title: Non-O157:H7 Shiga Toxin Producing DiarrhoeagenicEscherichia coli(STEC) in Southern India: A Tinderbox for Starting Epidemic.
abstract: BACKGROUND
  Outbreaks due to non-O157:H7 Shiga toxin producingEscherichia coli(STEC) resulting in Haemolytic Uraemic Syndrome (HUS) have garnered much attention because of associated mortality transcending across continents and also because diarrhoea due toE.coliitself is rare in developed countries. The actual incidence of non-O157:H7 STEC in sporadic acute diarrhoea is not fully elucidated, both in developing as well as in developed countries. Due to larger extent of faecal-oral transmission in developing countries it is prudent to look for non-O157: H7 STEC in such epidemiological settings because of very high potential to spread across larger geographical regions and cause life threatening illness.
  
  
  OBJECTIVE
  To determine the extent of acute diarrhoea caused by Shiga toxin producingE. coliand measure their genotypic diversity.
  
  
  METHODS
  The study was designed as a cross-sectional study and conducted between 2009-2011 in department of Microbiology at JN Medical College Belgaum (Karnataka) and Regional Medical Research Center, Belgaum (RMRC-ICMR). Stool samples from 300 sporadic cases of acute diarrhoea were processed by microscopy, culture, for the identification of diarrhoeagenic pathogens viz.Vibrio cholera,Shigellaspp.,Salmonellaspp. and protozoan parasites. PCR was performed for the detection ofeaeandstxgenes inE. coliisolates. Their relatedness was determined by Random Amplification of Polymorphic DNA (RAPD).
  
  
  RESULTS
  PCR detectedstxalong witheaein 23.2% culture isolates ofE.coliisolated from diarrhoea samples. Only three isolates were identified as STEC by serology as O59, O60 and O69 serotypes. Eleven clones were detected by RAPD fingerprinting in the 46 STEC isolates.
  
  
  CONCLUSIONS
  Non-O157:H7 STEC are prevalent in this region and laboratories shall look beyond O157:H7 serotype ofE.coli. These isolates have potential of causing outbreaks transcending borders. Hence they shall be reported and efforts be made to identify their sources and prevent spread.
authors.affiliation: Associate Professor, Department of Microbiology, All India Institute of Medical Sciences (AIIMS) , Bhopal, (M.P.), India .
authors.forename: Shashank
authors.initials: S
authors.lastname: Purwar
authors.affiliation: Scientist E, Regional Medical Research Centre (ICMR) , Belgaum, Karnataka, India .
authors.forename: Subrana
authors.initials: S
authors.lastname: Roy
authors.affiliation: Professor, Department of Microbiology, Jawaharlal Nehru Medical College Belgaum, Karnataka, India .
authors.forename: Sharada
authors.initials: S
authors.lastname: Metgud
keywords: Diarrhoea; Enterohaemorrhagic E.Coli (EHEC); Haemolytic Uraemic Syndrome (HUS); Verotoxigenic E.Coli (VTEC)