Shigatoxin-producing Escherichia coli (STEC), also known as Verocytotoxin-producing Escherichia coli (VTEC), infections constitute a major public health concern, as they are able to cause severe illnesses such as haemorrhagic colitis and haemolytic uremic syndrome, especially among children and the elderly. STEC are zoonotic pathogens, ruminants being recognized as the major reservoir for human infections. The large number of outbreaks occurring all over the world underlines the importance of these pathogens and highlights the need for both mandatory disease notification and cooperation between laboratories within and beyond state boundaries. The majority of the severe cases worldwide are caused by strains belonging to serogroups O157, O26, O111, O103 and O145, but, as the detection and typing technology improves, other serogroups are constantly reported.
Escherichia coli is part of the normal micro flora of the gastrointestinal tract of mammals and birds, but certain strains have been associated with gastrointestinal diseases in both humans and animals. These E. coli strains have been categorised into pathogenicity groups, based on their virulence properties . One of these groups is characterised by the production of potent cytotoxins that inhibit the protein synthesis within eukaryotic cells. These toxins are either termed verocytotoxins (VT), because of their activity on Vero cells, or Shiga toxins (Stx), because of their similarity with the toxin produced by Shigella dysenteriae . Therefore, these strains are either termed VT-producing E. coli (VTEC) or Stx-producing E. coli (STEC).
Enterohaemorrhagic E. coli (EHEC) constitute a subset of serotypes of STEC that has been firmly associated with bloody diarrhoea and haemolytic uraemic syndrome (HUS) in industrialised countries [5, 18]. The majority of the cases of severe disease are caused by strains of serotype O157:H7, but infections sustained by strains belonging to serogroups other than O157, like O26, O111, O103, and O145 have been increasingly reported [18, 25]. These strains are now usually referred to as non–O157 EHEC.
Stxs are considered to be the major virulence factor of STEC and comprise a family of structurally related cytotoxins with similar biological activity. The two main groups consist of Stx1, which is nearly identical to the toxin of S. dysenteriae type 1, and Stx2, which shares less than 60 % amino acid sequence with Stx1 . The genetic information for the production of Stx1 and Stx2 is located in the genome of lambdoid prophages integrated in the STEC chromosome . Whereas Stx1shows only little sequence variations, several variants of Stx2 with altered antigenic or biological characteristics have been described. Epidemiological studies have revealed that Stx2 is more associated with severe human disease than Stx1 . A certain number of variants are produced by strains of animal origin and are rarely observed in human isolates: Stx2e is mainly found in STEC causing oedema disease in pigs and Stx2f appears to be closely associated with STEC of avian origin .
Attaching and effacing adhesion
Most STEC included in the EHEC group colonise the intestinal mucosa with a mechanism that subverts the epithelial cell function  and induce a characteristic histopathologic lesion, defined as "attaching and effacing"(A/E). The A/E lesion is due to marked cytoskeletal changes and is characterised by effacement of microvilli and intimate adherence between the bacteria and the epithelial cell membrane, with accumulation of polymerised actin directly beneath the adherent bacteria . The complex mechanism of A/E adhesion is genetically governed by a large pathogenicity island (PAI) defined as Locus of Enterocyte Effacement (LEE) [8, 18].
Other virulence factors
Genetic analysis of the complete DNA sequence of STEC O157:H7  showed that almost 20 % of its chromosome is constituted by foreign DNA not present in the chromosome of E. coli K-12 and that has been probably acquired from other bacterial species through horizontal gene transfer. Similarly to the LEE, other regions of this foreign DNA can be considered as putative PAIs since they carry virulence-associated genes, show a lower GC content, and are inserted in tRNA loci. In particular, a PAI termed O#122 is present in most EHEC and enteropathogenic E. coli (EPEC), but not in other groups of E. coli .
STEC O157 possess a large virulence plasmid of approximately 90 Kb termed pO157. The nucleotide sequence of this plasmid showed that it encodes 35 proteins, some of which are presumably involved in the pathogenesis of EHEC infections . The enterohaemolysin (hly) operon is considered the best marker of the presence of pO157 and is also present in the large plasmids that can be detected in most non-O157 EHEC strains . Other putative virulence factors harboured by this plasmid comprise a katalase-peroxyidase and a serine protease, encoded by katP and espP genes, respectively . Another virulence gene, termed toxB, has been recently described in pO157  and it appears to be present in all the STEC O157 isolates .
STEC are zoonotic pathogens
STEC can be found in the gut of numerous animal species, but ruminants have been identified as a major reservoir of STEC that are highly virulent to humans, in particular STEC O157.
Cattle are considered to be the most important source of human infections with STEC O157, being asymptomatic excretors of the organism, which is a transient member of their normal gut micro flora . STEC O157 have also been frequently isolated from the intestinal content of sheep that is now considered a reservoir for human infection . STEC O157 has also been isolated from goats  and water buffalo .
STEC have been sporadically isolated from mammals other than ruminants, like pigs , horses , dogs  and farmed rabbits  but these species are not considered as actual hosts but rather as vectors transiently colonised after a contact with ruminant dejections.
Epidemiology of STEC infections
During the 1980s, most of the outbreaks of STEC O157 infection were food-borne and the food vehicles implicated were mostly inadequately cooked beef products and unpasteurised milk . In the past ten years, several outbreaks have been associated with low pH products like fermented salami, mayonnaise and yogurt . This has highlighted the tolerance of E. coli O157 to acidic pH and its ability to survive the processes of fermentation and drying. In addition, waterborne outbreaks and outbreaks associated with other types of environment-related exposures have been increasingly reported [14, 24]. The dispersion of untreated manure in the environment can cause the contamination of different items, which can then act as secondary vehicles of human infections [5, 7, 14].
An increasing spectrum of fruits and vegetables fertilised with ruminants’ manure or contaminated during harvesting or processing has been involved in outbreaks [5, 14, 24].
Having animals and raw products that are free from STEC is not feasible in practice. However, their occurrence can be minimised by applying high standards of hygiene in all the steps of the food production chain.
At the farm level, good hygiene and management practices remains at the present the best way to reduce the spread and persistence of STEC O157 in the farm.
STEC can survive in bovine faeces for a considerable time , therefore the handling of the animal dejections represents an important issue and manure and slurries should be properly composted to ensure the reduction of the microbial load [11, 13].
Farmers and people visiting farms should apply hygiene practices. In particular, farms receiving school visits must ensure that adults always control children, facilities for hand washing are easily available, and areas for food consume are clearly separated from those where the animals are kept.
At the abattoir level, good hygiene and manufacturing practices as well as implementation of HACCP will contribute in reducing faecal contamination of carcasses.
The general principles of food hygiene will be effective in preventing STEC infections also at the processing and retail levels of the food chain.
 Boerlin P., McEwen S.A., Boerlin-Petzold F., Wilson J.B., Johnson R.P., Gyles C.L., Associations between virulence factors of Shiga toxin-producing Escherichia coli and disease in humans, J. Clin. Microbiol. 37 (1999) 497-503.
 Bonardi S., Brindani F., Pizzin G., Lucidi L., D'Incau M., Liebana E., Morabito S., Detection of Salmonella spp., Yersinia enterocolitica and verocytotoxin-producing Escherichia coli O157 in pigs at slaughter in Italy, Int. J. Food. Microbiol. 85 (2003) 101-110.
 Burland V., Shao Y., Perna N.T., Plunkett G., Sofia H.J., Blattner F.R., The complete DNA sequence and analysis of the large virulence plasmid of Escherichia coli O157:H7, Nucleic Acids Res. 26 (1998) 4196-4204.
 Brunder W., Schmidt H., Frosch M., Karch H., The large plasmids of Shiga-toxin-producing Escherichia coli (STEC) are highly variable genetic elements, Microbiology 145 (1999)1005-1014.
 Caprioli A., Morabito S., Brugere H, Oswald E., Enterohaemorrhagic Escherichia coli: emerging issues on virulence and modes of transmission, Vet. Res. 36 (2005) 289311.
 Chalmers R.M., Salmon R.L., Willshaw G.A., Cheasty T., Looker N., Davies I., Wray C., Vero-cytotoxin-producing Escherichia coli O157 in a farmer handling horses, Lancet 349 (1997) 1816.
 Coia J.E., Sharp J.C., Campbell D.M., Curnow J., Ramsay C.N., Environmental risk factors for sporadic Escherichia coli O157 infection in Scotland: results of a descriptive epidemiology study, J. Infect. 36 (1998) 317-321.
 Frankel G., Phillips A. D., Rosenshine I., Dougan G., Kaper J. B. Knutton S., Enteropathogenic and enterohaemorrhagic Escherichia coli: more subversive elements, Mol. Microbiol. 30 (1998) 911-921.
 Galiero G., Conedera G., Alfano D., Caprioli A., Isolation of verocytotoxin-producing Escherichia coli O157 from water buffaloes (Bubalus bubalis) in southern Italy, Vet Rec. 156 (2005) 382-383.
 Heuvelink A.E., Van den Biggelaar F.L., De Boer E., Herbes R.G., Melchers W.J., Huis in 't Veld J.H., Monnens L.A., Isolation and characterization of verocytotoxin-producing Escherichia coli O157 strains from Dutch cattle and sheep, J. Clin. Microbiol. 36 (1998) 878-882.
 Jiang X., Morgan J., Doyle M.P., Fate of Escherichia coli O157:H7 during composting of bovine manure in a laboratoryscale bioreactor, J. Food Prot. 66 (2003) 25-30.
 Leclercq A., Mahillon J., Farmed rabbits and ducks as vectors for VTEC O157:H7, Vet. Rec. 152 (2003) 723-724.
 Lung A.J., Lin C.M., Kim J.M., Marshall M.R., Nordstedt R., Thompson N.P., Wei C.I., Destruction of Escherichia coli O157:H7 and Salmonella enteritidis in cow manure composting, J. Food Prot. 64 (2001) 1309-1314.
 McDowell D.A., Sheridan J.J., Survival and growth of Vero cytotoxin-producing E. coli in the environment, In Duffy G., Garvey P., McDowell D. (Eds.), Verocytotoxigenic Escherichia coli, Food & Nutrition Press INC. (2001) 279-304.
 Melton-Chelsa A.R., O'Brien A., Structure, biology, and relative toxicity of Shiga toxin family members for cells and animals. In Kaper J.B., O’Brien A. D. (Eds.), Escherichia coli O157:H7 and other Shiga toxin-producing E. coli strains. American Society for Microbiology, Washington, DC. (1998) 121-128.
 Meng J., Doyle M.P., Microbiology of Shiga-Toxin-Producing Escherichia coli in foods, In: Kaper, J.B., O’Brien, A. D. (Eds.), Escherichia coli O157:H7 and other Shiga-Toxin-Producing E. coli. American Society for Microbiology, Washington, DC, (1998) 92-108.
 Morabito S., Tozzoli R., Oswald E., Caprioli A., A mosaic pathogenicity island made up of the locus of enterocyte effacement and a pathogenicity island of Escherichia coli O157:H7 is frequently present in attaching and effacing E. coli, Infect. Immun. 71 (2003) 3343-3348.
 Nataro J.P. Kaper J.B., Diarrheagenic Escherichia coli, Clin. Microbiol. Rev. 11 (1998) 142-201.
 Perna N.T., Plunkett G. 3rd, Burland V., Mau B., Glasner J.D., Rose D.J., Mayhew G. F., Evans P.S., Gregor J., Kirkpatrick H.A., Posfai G., Hackett J., Klink S., Boutin A., Shao Y., Miller L., Grotbeck E.J., Davis N.W., Lim A., Dimalanta E.T., Potamousis K.D., Apodaca J., Anantharaman T.S., Lin J., Yen G., Schwartz D.C., Welch R.A. Blattner F.R., Genome sequence of enterohaemorrhagic Escherichia coli O157:H7, Nature 409 (2001) 529-533.
 Pritchard G.C., Willshaw G.A., Bailey J.R.,Carson T., Cheasty T., Verocytotoxin-producing Escherichia coli O157 on a farm open to the public: outbreak investigation and longitudinal bacteriological study, Vet. Rec. 147 (2000) 259-264.
 Schmidt H., Scheef J., Morabito S., Caprioli A., Wieler L.H., Karch H., A new Shiga toxin 2 variant (Stx2f) from Escherichia coli isolated from pigeons, Appl. Environ. Microbiol. 66 (2000) 12051208.
 Schmidt H., Bitzan M., Karch H., Pathogenic aspects of Shiga toxin-producing E. coli infections in humans. In Duffy G., Garvey P., McDowell D. (Eds.), Verocytotoxigenic Escherichia coli, Food & Nutrition Press INC. (2001) 241-262.
 Tatsuno I., Kimura H., Okutani A., Kanamaru K., Abe H., Nagai S., Makino K., Shinagawa H., Yoshida M., Sato K., Nakamoto J., Tobe T. Sasakawa C., Isolation and characterization of miniTn5Km2 insertion mutants of enterohemorragic Escherichia coli O157:H7 deficient in adherence to Caco-2 cells, Infect. Immun. 68 (2000) 5943-5952.
 Tozzi A.E., Gorietti S., Caprioli A., Epidemiology of human infections by Escherichia coli O157 and other verocytotoxinproducing E .coli, In Duffy G., Garvey P., McDowell D. (Eds.), Verocytotoxigenic Escherichia coli, Food & Nutrition Press INC. (2001) 161-179.
 Tozzi A.E., Caprioli A., Minelli F., Gianviti A., De Petris L., Edefonti A., Montini G., Ferretti A., De Palo T., Gaido M., Rizzoni G., Hemolytic Uremic Syndrome Study Group, Shiga toxinproducing Escherichia coli infections associated with hemolytic uremic syndrome, Italy, 1988-2000, Emerg. Infect. Dis. 9 (2003) 106-108.
 Tozzoli R., Caprioli A., Morabito S., Detection of toxB, a plasmid virulence gene of Escherichia coli O157, in enterohemorrhagic and enteropathogenic E. coli, J. Clin. Microbiol. 43(2005) 40524056.
 Trevena W.B., Hooper R.S., Wray C., Willswaw G.A., Cheasty T., Domingue G., Vero cytotoxin-producing Escherichia coli O157 associated with companion animals, Vet. Rec. 138 (1996) 400.
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