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Non-O157 Shiga toxin-producing Escherichia coli infections in the United States, 1983-2002.
J Infect Dis. 2005 Oct 15; 192(8):1422-9.JI

Abstract

BACKGROUND

Shiga toxin-producing Escherichia coli (STEC) O157:H7 is a well-recognized cause of bloody diarrhea and hemolytic-uremic syndrome (HUS). Non-O157 STEC contribute to this burden of illness but have been underrecognized as a result of diagnostic limitations and inadequate surveillance.

METHODS

Between 1983 and 2002, 43 state public health laboratories submitted 940 human non-O157 STEC isolates from persons with sporadic illnesses to the Centers for Diseases Control and Prevention reference laboratory for confirmation and serotyping.

RESULTS

The most common serogroups were O26 (22%), O111 (16%), O103 (12%), O121 (8%), O45 (7%), and O145 (5%). Non-O157 STEC infections were most frequent during the summer and among young persons (median age, 12 years; interquartile range, 3-37 years). Virulence gene profiles were as follows: 61% stx(1) but not stx(2); 22% stx(2) but not stx(1); 17% both stx(1) and stx(2); 84% intimin (eae); and 86% enterohemolysin (E-hly). stx(2) was strongly associated with an increased risk of HUS, and eae was strongly associated with an increased risk of bloody diarrhea. STEC O111 accounted for most cases of HUS and was also the cause of 3 of 7 non-O157 STEC outbreaks reported in the United States.

CONCLUSIONS

Non-O157 STEC can cause severe illness that is comparable to the illness caused by STEC O157. Strains that produce Shiga toxin 2 are much more likely to cause HUS than are those that produce Shiga toxin 1 alone. Improving surveillance will more fully elucidate the incidence and pathological spectrum of these emerging agents. These efforts require increased clinical suspicion, improved clinical laboratory isolation, and continued serotyping of isolates in public health laboratories.

Authors+Show Affiliations

Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. zud4@cdc.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16170761

Citation

Brooks, John T., et al. "Non-O157 Shiga Toxin-producing Escherichia Coli Infections in the United States, 1983-2002." The Journal of Infectious Diseases, vol. 192, no. 8, 2005, pp. 1422-9.
Brooks JT, Sowers EG, Wells JG, et al. Non-O157 Shiga toxin-producing Escherichia coli infections in the United States, 1983-2002. J Infect Dis. 2005;192(8):1422-9.
Brooks, J. T., Sowers, E. G., Wells, J. G., Greene, K. D., Griffin, P. M., Hoekstra, R. M., & Strockbine, N. A. (2005). Non-O157 Shiga toxin-producing Escherichia coli infections in the United States, 1983-2002. The Journal of Infectious Diseases, 192(8), 1422-9.
Brooks JT, et al. Non-O157 Shiga Toxin-producing Escherichia Coli Infections in the United States, 1983-2002. J Infect Dis. 2005 Oct 15;192(8):1422-9. PubMed PMID: 16170761.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Non-O157 Shiga toxin-producing Escherichia coli infections in the United States, 1983-2002. AU - Brooks,John T, AU - Sowers,Evangeline G, AU - Wells,Joy G, AU - Greene,Katherine D, AU - Griffin,Patricia M, AU - Hoekstra,Robert M, AU - Strockbine,Nancy A, Y1 - 2005/09/14/ PY - 2005/03/23/received PY - 2005/05/18/accepted PY - 2005/9/20/pubmed PY - 2005/12/13/medline PY - 2005/9/20/entrez SP - 1422 EP - 9 JF - The Journal of infectious diseases JO - J. Infect. Dis. VL - 192 IS - 8 N2 - BACKGROUND: Shiga toxin-producing Escherichia coli (STEC) O157:H7 is a well-recognized cause of bloody diarrhea and hemolytic-uremic syndrome (HUS). Non-O157 STEC contribute to this burden of illness but have been underrecognized as a result of diagnostic limitations and inadequate surveillance. METHODS: Between 1983 and 2002, 43 state public health laboratories submitted 940 human non-O157 STEC isolates from persons with sporadic illnesses to the Centers for Diseases Control and Prevention reference laboratory for confirmation and serotyping. RESULTS: The most common serogroups were O26 (22%), O111 (16%), O103 (12%), O121 (8%), O45 (7%), and O145 (5%). Non-O157 STEC infections were most frequent during the summer and among young persons (median age, 12 years; interquartile range, 3-37 years). Virulence gene profiles were as follows: 61% stx(1) but not stx(2); 22% stx(2) but not stx(1); 17% both stx(1) and stx(2); 84% intimin (eae); and 86% enterohemolysin (E-hly). stx(2) was strongly associated with an increased risk of HUS, and eae was strongly associated with an increased risk of bloody diarrhea. STEC O111 accounted for most cases of HUS and was also the cause of 3 of 7 non-O157 STEC outbreaks reported in the United States. CONCLUSIONS: Non-O157 STEC can cause severe illness that is comparable to the illness caused by STEC O157. Strains that produce Shiga toxin 2 are much more likely to cause HUS than are those that produce Shiga toxin 1 alone. Improving surveillance will more fully elucidate the incidence and pathological spectrum of these emerging agents. These efforts require increased clinical suspicion, improved clinical laboratory isolation, and continued serotyping of isolates in public health laboratories. SN - 0022-1899 UR - https://www.unboundmedicine.com/medline/citation/16170761/Non_O157_Shiga_toxin_producing_Escherichia_coli_infections_in_the_United_States_1983_2002_ L2 - https://academic.oup.com/jid/article-lookup/doi/10.1086/466536 DB - PRIME DP - Unbound Medicine ER -