Epidemiology and diagnosis of shiga toxin-producing Escherichia coli infections

Shiga toxin-producing Escherichia coli (STEC) have been identified as a wor ldwide cause of serious human gastrointestinal disease and the life-threate ning hemolytic uremic syndrome. The most common serotype implicated is E. c oli O157: H7, but infections involving various non-O157 serotypes have been found with increasing frequency in many countries. Food-borne outbreaks ca used by STEC can affect large numbers of people and cause serious morbidity , making the bacteria one of the most important emerging pathogens. Because there is no specific treatment of the disease currently available, there i s an urgent need for effective preventive measures based on a detailed unde rstanding of the epidemiology of STEC infections. Such measures will also b e dependent on the availability of rapid, sensitive, and simple procedures for the detection of the pathogens both in human samples and in samples of nonhuman origins such as food. This review summarizes the current knowledge on the epidemiology of STEC infection and presents a survey of laboratory methods currently available for diagnosis of STEC. Special attention is giv en to new diagnostic procedures for the less readily detectable non-O157 ST EC strains and to simple procedures, usually based on commercially availabl e kits, that can be used in routine clinical microbiological laboratories. (C) 1999 Elsevier Science Inc.