Shiga toxin-producing Escherichia coli in children with diarrhea: a prospective point-of-care study.
OBJECTIVE
To conduct a prospective cohort study to determine the frequency and characteristics of Shiga toxin (Stx)-producing Escherichia coli (STEC) infections in children with diarrhea attending an emergency department and a private clinic in Seattle, Washington.


METHODS
Between November 1998 and October 2001, 1851 stools were processed for STEC by sorbitol-MacConkey (SMAC) agar screening and a commercial Stx enzyme immunoassay (EIA).


RESULTS
STEC belonging to serotypes O157:H7 (n = 28), O103:H2 (n = 4), O118:H16 (n = 2), O26:H11, O111:nonmotile, O111:H8, O121:H19, and O rough:H11 (n = 1 each) were recovered from 39 (2.1%) stools. EIA and SMAC agar detected 89% and 100% of the patients with E coli O157:H7, respectively. E coli O157:H7-infected patients had significantly higher frequencies of bloody stools, fecal leukocytes, and abdominal tenderness and shorter symptom duration. Hemolytic uremic syndrome developed in 5 (18%) and none of the children infected with E coli O157:H7 and non-O157:H7 STEC, respectively (P =.30).


CONCLUSIONS
E coli O157:H7 is the predominant STEC in this population. Children infected with E coli O157:H7 have clinical presentations different from those whose stools contain non-O157:H7 STEC. Culture and Stx detection are needed to optimally detect STEC of all serotypes in stools. SMAC agar screening should not be replaced by EIA.
Department of Pediatrics, University of Washington and Children's Hospital and Regional Medical Center, Seattle, Washington, 98105, USA.
Eileen J
EJ
Klein
Jennifer R
JR
Stapp
Carla R
CR
Clausen
Daniel R
DR
Boster
Joy G
JG
Wells
Xuan
X
Qin
David L
DL
Swerdlow
Phillip I
PI
Tarr
D000293:Adolescent; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D015331:Cohort Studies; D003967:Diarrhea / Q000382:microbiology* / Q000628:therapy; D004636:Emergency Service, Hospital; D004926:Escherichia coli / Q000145:classification / Q000302:isolation & purification / Q000378:metabolism; D004927:Escherichia coli Infections / Q000382:microbiology / Q000628:therapy; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D007229:Infant Welfare; D008297:Male; D019095:Point-of-Care Systems; D011446:Prospective Studies; D022621:Shiga Toxin / Q000009:adverse effects* / Q000096:biosynthesis*; D013223:Statistics as Topic; D014861:Washington
D022621:Shiga Toxin