Diarrhea in young children associated with Escherichia coli non-O157 organisms that produce Shiga-like toxin☆,☆☆,★,★★
Section snippets
Patients
In 1994 we examined all children and adolescents less than 16 years of age who were hospitalized in either of the two children's hospitals in Würzburg, Germany, for the presence of diarrhea and recorded their clinical and demographic data. The two hospitals serve the children of a population of about 600,000 people, 104,000 of whom are less than 16 years of age and 39,000 less than 6 years of age.27 About 150,000 people live in the metropolitan area, the rest in a rural environment; the mean
RESULTS
During the 12-month period of 1994, a total of 468 hospitalized children were recognized as having diarrhea. The median age of patients was 3 years 4 months; 201 patients (43%) were female.
By standard culture techniques, a bacterial pathogen was identified in the stools of 71 children (15%). Salmonella was found in 63 children (13.5%). Of 63 isolates, 47 were Salmonella enteritidis. Campylobacter jejuni was found in 6 children (1.3%), and Yersinia enterocolitica in 2 (0.4%).
Colonies of E. coli
DISCUSSION
Non-O157:H7 SLTEC organisms were the second most frequent bacterial agent associated with diarrheal disease in this cohort of hospitalized children with diarrhea. The spectrum of illness was broader than previously reported25, 26 and did not differ from other infectious diarrhea. Among 13 children, we found two patients with bloody diarrhea, and one of them had incomplete HUS. A study from Seattle found one case of bloody diarrhea and no case of HUS among five children infected with non-O157:H7
Acknowledgements
We are grateful to Dr. G. Fricke, Kinderklinik am Mönchberg, Würzburg, for allowing us to study his patients. We thank Barbara Plaschke for technical assistance.
References (34)
Etiology and mechanisms of acute infectious diarrhea in infants in the United States
J PEDIATR
(1991)- et al.
Serological and biochemical properties of Shiga-like toxin (verocytotoxin)-producing strains of Escherichia coli, other than O-group 157, from patients in Germany
Int J Med Microbiol Virol Parasitol Infect Dis
(1992) - et al.
Sporadic cases of haemolytic-uraemic syndrome associated with faecal cytotoxin and cytotoxin-producing Escherichia coli in stools
Lancet
(1983) - et al.
Epidemiology of hemolytic-uremic syndrome in Canadian children from 1986 to 1988
J PEDIATR
(1991) - et al.
Haemorrhagic colitis and Vero-cytotoxin-producing Escherichia coli in England and Wales
Lancet
(1987) - et al.
Hemolytic-uremic syndrome and diarrhea associated with Escherichia coli 0157:H7 in a day care center
J PEDIATR
(1986) - et al.
Hospital-acquired Escherichia coli O157:H7-associated haemolytic-uraemic syndrome in a nurse
Lancet
(1988) - et al.
Epidemic Escherichia coli O157:H7 gastroenteritis and hemolytic-uremic syndrome in a Canadian Inuit community: intestinal illness in family members as a risk factor
J PEDIATR
(1994) - et al.
Shiga-like toxin-producing Escherichia coli in Seattle children: a prospective study
Gastroenterology
(1993) - et al.
High incidence of serum antibodies to Escherichia coli O157 lipopolysaccharide in children with hemolytic-uremic syndrome
J PEDIATR
(1991)
The epidemiology of infections caused by Escherichia coli O157:H7, other enterohemorrhagic E. coli, and the associated hemolytic-uremic syndrome
Epidemiol Rev
Escherichia coli O157:H7 and the hemolytic-uremic syndrome
N Engl J Med
Escherichia coli O157:H7: clinical. diagnostic, and epidemiological aspects of human infection
Clin Infect Dis
A DNA probe to identify enterohemorrhagic Escherichia coli of O157:H7 and other serotypes that cause hemorrhagic colitis and hemolytic-uremic syndrome
J Infect Dis
Molecular analysis of the plasmid-encoded hemolysin of Escherichia coli O157:H7 strain EDL 933
Infect Immun
Cloning and characterization of the eae gene of enterohaemorrhagic Escherichia coli O157:H7
Mol Microbiol
Escherichia coli O157:H7-associated hemolytic-uremic syndrome after ingestion of contaminated hamburgers
J PEDIATR
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Comparison of 2 proposed MLVA protocols for subtyping non-O157: H7 verotoxigenic Escherichia coli
2014, Diagnostic Microbiology and Infectious DiseaseCitation Excerpt :Multiple locus VNTR analysis (MLVA) is a reliable tool, able to establish genetic relationships between bacterial strains for epidemiological surveillance and molecular subtyping of pathogens such as verotoxigenic Escherichia coli (VTEC) (Keys et al., 2005; Lindstedt et al., 2003, 2004, 2007; Noller et al., 2003, 2004, 2006). VTEC has been identified as an important causal agent of hemolytic uremic syndrome (HUS) and bloody diarrhea (Griffin, 1998), being a frequently cause of gastrointestinal disease in America and Europe (Beutin et al., 1998; Huppertz et al., 1996; Johnson et al., 2006). Cattle colonized by VTEC are thought to be the primary reservoir of this bacterium, and its transmission to humans frequently results from the ingestion of contaminated food of bovine origin (Karmali, 1989; Nataro and Kaper, 1998).
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2011, Veterinary MicrobiologyCitation Excerpt :In Australia (Goldwater and Bettelheim, 1996) and Argentina (Lopez et al., 1989) VTEC non-O157 infections appear to be more common than E. coli O157:H7 infections. In Germany VTEC non-O157 have even replaced VTEC O157 as the most commonly isolated VTEC from patients with HUS (Huppertz et al., 1996). While the epidemiology of VTEC O157 is well established, epidemiological studies on VTEC non-O157 are limited.
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2010, Kidney InternationalCitation Excerpt :An established HUS episode with a documented preceding diarrhea was labeled as D+ HUS. Presence of non-bloody diarrhea was not an exclusion criterion.42 Exclusion criteria were a D+ HUS from an outbreak, a diagnosis of atypical HUS or use of plasma therapy (suspicion of thrombotic thrombocytopenic purpura).
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2008, Advances in Food and Nutrition ResearchCitation Excerpt :In particular, EHEC strains also contain the LEE, PAI and they form characteristic A/E lesions on cultured mammalian cells and in animals (Knutton et al., 1989; Tzipori et al., 1986). In fact, intimin, which is essential in EPEC pathogenesis as discussed above, is also found in EHEC O157 and other EHEC serotypes (Huppertz et al., 1996; Yu and Kaper, 1992). Although intimin is one of the only adhesins in EHEC demonstrated to play a role in colonization in vivo (Donnenberg et al., 1993), many other putative fimbrial and afimbrial adhesins have been identified in EHEC strains including Efa1 (Nicholls et al., 2000), LP fimbriae (Torres et al., 2002), curli (Kim and Kim, 2004), F9 (type I pilus homolog) (Low et al., 2006), E. coli common pilus (ECP) (Rendon et al., 2007), and type IV pilus (TFP) (Srimanote et al., 2002).
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From Children's Hospital and the Institute for Hygiene and Medical Microbiology, University of Würzburg, Würzburg, Germany, and the National Reference Center for Enterobacteriaceae, Hamburg, Germany
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Supported by Biotest GmbH, Dreieich, Germany.
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Reprint requests: Hans-Iko Huppertz, MD, Universitätskinderklinik, Josef-Schneider-Str. 2, D-97080 Würzburg, Germany.
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