. Web. 08 Nov. 2011. <>.
  12. ^ a b c Reinberg, Steven. "German E. Coli Strain Especially Lethal - Infectious Diseases: Causes, Types, Prevention, Treatment and Facts on" MedicineNet Inc, 22 June 2011. Web. 08 Nov. 2011. <>.
  13. ^ European Food Safety Authority. "Shiga Toxin-producing E. Coli (STEC) O104:H4 2011 Outbreaks in Europe:." EFSA Journal. European Food Safety Authority, 3 Nov. 2011. Web. 08 Nov. 2011. <>.
  14. ^ a b Gorman, Christine. "E. Coli on the March: Scientific American." Science News, Articles and Information | Scientific American. Scientific American, 7 Aug. 2011. Web. 08 Nov. 2011. <>.
  15. ^ "July 8, 2011: Outbreak of Shiga Toxin-producing E. Coli O104 (STEC O104:H4) Infections Associated with Travel to Germany | E. Coli." Centers for Disease Control and Prevention. Center for Disease Control and Prevention, 8 July 2011. Web. 08 Nov. 2011. <>.
  16. ^ "CDC - Escherichia coli O157:H7, General Information - NCZVED." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 8 July 201. Web. 08 Nov. 2011.