title: Shiga-like toxin-producing Escherichia coli O111 and associated hemolytic-uremic syndrome: a family outbreak.
abstract: OBJECTIVE
  To describe a family cluster of Shiga toxin-producing Escherichia coli O111ac:NM infection.
  
  
  METHODS
  The index case was identified as part of a United States prospective study of hemolytic-uremic syndrome. Epidemiologic investigation was conducted through interviews. E. coli O111:NM infection was characterized through culture and serology. Shiga toxin 1 and 2 gene sequences were determined with oligonucleotide DNA probes.
  
  
  RESULTS
  All three children and both parents had nonbloody diarrhea, vomiting and abdominal cramps, and one child developed hemolytic-uremic syndrome. Shiga toxin 1- and 2-producing E. coli O111ac:NM was isolated from two children. IgG antibodies to E. coli O111 were detected in all three children.
  
  
  CONCLUSIONS
  To our knowledge this is the first reported cluster of O111 infection and only the second caused by non-O157 Shiga toxin-producing E. coli in North America.
authors.affiliation: Foodborne and Diarrheal Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
authors.forename: N
authors.initials: N
authors.lastname: Banatvala
authors.forename: M M
authors.initials: MM
authors.lastname: Debeukelaer
authors.forename: P M
authors.initials: PM
authors.lastname: Griffin
authors.forename: T J
authors.initials: TJ
authors.lastname: Barrett
authors.forename: K D
authors.initials: KD
authors.lastname: Greene
authors.forename: J H
authors.initials: JH
authors.lastname: Green
authors.forename: J G
authors.initials: JG
authors.lastname: Wells
mesh_terms: D001427:Bacterial Toxins / Q000032:analysis; D002675:Child, Preschool; D016000:Cluster Analysis; D004768:Enterotoxins / Q000032:analysis*; D004926:Escherichia coli / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D007223:Infant; D008297:Male; D012698:Serologic Tests; D012703:Serotyping; D022603:Shiga Toxins
chemical_list: D001427:Bacterial Toxins; D004768:Enterotoxins; D022603:Shiga Toxins