title: Cluster of hemolytic-uremic syndrome caused by Shiga toxin-producing Escherichia coli O26:H11.
abstract: BACKGROUND
  The epidemiology and clinical characteristics of the hemolytic-uremic syndrome (HUS) caused by Escherichia coli O157:H7 are well-known, but HUS attributable to non-O157:H7 Shiga toxin (Stx)-producing E. coli (STEC) are less thoroughly described. Here we report a cluster of HUS cases caused by STEC O26:H11 the most common non-O157:H7 STEC isolated from sporadic cases of HUS in Europe.
  
  
  METHODS
  Three children between 13 and 17 months of age, living in the same small town, developed HUS within an interval of 5 days. We present clinical and microbiologic data on the patients and their infecting isolates.
  
  
  RESULTS
  The clinical course ranged from mild uncomplicated HUS to severe HUS complicated by multiorgan involvement. Microbiologic investigation demonstrated STEC of serotype O26:H11 in stools of all the patients. The phenotypic and molecular characterization of the STEC O26:H11 isolates demonstrated that these strains were identical and, unusual for STEC O26, they harbored the stx2 but not the stx1 gene. None of the patients had evidence of STEC O157:H7 infection either by culture or by E. coli O157 serology. The source of the STEC O26:H11 infection was undetermined.
  
  
  CONCLUSIONS
  Our results demonstrate that diagnostic procedures based on the detection of stx genes and/or Stx production and subsequent subtyping of the isolates using molecular methods are necessary to identify such outbreaks caused by non-O157:H7 STEC.
authors.affiliation: Department of Pediatrics, Children's Hospital of Friedrich-Schiller-University, Kochstrasse 2, D-07745 Jena, Germany. joachim.misselwitz@med.uni-jena.de
authors.forename: Joachim
authors.initials: J
authors.lastname: Misselwitz
authors.forename: Helge
authors.initials: H
authors.lastname: Karch
authors.forename: Martina
authors.initials: M
authors.lastname: Bielazewska
authors.forename: Ulrike
authors.initials: U
authors.lastname: John
authors.forename: Felix
authors.initials: F
authors.lastname: Ringelmann
authors.forename: Gabriele
authors.initials: G
authors.lastname: Rönnefarth
authors.forename: Ludwig
authors.initials: L
authors.lastname: Patzer
mesh_terms: D016000:Cluster Analysis; D004196:Disease Outbreaks; D019453:Escherichia coli O157 / Q000302:isolation & purification*; D005243:Feces / Q000382:microbiology; D005260:Female; D005798:Genes, Bacterial; D005858:Germany / Q000453:epidemiology; D006463:Hemolytic-Uremic Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D018189:Immunomagnetic Separation; D015994:Incidence; D007223:Infant; D008297:Male; D018570:Risk Assessment; D012494:Sampling Studies; D012698:Serologic Tests; D012720:Severity of Illness Index; D022621:Shiga Toxin / Q000009:adverse effects*
chemical_list: D022621:Shiga Toxin