Cluster investigation of mixed O76:H19 Shiga toxin-producing Escherichia coli and atypical enteropathogenic E. coli infection in a Spanish household

A Spanish household was identified through a Public Health follow up on a Shiga toxin-producing Escherichia coli (STEC)-positive 14-month-old girl reporting bloody diarrhoea, with the four household members experiencing either symptomatic or asymptomatic STEC and/or atypical enteropathogenic E. coli (aEPEC) shedding. In total, two different O76:H19 STEC strains and six aEPEC strains belonging to multiple serotypes were isolated and characterized in the household during a 5-month period. Prolonged asymptomatic shedding of O76:H19 STEC and O51:H49 aEPEC was detected in two family members. Although there was no conclusive evidence, consumption of vegetables fertilized with sheep manure was the suspected source of infection. This study highlights the risk of cross-infections posed by prolonged asymptomatic carriage and close household contact between family members, and illustrates the importance of molecular epidemiology in understanding disease clusters.We thank José Manuel Luquin and Gemma Poignonfor facilitating the follow-up sampling of the house-hold members and relatives. We thank DanielEibach for critically reviewing the manuscript. Wealso thank Flemming Scheutz for conventional O:Hserotyping the strains. Sergio Sánchez acknowledgesthe Juan de la Cierva programme from theMinisterio de Economía y Competitividad for hisresearch contract. This study was supported by theMadrid Regional Government (P2009/AGR-1489)