Diarrhoeagenic Escherichia Coli & Shigella

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Diarrhoeagenic Escherichia Coli & Shigella

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Diarrhoeagenic Escherichia Coli & Shigella

E coli is one of the predominant bacteria of the human gut and is usually harmless however there is a group of diarrhoeagenic E coli which are a significant cause of diarrhoeal illness world wide.

These diarrhoeagenic E coli, classified on the basis of their virulence factors, differ in the severity of disease they can cause. They include Enteroaggregative E coli (EAEC), Enteropathogenic E coli (EPEC), Enterotoxigenic E coli (ETEC), Shiga-like toxin-producing E coli (STEC) including E coli 0157 , and Enteroinvasive E coli (EIEC).

Shigella infection also known as shigellosis is caused by four species. S. flexneri and S sonnei are more commonly detected in Ireland. S dysenteriae and S boydii are mainly associated with travel to endemic areas. Shigella infection can range from mild diarrhoeal disease to severe life-threatening illness.

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Clinical Details

Transmission of pathogenic E coli mainly occurs through consumption of food or water contaminated with human or animal faeces. Person-to-person transmission may also occur, but it is less common.

Pathotype	Clinical Details
EAEC	Transmission of EAEC is generally by the faecal-oral route via contaminated food and water. EAEC cause an inflammatory diarrheal illness characterized by watery and sometimes bloody stool, accompanied by low grade fever, vomiting, and abdominal pain. Asymptomatic carriage can occur.
EPEC	EPEC are a significant cause of infantile diarrhoea particularly in developing countries. EPEC do not produce enterotoxins or Shiga-like toxins instead causing damage to the gut by direct attachment. Infection can result in prolonged or persistent diarrhoea. . Asymptomatic carriage of EPEC also occurs.
ETEC	ETEC are an important cause of diarrhoea in developing countries especially among children, and are the most common bacterial cause of watery diarrhoea in travellers returning from abroad. Illness occurs 1-3 days after exposure and usually lasts 3-4 days although some people may experience more prolonged symptoms. ETEC may also be carried asymptomatically
STEC	May also be referred to as Verocytotoxin producing E coli (VTEC) or Enterohaemorrhagic E Coli (EHEC) STEC are a primary cause of bloody diarrhoea and can progress to a potentially fatal condition known as haemolytic uremic syndrome. The serogroup E coli 0157 is one of the most common strains to cause serious illness. STEC are important foodborne pathogens. Infections may also be waterborne, transmitted person-to-person, or via contact with animals, especially cattle, which are a reservoir for STEC.
EIEC	EIEC invades the colon and produce a watery diarrhoea syndrome that is identical to that caused by Shigella.
Shigella	Shigella are typically transferred through person-to-person contact or ingestion of contaminated food or water (humans and other primates are the only known animal reservoirs). Those most at risk of infection include children in child care centres, overseas travellers and men who have sex with men Severe illness may occur in infection with S dysenteriae whilst S sonnei tends to produce milder symptoms. Asymptomatic carriage can occur.

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Sample Type &

Volume Required

Loose/liquid human faecal sample.

Enfer Medical

Tests/Assays

The test for diarrhoeagenic Escherichia Coli & Shigella offered by Enfer Medical is carried out by real-time multiplexed PCR, as part of an extended gastrointestinal panel. The test is CE-IVD certified.

NOTE: It is not possible to differentiate Shigella from EIEC using this test as the molecular target (iPAH), if found, is in all Shigella species as well as EIEC. To aid in identification of STEC of the 0157 serotype, the panel has a target specific to this serotype. The E coli 0157 result is not reported unless a STEC is also detected.

Panel Tests

The pathogens detected on this panel are:

Bacteria	Viruses	Parasites
Campylobacter	Adenovirus F40/41	Cryptosporidium
Clostridium difficile toxin A/B	Astrovirus	Cyclospora cayetanensis
Plesiomonas shigelloides	Rotavirus A	Entamoeba histolytica
Salmonella	Novovirus GI/GII	Giardia lamblia
Vibrio	Sapovirus (Genogroups I, II, IV and V)
Yersinia enterocolitica
Escherichia coli/Shigella

Patient

Request Form

For clients using the Enfer Medical Client Portal, the Enfer Medical Patient Request Form (PRF) will be generated when you have completed your “Test Request” within the portal linked below.

Enfer Medical Portal

Please note that samples suspected of containing high risk pathogens such as Mycobacterium tuberculosis should be clearly identified on the form and packed separately from other samples.

24 hours

Results are available next working day.

7 Days a Week

This assay is available seven days a week.

Packaging

The packaging/preparation of samples for delivery to the laboratory are required to be in adherence to all national regulations for the safe transport of biological materials. HSE guidance can be reviewed HERE.
There are specific packaging instructions and labelling requirements requiring triple packaging including:

Primary leak-proof container – tube or vial containing the sample.
Secondary watertight container, with absorbent material, intended to protect the primary container.
Outer container protects the secondary container.
Patient Request forms must be placed between the secondary container and the outer shipping container.

Further information on the packaging/preparation of samples for delivery to the laboratory is contained within the Enfer Medical Laboratory User Manual which clients are provided with.

Storage & Stability

Samples must be tested within 4 hours of collection if stored at room temperature. Samples must be tested within 4 days of collection if stored at 2-8°C.

Transporting
Samples

In addition to the packaging of samples, the transport/delivery of clinical samples to the laboratory is required to be in adherence to all national regulations for the safe transport of biological materials. Enfer Medical provides a fully compliant logistics service, aligned with clients’ testing requirements.

Prompt transport of specimens:
To ensure prompt testing of samples and release of results within the published test turnaround times, samples should arrive to the laboratory by 18:00. Test turnaround time is measured from receipt of the sample at the laboratory until the time the authorised results are reported to users.

Acceptance/Rejection
of Samples

In rare cases specimens may not be suitable for testing on arrival to the laboratory. In that case the sample will be rejected at the receipt stage and the service user will be notified immediately and an explanation as to why the sample could not be processed will be provided. Reasons why samples cannot be processed include but are not limited to:

Samples received beyond the stability limits and/or not at the correct temperature indicated for each test.
Incorrect sample type received.
Leaking samples, sample not received or sample insufficient for analysis as stated below within sample requirements.
Non-compliant samples or request forms i.e. those missing sample date information, missing sample test request and/or missing sample site/type information.
Samples received without the necessary patient identifiers.

Clients will be provided with guidance on Sample Receipt Anomalies.

Our Services

Service

Health & Wellness

General health and wellness testing can include a variety of tests, depending on the needs of the individual or recommendations of

Find Out More

Service

Sexual Health

Regular STI screening facilitates early treatment and reduces the long-term consequences of infection.

Find Out More

Service

Respiratory Health

Rapid early pathogen identification has important treatment and infection control implications. See our range of tests here.

Find Out More

Service

Reproductive & Female Health

Hormonal analysis is hugely beneficial to identifying problems that can arise during the reproductive years.

Find Out More

Service

All Services

View the full suite of services at Enfer Medical here.......

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Result Values:

Qualitative results will be reported for each pathogen as:

Qualitative results

DETECTED
NOT DETECTED
INVALID

Please note this is a notifiable disease under the Infectious Diseases (Amendment) Regulations 2020 (S.I. No. 53 of 2020) February 2020.

Please refer to the Health Protection Surveillance Centre for the Case Definitions for Notifiable Diseases:

HPSC Link

Accessing

Your Results

Following receipt at the Laboratory, results should be available on the next working day and will be reported to the referring clinician via the Enfer Medical Client Portal or in a format agreed with clients.

Client Login

Established clients can login to the portal using the link above.