Necrotoxic Escherichia coli (NTEC): two emerging categories of human and animal pathogens.

Necrotoxic Escherichia coli (NTEC) were originally defined as strains of E. coli producing a toxin called cytotoxic necrotising factor (CNF). Two types of CNF have been identified, each of them being genetically linked to several other specific virulence markers, a situation that allows the definition of two distinct homogeneous categories of NTEC called NTEC-1 and NTEC-2. CNF1 and CNF2 are highly homologous holoproteins containing 1,014 amino acids that exert both lethal and necrotic activities in vivo and induce multinucleation and actin stress fibres in cell cultures. The activity of CNFs on mammal cells is due to their ability to constitutively activate by deamidation the Rho proteins, a family of small GTPases that regulate the physiology of the cell cytoskeleton. In NTEC-1, the gene encoding CNF1 belongs to a pathogenicity island which also comprises the genes encoding for alpha-haemolysin and P-fimbriae. In NTEC-2 strains, CNF2 is encoded by a plasmid that also encodes, in 100% of the isolates, a new member of the cytolethal distending toxin family (CDT-III) and in about 50% of the isolates, the F17b-fimbrial adhesin that confers the ability to adhere to calf intestinal villi. The presence of CDT is also suspected in a large majority of NTEC-1 strains. NTEC-1 strains can be found in humans and in all species of domestic mammals, whereas NTEC-2 strains have only been reported in ruminants. The implication of NTEC strains has been clearly established in extra-intestinal infections of humans and animals, for instance in urinary tract infections for NTEC-1 strains. Their role in severe dysenteric syndromes, both in humans and animals, is substantiated by several clinical reports, but there is little published information on this pathogenicity in animal models of infection. The combined production of several powerful toxins (haemolysin, CNF, CDT) by NTEC strains makes them, however, potentially aggressive pathogens which deserve to be searched for on a larger scale. Moreover, NTEC-1 from man and animals appear to be highly related according to available molecular markers, which indicates that domestic animals could constitute reservoirs of NTEC strains which are pathogenic for humans.