

@article {7659,
	title = {Detection, isolation, and molecular subtyping of Escherichia coli O157 : H7 and Campylobacter jejuni associated with a large waterborne outbreak},
	journal = {Journal of Clinical Microbiology},
	volume = {41},
	number = {1},
	year = {2003},
	note = {Detection, isolation, and molecular subtyping of Escherichia coli O157 : H7 and Campylobacter jejuni associated with a large waterborne outbreak; 193; J English Article Limberger, RJ, New York State Dept Hlth, Wadsworth Ctr, David Axelrod Inst Publ Hlth, POB 22002,120 New Scotland Ave, Albany, NY 12201 USA 12 AMER SOC MICROBIOLOGY WASHINGTON 1752 N ST NW, WASHINGTON, DC 20036-2904 USA J CLIN MICROBIOL JAN Discipline: Microbiology 635NY NOT IN FILE 0095-1137 New York State Dept Hlth, Wadsworth Ctr, David Axelrod Inst Publ Hlth, Albany, NY 12201 USA. New York State Dept Hlth, Ctr Community Hlth, Albany, NY 12201 USA. New York State Dept Hlth, Ctr Environm Hlth, Albany, NY 12201 USA. Ctr Dis Control \& Prevent, Epidemiol Program Off, Epidem Intelligence Serv, Atlanta, GA USA.; ID: 22},
	pages = {174-180},
	abstract = {<p>The largest reported outbreak of waterborne Escherichia coli O157:117 in the United States occurred in upstate New York following a county fair in August 1999. Culture methods were used to isolate E. coli O157:H7 from specimens from 128 of 775 patients with suspected infections. Campylobacter jejuni was also isolated from stools of 44 persons who developed diarrheal illness after attending this fair. There was one case of a confirmed coinfection with E. coli O157:H7 and C. jejuni. Molecular detection of stx(1) and stx(2) Shiga toxin genes, immunomagnetic separation (IMS), and selective culture enrichment were utilized to detect and isolate E. coli O157:H7 from an unchlorinated well and its distribution points, a dry well, and a nearby septic tank. PCR for stx(1) and stx(2) was shown to provide a useful screen for toxin-producing E. coli O157:H7, and IMS subculture improved recovery. Pulsed-field gel electrophoresis (PFGE) was used to compare patient and environmental E. coli O157:H7 isolates. Among patient isolates, 117 of 128 (91.5\%) were type 1 or 1a (three or fewer bands different). Among the water distribution system isolates, 13 of 19 (68\%) were type 1 or 1a. Additionally, PFGE of C jejuni isolates revealed that 29 of 35 (83\%) had indistinguishable PFGE patterns. The PFGE results implicated the water distribution system as the main source of the E. coli O157:H7 outbreak. This investigation demonstrates the potential for outbreaks involving more than one pathogen and the importance of analyzing isolates from multiple patients and environmental samples to develop a better understanding of bacterial transmission during an outbreak</p>
},
	keywords = {APPLE CIDER, Bacterial, Campylobacter jejuni, CAMPYLOBACTER-JEJUNI, CLONAL TURNOVER, COLI, Culture, Detection, distribution system, Environmental water, ENVIRONMENTAL-SAMPLES, Escherichia coli, ESCHERICHIA-COLI, FIELD GEL-ELECTROPHORESIS, FOOD SAMPLES, GEL-ELECTROPHORESIS, GENE, Hemolytic-Uremic Syndrome, Immunomagnetic Separation, infection, infections, JEJUNI, methods, Microbiology, MULTIPLEX PCR, OUTBREAK, OUTBREAKS, PCR, POLYMERASE-CHAIN-REACTION, SAMPLES, SYSTEM, TOXIN, UNITED-STATES, water, WATERBORNE OUTBREAK, WELL},
	author = {Bopp,D. J. and Sauders,B. D. and Waring,A. L. and Ackelsberg,J. and Dumas,N. and Braun-Howland,E. and Dziewulski,D. and Wallace,B. J. and Kelly,M. and Halse,T. and Musser,K. A. and Smith,P. F. and Morse,D. L. and Limberger,R. J.}
}
