DIARRHEA IN YOUNG-CHILDREN ASSOCIATED WITH ESCHERICHIA-COLI NON-O157 ORGANISMS THAT PRODUCE SHIGA-LIKE TOXIN

Objective: To assess the clinical manifestations and incidence of infe ction associated with Shiga-like toxin-producing Escherichia coil (SLT EC). Study design: Children with diarrhea within a defined geographic area during a 12-month period were examined for the presence of SLTEC in their stools by polymerase chain reaction with the use of primers t hat were complementary to sequences of Shiga-like toxins types I and I I and to other virulence factors. Results: There were 13 SLTEC infecti ons among 468 children with diarrhea. Besides Shiga-like toxin sequenc es, the virulence genes eae and EHEC-hly were found in 10 isolates; th ese isolates were categorized as enterohemorrhagic E. coil (EHEC). Onl y 2 of 13 isolates were of the O157 strain, All reported cases occurre d in summer (June through September) with the exception of one case in April, The infections were sporadic, and the infected children lived in rural and urban areas, Three infections in children with disabiliti es were hospital acquired. The majority of children had watery diarrhe a, two had bloody diarrhea, and one had mild hemolytic-uremic syndrome . The overall incidence of SLTEC infection wets 12.5 hospitalized chil dren per 100,000 children less than 16 years of age. Conclusions: The most frequent clinical manifestation of SLTEC infection was watery dia rrhea indistinguishable from other forms of infectious diarrhea, The s hift from the O157 strain toward non-O157 SLTEC strains associated wit h diarrhea, also observed in German patients with hemolytic-uremic syn drome, points to a change in the epidemiologic features of SLTEC-assoc iated disease, Testing for non-O157 SLTEC should be considered in chil dren with diarrhea without a recognized cause.