title: Shiga Toxin-Producing Escherichia coli in Diarrheal Stool of Swedish Children: Evaluation of Polymerase Chain Reaction Screening and Duration of Shiga Toxin Shedding.
abstract: BACKGROUND
  Shiga toxin (Stx)-producing Escherichia coli (STECs) are the most common cause of acute renal failure in children. The present study evaluated a 10-year STEC polymerase chain reaction screening regimen in children.
  
  
  METHODS
  All routine stool culture specimens from patients below 10 years of age (n = 10 342) from May 2003 through April 2013 in the County of Jönköping, Sweden, were included. Patients were divided in 1 group where analyses of STEC were requested by the clinician (n = 2366) and 1 screening group (n = 7976). Patients who were positive for STEC were tested weekly until they were negative. Clinical data were collected through a questionnaire and by reviewing medical records.
  
  
  RESULTS
  In specimens from 191 patients, stx was found (162 index cases). The prevalence was 1.8% in the requested group and 1.5% in the screening group (P = .5). Diarrhea was the most frequent symptom reported in 156 cases and of these 29 (19%) had hemorrhagic colitis (HC) and 7 children developed hemolytic uremic syndrome (HUS). No difference regarding severity of symptoms between the groups was found. Stx2 predominated in cases with HC (P < .0001) and HUS (P = .04). Median stx shedding duration was 20 days (1-256 days), and no difference in duration was seen between stx types (P = .106-1.00) and presence of eaeA (P = .72).
  
  
  CONCLUSIONS
  Most STEC cases were found in the screening group with comparable prevalence and disease severity as in patients where analysis was requested. Furthermore, non-O157 serotypes caused severe disease when carrying stx2, and prolonged shedding of STEC may be a risk for transmission.
authors.affiliation: Department of Clinical Microbiology, County Hospital Ryhov, Jönköping, Sweden.
authors.forename: Andreas
authors.initials: A
authors.lastname: Matussek
authors.affiliation: Department of Communicable Disease Control, County of Jönköping, Sweden.
authors.forename: Ing-Marie
authors.initials: IM
authors.lastname: Einemo
authors.affiliation: Department of Clinical Microbiology, County Hospital Ryhov, Jönköping, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Jogenfors
authors.affiliation: Public Health Agency of Sweden, Solna.
authors.forename: Sven
authors.initials: S
authors.lastname: Löfdahl
authors.affiliation: Department of Clinical Microbiology, County Hospital Ryhov, Jönköping, Sweden.
authors.forename: Sture
authors.initials: S
authors.lastname: Löfgren
mesh_terms: D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000382:microbiology*; D004927:Escherichia coli Infections / Q000175:diagnosis*; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016133:Polymerase Chain Reaction; D022621:Shiga Toxin; D054323:Shiga-Toxigenic Escherichia coli / Q000302:isolation & purification*; D013548:Sweden
chemical_list: D022621:Shiga Toxin
keywords: STEC; Shiga toxin; screening; serotype; shedding