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We agree with the authors that active surveillance of haemolytic uraemic syndrome (HUS) patients allows the detection of outbreaks of virulent STEC strains and that underascertainement of verocytotoxin-producing E. coli (VTEC) is explained by the non-routine practice of culturing stools, by the under-use of sorbitol-MacConkey (SMAC) agar, and by the fact that most clinical laboratories do not test for these micro-organisms in routine gastroenteritis samples.

euro surveillance/eurosurveillance

Author's reply: Looking for tips to find icebergs - surveillance of haemolytic uraemic syndrome to detect outbreaks of Shiga toxin-producing E. coli infection