In January 2025, Santé publique France detected several cases of hemolytic uremic syndrome (HUS) in adults caused by a rare serotype of Shiga toxin-producing Escherichia coli, STEC O77g:H18. Epidemiological and traceability investigations linked the consumption of raw-milk cheese to these cases. The outbreak strain belonged to sequence type 69 (ST69) and harbored a Shiga toxin (stx) subtype stx2d located on a unique prophage. Putative virulence genes cdt-VABC, hlyE, fimH, and lpfA were detected; however, STEC virulence genes (eae and aggR) were absent. Phylogenetic analysis of E. coli O77g strains from public databases (Enterobase and NCBI) placed the outbreak strain within a cluster of clinical E. coli O77g:H18, ST69, stx2d strains isolated between 2012 and 2025, including one linked to a HUS case in France and three in Australia. This strain, distinct from O77g:H18 strains previously isolated from dairy products, is therefore not a new lineage. The closest cluster contains eight stx-negative strains isolated from poultry between 1990 and 2024 in Europe and North America. Differences in virulence gene composition between the "outbreak cluster" and the "poultry cluster" suggest a common ancestor that has diverged over time. The "outbreak cluster" is characterized by strains carrying an IncFIA/FIB plasmid encoding a putative enterotoxin gene (elt) absent in other E. coli strains in GenBank. We developed qPCR assays specific for the putative enterotoxin and O77g O-group. Combined with a PCR for stx2, these assays allow rapid screening of suspect unpasteurized cheese for the outbreak strain.IMPORTANCEThe emergence of hybrid pathotypes of Shiga toxin-producing Escherichia coli (STEC) has been of importance in recent years in public health. This outbreak, related to a rare serotype of STEC and involving an enterotoxigenic E. coli (ETEC)/STEC hybrid, highlights the necessity of phylogenetic analyses to investigate the origin of contamination with such strains. Our study suggests a common ancestor between the outbreak strain and strains isolated from poultry. We also provided molecular tools to target specifically this outbreak strain and help in future epidemiological investigations.
Analysis of the genetic and phylogenetic context of Escherichia coli O77g:H18 associated with clustered cases of HUS in France in 2025
Fabien Vorimore·Sabine Delannoy·Aurélie Cointe·Justine de Larminat·Philippe Bidet·Stéphane Bonacorsi·Carolina Silva Nodari·François-Xavier Weill·Patrick Fach·Maï-Lan Tran

