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      Shiga Toxin–Producing Escherichia coli Infections Associated with Hemolytic Uremic Syndrome, Italy, 1988–2000

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          Abstract

          The mean annual incidence of hemolytic uremic syndrome in persons <15 years of age in Italy from 1988 to 2000 was 0.28 per 100,000 population. Laboratory investigations showed that Shiga toxin–producing Escherichia coli (STEC) infection occurred in 73.1% of patients. STEC O157 was the most common serotype, but a considerable number of cases were from infections by non-O157 STEC.

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          The United States National Prospective Hemolytic Uremic Syndrome Study: microbiologic, serologic, clinical, and epidemiologic findings.

          Wayne Greene, Adam Wells, Stefan Green … (2001)
          The frequency of Shiga toxin-producing Escherichia coli (STEC) serotypes associated with postdiarrheal hemolytic uremic syndrome (HUS) cases among children and adults in the United States and the proportion with IgM or IgG lipopolysaccharide antibodies to E. coli O157 were determined by use of a nationwide sample from January 1987 through December 1991. Among 83 patients, STEC were isolated from 30 (43%) of 70 whose stool cultures yielded bacterial growth (25 E. coli O157 isolates and 5 non-O157 STEC isolates). Fifty-three (80%) of 66 patients with serum samples had positive O157 lipopolysaccharide antibody titers. Of the 83 patients, 60 (72%) had evidence of STEC infection, including 6 of 8 adults whose illnesses also met criteria for thrombotic thrombocytopenic purpura. Data from a subset of patients suggest that E. coli O157 was the cause of > or = 80% of the STEC infections. All 3 women who were postpartum had evidence of E. coli O157 infection. STEC infection should be considered the likely cause for all persons with postdiarrheal HUS.
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            Haemolytic uraemic syndromes in the British Isles 1985-8: association with verocytotoxin producing Escherichia coli. Part 1: Clinical and epidemiological aspects.

            H Kleanthous, David Taylor, D Milford … (1990)
            A prospective study of the clinical and epidemiological features of the haemolytic uraemic syndromes was conducted over a three year period in the British Isles. Two hundred and ninety eight children were reported. In two thirds of cases stool samples were analysed for the presence of Verocytotoxin producing Escherichia coli (VTEC) and neutralisable Verocytotoxin. A total of 273 (95%) patients had a prodrome of diarrhoea. In these a seasonal variation in the incidence of haemolytic uraemic syndrome was demonstrated, the 1-2 year age range was most often affected, and the peripheral blood neutrophil count correlated positively with an adverse outcome. Patients presenting without diarrhoea showed none of these associations and had a significantly greater morbidity and mortality. Evidence for VTEC infection was found in 58 (33%) of 178 diarrhoea associated cases whose stools were analysed, although VTEC were identified in five of eight (62%) patients whose stools were collected within three days of the onset of diarrhoea. Most isolates produced VT2 either alone, or together with VT1. There was no evidence of VTEC infection in patients without prodromal diarrhoea.
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              The role of Escherichia coli O 157 infections in the classical (enteropathic) haemolytic uraemic syndrome: results of a Central European, multicentre study.

              J Burén, H-G König, Christoph Müller … (1993)
              To assess the importance of infection by Verotoxin (VT) producing Escherichia coli (VTEC) in children with HUS in Central Europe, stool and/or serum samples obtained from 147 patients from 28 paediatric centres were prospectively examined for the presence of VTEC and the kinetics of faecal VT titres (FVT), and for VT neutralization titres and antibodies against E. coli O 157 lipopolysaccharide, respectively. Ninety-two percent of the patients had classic (enteropathic) HUS (E+ HUS). Evidence of VTEC infection was obtained in 86% of them. VTEC/FVT were identified in 55/118 E+ cases (47%). A prominent feature was the frequent isolation of sorbitol-fermenting, VT2-producing E. coli O 157.H-.VT1 (C600/H19) was neutralized by 9%, and VT2 (C600/933W) by 99% of the initial serum samples from E+ patients, compared to 3% (VT1) and 100% (VT2) from age-related controls. Fourfold titre rises against VT1 and/or VT2 were observed in 13/70 (19%), and significantly elevated O 157 LPS IgM and/or IgA antibodies in 106/128 (83%) of the E+ patients. The ubiquitous VT2 neutralizing principle in the serum of HUS patients as of healthy controls warrants further investigations.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Emerg Infect Dis
                Journal ID (publisher-id): EID
                Title: Emerging Infectious Diseases
                Publisher: Centers for Disease Control and Prevention
                ISSN (Print): 1080-6040
                ISSN (Electronic): 1080-6059
                Publication date (Print): January 2003
                Volume: 9
                Issue: 1
                Pages: 106-108
                Affiliations
                [* ]Istituto Superiore di Sanità, Rome, Italy
                [† ]Ospedale Pediatrico Bambino Gesù, Rome, Italy
                [‡ ]Pediatric Clinic “De Marchi,” Milan, Italy
                [§ ]University of Padua, Padua, Italy
                []Santobono Hospital, Naples, Italy
                [# ]Giovanni XXIII Hospital, Bari, Italy
                [** ]Regina Margherita Hospital, Turin, Italy.
                Author notes
                Address for correspondence: Dr. A.E. Tozzi, Department of Communicable Disease, Unit of Epidemiology and Biostatistics, Istituto Superiore di Sanità, V. le R. Elena 299 00161 Roma – Italy; fax +39 06 49387292; e-mail: tozzi@ 123456iss.it
                Article
                Publisher ID: 02-0266
                DOI: 10.3201/eid0901.020266
                PMC ID: 2873761
                PubMed ID: 12533290
                SO-VID: 0b9d09aa-e443-470c-852f-b0d2baafa52b
                History
                Categories
                Subject: Research

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: shiga toxin-producing escherichia coli,hemolytic uremic syndrome,stec,epidemiology,hus,laboratory diagnosis,research
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: shiga toxin-producing escherichia coli, hemolytic uremic syndrome, stec, epidemiology, hus, laboratory diagnosis, research

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