Premium
CHARACTERISTICS OF SHIGA TOXIN‐PRODUCING E. COLI CAUSING HUS IN AUSTRALIA
Author(s) -
Elliot EJ,
RobinsBrowne R,
Hogg G
Publication year - 2001
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2001.ca01-16.x
Subject(s) - medicine , shiga toxin , outbreak , bloody diarrhea , serotype , virulence , diarrhea , etiology , vomiting , microbiology and biotechnology , shigella dysenteriae , asymptomatic , shiga like toxin , shigella , salmonella , virology , escherichia coli , biology , bacteria , biochemistry , genetics , gene
Infection with Shiga toxin‐producing E. coli (STEC) may be asymptomatic or may result in gastroenteritis or hemorrhagic colitis. Haemolytic uraemic syndrome is a rare complication of gastrointestinal infection with STEC seen mainly in children. It is characterised by microangiopathic haemolytic anaemia, thrombocytopenia and acute renal failure. In Europe, North America and Japan, STEC O157:H7 is commonly implicated as the cause of HUS. Shigella dysenteriae is frequently implicated in developing communities. Aim To determine the aetiology of HUS in Australia and the type and virulence characteristics of stool pathogens. Methods Active, national surveillance for HUS with monthly reporting by paediatricians. Stool culture, serotyping and virulence characteristics (production of Shiga toxin [Stx] 1 & 2 and enterohaemolysin, and carriage of eae gene) of isolates in specialised laboratories. Results Between July 1994–December 2000, 134 children with HUS were identified (114 with ‘diarrhoea‐associated’ HUS (20 comprised an outbreak) and 20 with ‘atypical’ HUS. Of 114 cases with gastrointestinal symptoms, 59 were male, mean (SD) age 50 (43) months, range 2–169 months (71% < 5 years). All had anaemia and acute renal failure. Symptoms included diarrhoea (96%), bloody diarrhoea (47%), and vomiting 78%. Stool +/or sera were received from 74 (65%) STEC serotypes from 44 cases included O111:H‐ (26), O113:H21 (5), O157:H‐ (2), O157:H? (2), and one each of O26:H‐, O111:H8, O76:H7, O15:H‐, O130:H11, O1:H7, OR:H9, ONT:H7, ONT:H‐. The most common isolate was O111:H‐, which also caused the outbreak. All O111:H‐ produced Stx1, Stx2 and enterohaemolysin and carried eae . Other isolates had ≥1 but not all these virulence characteristics. Conclusions A heterogeneous group of STEC was associated with HUS in Australia and differs from that described elsewhere. In particular, STEC O111:H‐ predominated and no STEC O157:H7 was isolated. These findings have implications for laboratory diagnosis and epidemiological tracing of STEC‐associated infections.