Quantifying Colonization Potential of Enterohemorrhagic Escherichia coli O157 Using Bovine In Vitro Organ Culture and Immunofluorescent Staining

Abstract

A robust semiquantitative method for measuring the colonization potential of O157 enterohemorrhagic Escherichia coli (EHEC) strains was developed combining an established ex vivo model infection system, bovine in vitro organ culture, with detection of bacteria attached to tissue sections by immunofluorescent assay (bIVOC-IFA) using Quantum dot^® nanocrystal technology. The method was tested on ten O157 strains chosen to reflect a diversity of genotypes found in New Zealand based on the novel polymerase chain reaction–binary typing (P-BIT) system. High- and low-colonizing EHEC O157 strains were identified using bIVOC-IFA, with the highest colonizing strain belonging to the pulsed-field gel electrophoresis type most commonly identified from New Zealand beef meat. Furthermore, all of the toxigenic O157 strains exhibiting a low-colonizing phenotype were closely related, belonging to the same P-BIT genotype cluster. Future use of this method to characterize EHEC strains could provide valuable information for risk assessment and risk management interventions aimed at improving food safety along the beef farm to fork continuum.

Introduction

I n vitro organ culture (IVOC) is the ”gold standard” model infection system for studying the interaction of Escherichia coli with the mucosal surfaces of the gut and has been widely used for the study of enterohemorrhagic E. coli (EHEC) pathogenesis (Cobbold et al., 2004; Fitzhenry et al., 2002; Garmendia et al., 2004; Girard et al., 2007; Lowe et al., 2009; Naylor et al., 2003; Phillips et al., 2000). EHEC are responsible for the majority of E. coli outbreaks in the developed world, causing hemorrhagic colitis that can progress to the severe and sometimes fatal condition hemolytic uremic syndrome (HUS) (Meng et al., 2001). EHEC are characterized by production of one or more Shiga toxins and the ability to form a characteristic attaching and effacing lesion on intestinal epithelia (Nataro et al., 1998; Stevens et al., 2002). The EHEC serogroup O157 is predominantly responsible for most human infections, although serogroups O26, O103, and O111 are also frequently implicated in the United States and Europe (Brown et al., 1997).

Ruminants are an important EHEC reservoir, with contamination of associated food products by fecal material containing EHEC being an important vehicle for human infection (Lake et al., 2001). A study in Scotland found that approximately 11.2% of cattle carry EHEC O157 at the time of slaughter (Ogden et al., 2004).

These figures may be even higher in the United States, with one study estimating the prevalence of E. coli O157 on the hides of cull cattle at slaughter to be 46.9% (Brichta-Harhay et al., 2008). Since cattle carry the organism asymptomatically, and carriage can be widespread, control of EHEC O157 on the farm has been difficult and challenging.

An epidemiological model incorporating prevalence data on farms and the heterogeneous fecal shedding rates of E. coli O157 by cattle has determined that 80% of transmission amongst cattle is the result of bacterial shedding by 20% of the most infectious individuals (Matthews et al., 2006). Therefore, control strategies aimed at reducing bacterial loads in these ”super shedder” cattle offer the best potential to reduce the prevalence of EHEC in the beef supply (Chase-Topping et al., 2008; Fairbrother et al., 2006; Stevens et al., 2002). How some animals develop persistent EHEC infection at the terminal rectum and become ”super shedders” is not well understood (Chase-Topping et al., 2005). Potentially, individual EHEC strain characteristics are a factor. One epidemiological study in Scotland has identified a particular O157 phage type (PT), PT 21/28, as a risk factor for super-shedding and severe human morbidity (Chase-Topping et al., 2007; Lynn et al., 2005).

The bIVOC model infection system has previously been used to quantify colonization levels of EHEC O157, with bovine spiral colon and jejunum explants, using a procedure that involved dislodgement of bacteria from the surface of the tissue and enumeration by culture or immunoflourescent detection (Cobbold et al., 2004; Lowe et al., 2009). Although quantitative, this method does not allow for a visual assessment of the quality of the bovine tissue used or the destruction to the mucosal surface that may occur due to the interaction of the bacteria with the tissue. The bIVOC method has been used in combination with immunofluorescent detection of EHEC to characterize the interaction of the bacteria with the tissue surface of bovine terminal rectal explants (Baehler et al., 2000, 2002; Girard et al., 2005), but thus far immunofluorescent detection has not been used to quantify colonization or compare adherence amongst O157 strains. In this study, we developed a semiquantitative method to assess colonization of strains of interest using the bIVOC model infection system in conjunction with immunofluorescent detection of bacteria (bIVOC-IFA) using Quantum dot (Qdot^®) nanocrystal technology, a recently described, highly photostable fluorophore (Hotz, 2005). We tested the utility of the culture-independent bIVOC-IFA method with a set of strains chosen to represent a range of O157 genotypes found within New Zealand, as determined by the novel Shiga-toxigenic Escherichia coli (STEC) polymerase chain reaction–binary typing (P-BIT) system (Brandt et al., 2011).

Materials and Methods

Bacterial strain preparation

Bacterial strains were obtained from the New Zealand Culture Collection and the Enteric Reference Laboratory (National Centre for Biosecurity and Infectious Diseases, Wallaceville, New Zealand) (Table 1). EHEC genotype (stx1, stx2, stx2c, stx2d, eaeA, and ehxA) was determined by polymerase chain reaction (PCR) using previously described methods (Paton et al., 1998; Wang et al., 2002). Pulsed-field gel electrophoresis (PFGE) XbaI typing, STEC P-BIT typing, and clustering for the O157 stains used in this study have been previously published (Brandt et al., 2011). Strains were streaked for single colonies from a frozen glycerol stock onto Luria broth (LB) agar plates and grown overnight at 37°C. After incubation, single colonies were inoculated into LB and grown to stationary phase overnight shaking at 37°C. Bacterial cells were pelleted by centrifugation at 4,000 x g for 10 min and resuspended in fresh LB. The final inoculum applied to each tissue biopsy was approximately 10⁸ colony-forming unit (CFU), the minimum dose required to produce colonization by the lowest colonizing strain NZRM3614; this dose is within the range (10³ to 10⁸ CFU) used previously to compare O157 strain colonization in a bIVOC adherence assay (Lowe et al., 2009) and is less than the infectious dose used to compare colonization of different O157 strains in cattle using rectal application of bacteria (Sheng et al., 2006).

Table 1.

Enterohemorrhagic Escherichia coli (EHEC) Strains Used in This Study

Strain	Serotype	Source	EHEC genotype ^a	PFGE Xba1 type ^b	STEC 24 P-BIT code ^b	O157 P-BIT cluster ^b
ERL03-1416	O157:H7	Water	stx₂, eaeA, ehxA	Xb0179	16557300	1
ERL04-3476	O157:H7	Pork	stx_2(c), eaeA, ehxA	Xb0070	77777604	4
ERL05-0623	O157:H7	Bobby veal shank	stx₁, stx_2(d), eaeA, ehxA	Xb0092	72777303	3
ERL05-1306	O157:[H7]^c	Diced lamb	stx₁, stx_2(c), eaeA, ehxA	Xb0191	76777701	3
ERL06-2442	O157:H7	Bovine (bobby fecal)	stx₂, eaeA, ehxA	Xb0164	17777340	1
ERL06-2497	O157:H7	Bovine	stx₁, stx₂, eaeA, ehxA	Xb0095	77573301	3
ERL06-2503	O157:[H7]^c	Bovine (bobby fecal)	stx₂, eaeA, ehxA	Xb0040^d	77777300	2
NZRM3614^e	O157:H7	Human	eaeA, ehxA	Xb0197	73277100	2
NZRM4165	O157:HNM	Human	stx₁, stx_2(d), eaeA, ehxA	Xb0048	76775333	3
NZRM4169	O157:H7	Human	stx_2(c), eaeA, ehxA	Xb0041	77377700	4

stx2 allele indicated in subscript parenthesis.

As published in Brandt et al. (2011).

[ ] indicates negative by latex agglutination, but positive by polymerase chain reaction.

Most prevalent PFGE Xba1 type isolated from New Zealand meat.

Non-toxigenic lab strain of O157:H7.

PFGE, pulsed-field gel electrophoresis; STEC, Shiga-toxigenic Escherichia coli; P-BIT, polymerase chain reaction–binary typing.

bIVOC tissue preparation and infection

Explants from the terminal rectum of 2–3-year-old beef cattle (Hereford and Angus breeds) were prepared using previously described methods (Baehler and Moxley, 2000; Girard, 2007). Briefly, fresh biopsies from the last centimeter of the terminal rectum were excised, rinsed in cold, sterile phosphate-buffered saline (PBS), and stored in Roswell Park Memorial Institute (RPMI) 1640 complete medium on ice during transport to the laboratory. RPMI 1640 complete medium contained 10% fetal bovine serum (heat inactivated), 0.25% lactalbumin hydrolysate, 0.2 μg/mL hydrocortisone, 0.1 μg/mL insulin, 75 mM β-mercaptoethanol, 2 mM l-glutamate, and 2 mM l-aspartate (Girard et al., 2005). Explants were then cut into 3×3 mm² sections using a sterile scalpel and placed on top of biopsy foam pads (ProSciTech, Queensland, Australia) in a 24-well tissue culture plate. Triplicate infections of explants were performed per strain in 1 mL of RPMI 1640 complete medium at 37°C/5% CO₂ for 4 h, with the medium being changed after 2 h of incubation. An infection period of 4 h was chosen based on previous studies that demonstrated good tissue preservation equal to uninfected explants under these conditions (Baehler et al., 2000, 2002; Girard et al., 2005). Infected explants were then fixed in 10% neutral-buffered formalin and stored at 4°C overnight prior to paraffin-embedding and vertical cross-sectioning (3 μm wide) in the middle of the biopsy. Three experiments, using explants from different animals collected on different occasions, were performed for each bacterial strain. Three uninfected explants were also prepared from each animal to determine that the tissue was negative for the presence of O157 EHEC prior to inclusion of data from that animal in the analysis.

Immunostaining

Tissue sections on glass slides were deparaffinised by incubation at 60°C until the wax had melted. All other procedures were conducted at room temperature unless otherwise stated. Slides were washed twice in SafSolvent (Ajax Finechemicals, Auckland, New Zealand) for 5 min. Slides were rehydrated in decreasing ethanol concentrations (100%, then 95%, then 70%) for 3 min in each solution and then washed twice in PBS for 5 min. Slides were blocked in 6% bovine serum albumin/0.1% Triton X-100 in PBS for 1 h. Primary anti-serum, Difco rabbit anti-O157 serum (Fort Richard Laboratories, Auckland, New Zealand), was diluted 1:100 in blocking solution/10% normal rabbit serum and applied to slides for 1 h. Slides were then washed three times in PBS. The secondary antibody, goat anti-rabbit IgG conjugated to Qdot^® 655 (Invitrogen Corp., Carlsbad, CA), was diluted 1:500 in blocking solution/10% normal goat serum/5 μg mL⁻¹ Hoechst 33342 (Invitrogen Corp.) and applied to slides for 1 h. Slides were washed three times in PBS and mounted with Vectashield (Vector Labs, Burlingame, CA) under a no. 1 glass coverslip sealed to the slide with nail polish. Qdot^® fluorophore-conjugated secondary antibodies were used to provide additional brightness and stability during confocal imaging. We did not observe any photobleaching during image acquisition and found that tissue staining was stable for at least 6 months when slides were stored in the dark at 4°C.

Semiquantifying bacterial colonization using confocal microscopy

Tissue sections were analyzed using an inverted Leica TCS SP5 confocal laser scanning microscope (CLSM) with LAS AF imaging software (Leica Microsystems, Wetzlar, Germany). Bacterial cells were visualized using a 100× NA 1.2 oil immersion lens with 2× zoom using excitation 488 nm and emission of 630–690 nm. The majority of bacterial cells attached to the surface of the terminal rectal tissue were enumerated by eye along the entire length of the tissue section. In the case of the high-colonizing strains in particular, bacterial clumps were observed, which were more difficult to count by eye. These areas were photographed and as many bacteria as possible were counted by digital zooming of electronic images. As this method is semiquantitative, failure to resolve all of the bacteria in the images did not change the placement of a strain as a high or low colonizer. Enumeration was performed from three explants per strain taken from three separate animals.

The total number of bacterial cells was then normalized to the surface length (mm) of the tissue section. The surface length of a given tissue section was determined by using a standard metric ruler and light box. Single bacteria were counted individually through the microscope ocular. Bacteria growing in clumps were counted by generating a series of z-stack images of width 0.5 μm. The tissue integrity of each immunostained sample was assessed by differential interference contrast (DIC) microscopy; only sections with comparable tissue integrity to uninfected control samples were used for bacterial cell enumeration and subsequent comparison between bacterial strains. A representative image of an immunostained section from a high-colonizing EHEC O157 strain is presented in Figure 1.

FIG. 1.

Representative image of O157 enterohemorrhagic Escherichia coli (strain ERL04-3476) colonizing the surface of a bovine terminal rectum explant. Bacteria were detected by immunostaining using a primary antisera recognizing the O157 O-antigen and a secondary antibody conjugated to Quantom dot (Qdot^®) 655. Confocal optical sections were collected at 0.5-μm intervals with a 100× NA 1.2 oil immersion lens using 488-nm excitation with fluorescence collected at 630–690 nm. A single representative section is shown. (A,B) O157 staining (red fluorescence) and a concurrent transmitted light image. Scale bar=10 μm. (C,D) An enlargment of the region shown boxed in A and B. Scale bar=2 μm.

Statistical analysis

Strains were separated into two groups: high colonizers (>50 bacteria per mm tissue section in two or more experiments) and low colonizers (<50 bacteria per mm tissue section in all experiments). The Mann-Whitney one-tailed U-test was used to determine if the attachment and growth of low-colonizing strains was less than high-colonizing strains. This non-parametric test was used due to the difference in variances of the two groups, due to inter-experimental variation, and to avoid normality assumptions.

Results

The colonization potential of 10 EHEC O157 strains was quantified using bIVOC-IFA (Fig. 2). Bacterial strains were selected based on diverse origin of isolation and genotype, using the novel P-BIT typing system in an effort to test a range of strains found within New Zealand (Table 1) (Brandt et al., 2011). The strain set included the most commonly isolated PFGE type found in New Zealand beef products (Xb0040; personal communication, Dr. Brent Gilpin) as a potential high-colonizing strain, and a highly passaged attenuated (non-toxigenic) O157 lab strain (NZRM3614) as a potential low-colonizing strain.

FIG. 2.

Semiquantification of colonization levels of bovine terminal rectum explants by different O157 strains using bovine in vitro organ culture, with detection of bacteria attached to tissue sections by immunofluorescent assay (bIVOC-IFA). (A) Raw bacterial counts from three experiments performed with tissue harvested on three separate occasions from different cows. Data are normalized to the surface length of the tissue section analyzed. Infections were performed with 3 mm² bovine terminal rectal explants. Explants were challenged with 1×10⁸ CFU for 4 h at 37°C, fixed, paraffin-embedded, sectioned, and immunostained with the appropriate O-antigen antiserum and Quantom dot (Qdot^®) 655-conjugated secondary antibody. (B) The average bacterial count per mm tissue section surface length converted to log₁₀. Error bars represent the standard error of the mean. The O157 strains form two separate groups (p<0.001 by one-tailed Mann-Whitney U-test). Data presented in part B represents the mean values of raw data presented in part A.

The bIVOC-IFA model infection system was robust enough to separate the O157 strain set into two groups (p<0.001 by Mann-Whitney one-tailed test): a group of low-colonizing strains (n=4) and a group of high-colonizing strains (n=6; Fig. 2A). There was a one log₁₀ difference in bacterial numbers attached to the mucosal surface of a representative tissue section between the low-colonizing group (strain average 0.75±0.15 log₁₀ CFU per mm tissue section surface) and the high-colonizing group (strain average 1.9±0.10 log₁₀ CFU per mm tissue section surface; Fig. 2B). The strain with the lowest colonization levels was an attenuated non-toxigenic lab strain (NZRM3614) and the highest colonization levels were measured for the O157 strain (ERL06-2503) with the PFGE type most commonly isolated from New Zealand beef (Xb0040). Along with the non-toxigenic lab strain, the low-colonizing group of strains consisted of three O157 strains from the same O157 P-BIT cluster, cluster 3, of strains with the distinguishing feature of possessing both the stx1 and stx2 genes.

Discussion

A semiquantitative method called bIVOC-IFA was developed to assess the colonization potential of O157 strains by combining an established ex vivo model infection system with immunofluorescent detection of bacteria attached to tissue sections. The follicle-rich region of the bovine terminal rectum was used because this region of the gastrointestinal tract is a location where EHEC O157 in cattle naturally persists and because terminal rectal explants have previously been used to study the interactions of this serotype with host gut tissue (Girard et al., 2007; Lim et al., 2007; Naylor et al., 2003, 2005). The low-colonizing strains identified by the bIVOC-IFA colonization assay included the attenuated non-toxigenic lab strain and strains carrying both stx1 and stx2 genes (P-BIT cluster 3). All O157 carrying stx2 alone displayed high colonization in the bIVOC-IFA assay. These results are consistent with studies of the prevalence of stx genes in bovine O157 isolates, which have reported the presence of stx1 much less frequently (<20%) than the presence of stx2 (100%) (Alam et al., 2006; Lefebvre et al., 2009; Paiba et al., 2002). O157 strains carrying both stx1 and stx2 have also been reported to be less virulent in humans and are less cytotoxic in in vitro cell assays and in in vivo neurotropic assays in piglets than strains carrying stx2 alone (Diarra et al., 2009; Donohue-Rolfe et al., 2000; Ethelberg et al., 2004; Griffin et al., 1991; Lefebvre et al., 2009; Rivas et al., 2006).

The one inconsistency in our results is the stx1- and stx2-carrying strain ERL05-1306 (P-BIT cluster 3) which exhibited a high colonization phenotype in our assay. This is an intriguing result because this strain was chosen for the study because it is the only non-P-BIT cluster 4 strain that we have identified thus far which carries the stx2c allele (Brandt et al., 2011). Similar to ERL05-1306, both stx2c-carrying (PBIT cluster 4) O157 strains that were tested in our bIVOC-IFA model infection system displayed a high colonization phenotype. This is consistent with a number of studies that have identified stx2c as the dominant subtype associated with bovine isolates (Oseki et al., 2002; Ding et al., 2011; Franz et al., 2012), which would suggest a propensity for these strains to colonize cattle. Furthermore, the PFGE type most commonly isolated from New Zealand beef products, represented by strain ERL06-2503, displayed the highest colonization levels in the bIVOC-IFA colonization assay. Taken together, these preliminary results suggest that our model bovine colonization system can identify “low-risk” strains from “high-risk” strains, in terms of prevalence amongst cattle.

Despite inter-experimental variation (Fig. 2A), which may have been attributed to a number of parameters (e.g., quality of the bovine tissue sample, use of outbred animals, quality of tissue sectioning, and/or the strength of immunostaining), partitioning of strains into low- and high-colonizing groups was achieved using the bIVOC-IFA method. Use of a representative section from the middle of the explant was sufficient to discriminate between the two phenotypic groups, as the bIVOC-IFA method was capable of identifying the attenuated lab strain and the most prevalent O157 phage type found in New Zealand beef products as the lowest and highest colonizing strains, respectively.

The benefit of using bIVOC-IFA, as opposed to previously published methods used to enumerate E. coli colonization on bovine tissues (Cobbold et al., 2004; Lowe et al., 2009), is that bIVOC-IFA does not require dislodging bacteria from the surface of the tissue, which is advantageous as the samples could also be used to assess differences in colonization patterns and tissue pathology. More importantly, bIVOC-IFA allows visual comparison of tissue integrity between samples, which is important when making comparisons between bacterial strains as a low-colonizing phenotype could be misinterpreted due to poor quality of the tissue explant or severe destruction of the tissue surface mucosa during infection. The bIVOC-IFA method can be completed within 2 working days, which is similar to culture enumeration methods that require overnight incubation. Furthermore, the bIVOC-IFA method could be modified for high-throughput analysis by using a qualitative assessment of slides viewed at a lower (e.g., 10×) magnification with a standard fluorescent microscope.

Conclusion

This work describes a semiquantitative method for enumerating the colonization potential of a major foodborne pathogen, using an established ex vivo model infection system in a host animal responsible for zoonotic infections. The bIVOC-IFA method could be used by the beef industry to target potential interventions to farms harboring EHEC O157 super-shedding strains, those identified as high-colonizing strains in the bIVOC-IFA assay. The results presented in this study are indicative of the potential for bIVOC-IFA to be used in this manner; however, further validation of the method would first be required using a well-defined set of EHEC O157 strains with known prevalences and shedding characteristics in New Zealand cattle. In addition to application within the beef industry, this method could be used as a model system to compare environmental and clinical EHEC O157 strains in regards to their potential to colonize a bovine host, providing valuable strain-based information for risk assessment and modeling aimed at improving food safety.

Footnotes

Acknowledgments

We would like to thank South Pacific Meats Ltd. (Malvern, Christchurch, New Zealand) for providing bovine colonic tissue and Carolyn Nicol (ESR, New Zealand) for use of select EHEC strains. We would like to thank Drs. Manfred Ingerfeld and David Collings (University of Canterbury, Christchurch, New Zealand) for technical assistance in generating the CLSM images, Jennifer Lucas (Gribbles Veterinary, Christchurch, New Zealand) for tissue sectioning, and Beverley Horn (ESR, New Zealand) for help with statistical analysis of the data. This work was enabled by capability funding provided by the New Zealand Ministry of Research Science and Technology.

Disclosure Statement

No competing financial interests exist.

References

Alam

, Zurek

. Seasonal prevalence of Escherichia coli O157:H7 in beef cattle feces. J Food Prot, 2006; 69:3018–3020.

Baehler

, Moxley

. Escherichia coli O157:H7 induces attaching-effacing lesions in large intestinal mucosal explants from adult cattle. FEMS Microbiol Lett, 2000; 185:239–242.

Baehler

, Moxley

. Effect of culture conditions on Escherichia coli O157:H7–mediated attaching-effacing lesions in a bovine large intestinal mucosal explant model. FEMS Microbiol Lett, 2002; 212:107–110.

Brandt

, King

, Cornelius

, Premaratne

, Besser

, On

. Molecular risk assessment and epidemiological typing of Shiga toxin–producing Escherichia coli by using a novel PCR binary typing system. Appl Environ Microbiol, 2011; 77:2458–2470.

Brichta-Harhay

, Guerini

, Arthur

, Bosilevac

, Kalchayanand

, Shackelford

, Wheeler

, Koohmaraie

. Salmonella and E. coli O157:H7 contamination on hides and carcasses of cull cattle presented for slaughter in the United States: An evaluation of prevalence and bacterial loads by immunomagnetic separation and direct plating methods. Appl Environ Microbiol, 2008; 74:6289–6297.

Brown

, Harmon

, Zhao

, Doyle

. Experimental Escherichia coli O157:H7 carriage in calves. Appl Environ Microbiol, 1997; 63:27–32.

Chase-Topping

, Gally

, Low

, Matthews

, Woolhouse

. Super-shedding and the link between human infection and livestock carriage of Escherichia coli O157. Nat Rev Microbiol, 2008; 6:904–912.

Chase-Topping

, Kruuk

, Lajous

, Touzeau

, Matthews

, Simm

, Foster

, Rupp

, Eychenne

, Hunter

, Elsen

, Woolhouse

. Genotype-level variation in lifetime breeding success, litter size and survival of sheep in scrapie-affected flocks. J Gen Virol, 2005; 86:1229–1238.

Chase-Topping

, McKendrick

, Pearce

, MacDonald

, Matthews

, Halliday

, Allison

, Fenlon

, Low

, Gunn

, Woolhouse

. Risk factors for the presence of high-level shedders of Escherichia coli O157 on Scottish farms. J Clin Microbiol, 2007; 45:1594–1603.

10.

Cobbold

, Desmarchelier

. In vitro studies on the colonization of bovine colonic mucosa by Shiga-toxigenic Escherichia coli (STEC) Epidemiol Infect, 2004; 132:87–94.

11.

Diarra

, Giguère

, Malouin

, Lefebvre

, Bach

, Delaquis

, Aslam

, Ziebell

, Roy

. Genotype, serotype, and antibiotic resistance of sorbitol-negative Escherichia coli isolates from feedlot cattle. J Food Prot, 2009; 72:28–36.

12.

Ding

, Huang

, Mao

, Zou

. Characterization of stx2 and its variants in Escherichia coli O157:H7 isolated from patients and animals. African J Biotech, 2011; 10:2991–2998.

13.

Donohue-Rolfe

, Kondova

, Oswald

, Hutto

, Tzipori

. Escherichia coli O157:H7 strains that express Shiga toxin (Stx) 2 alone are more neurotropic for gnotobiotic piglets than are isotypes producing only Stx1 or both Stx1 and Stx2. J Infect Dis, 2000; 181:1825–1829.

14.

Ethelberg

, Olsen

, Scheutz

, Jensen

, Schiellerup

, Enberg

, Petersen

, Olesen

, Gerner-Smidt

, Mølbak

. Virulence factors for hemolytic uremic syndrome, Denmark. Emerg Infect Dis, 2004; 10:842–847.

15.

Fairbrother

, Nadeau

. Escherichia coli: On-farm contamination of animals. Rev Sci Tech, 2006; 25:555–569.

16.

Fitzhenry

, Pickard

, Hartland

, Reece

, Dougan

, Phillips

, Frankel

. Intimin type influences the site of human intestinal mucosal colonisation by enterohaemorrhagic Escherichia coli O157:H7. Gut, 2002; 50:180–185.

17.

Franz

, van Hoek

, van der Wal

, de Boer

, Zwartkruis-Nahuis

, van der Zwaluw

, Aarts

, Heuvelink

. Genetic features differentiating bovine, food, and human isolates of Shiga toxin–producing Escherichia coli O157 in The Netherlands. J Clin Microbiol, 2012; 50:772–780.

18.

Garmendia

, Phillips

, Carlier

, Chong

, Schüller

, Marches

, Dahan

, Oswald

, Shaw

, Knutton

, Frankel

. TccP is an enterohaemorrhagic Escherichia coli O157:H7 type III effector protein that couples Tir to the actin-cytoskeleton. Cell Microbiol, 2004; 6:1167–1183.

19.

Girard

, Batisson

, Frankel

, Harel

, Fairbrother

. Interaction of enteropathogenic and Shiga toxin–producing Escherichia coli and porcine intestinal mucosa: Role of intimin and Tir in adherence. Infect Immun, 2005; 73:6005–6016.

20.

Girard

, Dziva

, van Diemen

, Phillips

, Stevens

, Frankel

. Adherence of enterohemorrhagic Escherichia coli O157, O26, and O111 strains to bovine intestinal explants ex vivo. Appl Environ Microbiol, 2007; 73:3084–3090.

21.

Griffin

, Tauxe

. The epidemiology of infections caused by Escherichia coli O157:H7, other enterohemorrhagic E. coli, and the associated hemolytic uremic syndrome. Epidemiol Rev, 1991; 13:60–98.

22.

Hotz

. Applications of quantum dots in biology: An overview. Methods Mol Biol, 2005; 303:1–17.

23.

Lake

et al. Risk profile. Shiga toxin producing Escherichia coli in red meat and meat productsClient report FW0154Christchurch, New Zealand: Institute of Environmental Science & Research, Ltd., 2001.

24.

Lefebvre

, Diarra

, Vincent

, Moisan

, Malouin

. Relative cytotoxicity of Escherichia coli O157:H7 isolates from beef cattle and humans. Foodborne Pathog Dis, 2009; 6:357–364.

25.

Lim

, Li

, Sheng

, Besser

, Potter

, Hovde

. Escherichia coli O157:H7 colonization at the rectoanal junction of long-duration culture-positive cattle. Appl Environ Microbiol, 2007; 73:1380–1382.

26.

Lowe

, Baines

, Selinger

, Thomas

, McAllister

, Sharma

. Escherichia coli O157:H7 strain origin, lineage, and Shiga toxin 2 expression affect colonization of cattle. Appl Environ Microbiol, 2009; 75:5074–5081.

27.

Lynn

, O'Brien

, Taylor

, Adak

, Chart

, Cheasty

, Coia

, Gillespie

, Locking

, Reilly

, Smith

, Waters

, Willshaw

. Childhood hemolytic uremic syndrome, United Kingdom and Ireland. Emerg Infect Dis, 2005; 11:590–596.

28.

Matthews

, Low

, Gally

, Pearce

, Mellor

, Heesterbeek

, Chase-Topping

, Naylor

, Shaw

, Reid

, Gunn

, Woolhouse

. Heterogeneous shedding of Escherichia coli O157 in cattle and its implications for control. Proc Natl Acad Sci USA, 2006; 103:547–552.

29.

Meng

, Doyle

, Zhao

. Enterohemorrhagic Escherichia coli. Food Microbiology: Fundamentals and Frontiers, 2nd Doyle

, Beuchat

, Montville

. Washington, DC: American Society for Microbiology Press, 2001; 193–213.

30.

Nataro

, Kaper

. Diarrheagenic Escherichia coli. Clin Microbiol Rev, 1998; 11:142–201.

31.

Naylor

, Low

, Besser

, Mahajan

, Gunn

, Pearce

, McKendrick

, Smith

, Gally

. Lymphoid follicle-dense mucosa at the terminal rectum is the principal site of colonization of enterohemorrhagic Escherichia coli O157:H7 in the bovine host. Infect Immun, 2003; 71:1505–1512.

32.

Naylor

, Roe

, Nart

, Spears

, Smith

, Low

, Gally

. Escherichia coli O157:H7 forms attaching and effacing lesions at the terminal rectum of cattle and colonization requires the LEE4 operon. Microbiology, 2005; 151:2773–2781.

33.

Ogden

, MacRae

, Strachan

. Is the prevalence and shedding concentrations of E. coli O157 in beef cattle in Scotland seasonal? FEMS Microbiol Lett, 2004; 233:297–300.

34.

Osek

, Gallien

. Molecular analysis of Escherichia coli O157 strains isolated from cattle and pigs by the use of PCR and pulsed-field gel electrophoresis methods. Vet Med—Czech, 2002; 47:149–158.

35.

Paiba

, Gibbens

, Pascoe

, Wilesmith

, Kidd

, Byrne

, Ryan

, Smith

, McLaren

, Futter

, Kay

, Jones

, Chappell

, Willshaw

, Cheasty

. Faecal carriage of verocytotoxin-producing Escherichia coli O157 in cattle and sheep at slaughter in Great Britain. Vet Rec, 2002; 150:593–598.

36.

Paton

, Paton

. Detection and characterization of Shiga toxigenic Escherichia coli by using multiplex PCR assays for stx1, stx2, eaeA, enterohemorrhagic E. coli hlyA, rfbO111, and rfbO157. J Clin Microbiol, 1998; 36:598–602.

37.

Phillips

, Frankel

. Intimin-mediated tissue specificity in enteropathogenic Escherichia coli interaction with human intestinal organ cultures. J Infect Dis, 2000; 181:496–500.

38.

Rivas

, Miliwebsky

, Chinen

, Roldán

, Balbi

, García

, Fiorilli

, Sosa-Estani

, Kincaid

, Rangel

, Griffin

. Case-Control Study Group. Characterization and epidemiologic subtyping of Shiga toxin–producing Escherichia coli strains isolated from hemolytic uremic syndrome and diarrhea cases in Argentina. Foodborne Pathog Dis, 2006; 3:88–96.

39.

Sheng

, Lim

, Knecht

, Li

, Hovde

. Role of Escherichia coli O157:H7 virulence factors in colonization at the bovine terminal rectal mucosa. Infect Immun, 2006; 74:4685–4693.

40.

Stevens

, van Diemen

, Dziva

, Jones

, Wallis

. Options for the control of enterohaemorrhagic Escherichia coli in ruminants. Microbiology, 2002; 148:3767–3778.

41.

Stevens

, van Diemen

, Frankel

, Phillips

, Wallis

. Efa1 influences colonization of the bovine intestine by Shiga toxin–producing Escherichia coli serotypes O5 and O111. Infect Immun, 2002; 70:5158–5166.

42.

Wang

, Clark

, Rodgers

. Detection in Escherichia coli of the genes encoding the major virulence factors, the genes defining the O157:H7 serotype, and components of the type 2 Shiga toxin family by multiplex PCR. J Clin Microbiol, 2002; 40:3613–3619.