Haemolytic uraemic syndromes in the British Isles, 1985-8: association with verocytotoxin producing Escherichia coli. Part 2: Microbiological aspects.

H Kleanthous, H R Smith, S M Scotland, R J Gross, B Rowe, C M Taylor, D V Milford

Department of Nephrology, Children's Hospital, Birmingham.

In a three year study of children under 16 years with haemolytic uraemic syndrome faecal samples were examined for the presence of Verocytotoxin producing Escherichia coli (VTEC) using DNA probes and for free neutralisable Verocytotoxin in a Vero cell assay with specific antisera. There was evidence of VTEC infection in 58 of 185 (31%) samples. A total of 53 VTEC was identified from patients with haemolytic uraemic syndrome. Thirty eight VTEC belonged to serotype O157:H7 or O157:H-, 34 produced VT2 only, and four strains produced both VT1 and VT2. The remaining 15 VTEC belonged to nine different O serogroups; three strains produced VT1, 10 produced VT2, and two were positive for VT1 and VT2. Three control groups of patients without haemolytic uraemic syndrome were also examined. There was evidence of VTEC infection in 8%, 6%, and 4% of specimens from individuals with bloody diarrhoea, those with diarrhoea only, and healthy controls respectively. VTEC from the bloody diarrhoeal and diarrhoeal controls were O157:H7 but those from the healty controls could not be O serogrouped. This study confirms the association of VTEC, and particularly strains of O157:H7, with haemolytic uraemic syndrome. Strains producing VT1, VT2, or both toxins were isolated, although over 94% of VTEC produced VT2 alone or together with VT1.

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