Epidemiology and Infection

Research Article

The role of Escherichia coli O 157 infections in the classical (enteropathic) haemolytic uraemic syndrome: Results of a Central European, multicentre study

M. Bitzana1 p1, K. Ludwiga1, M. Klemta1, H. Königa1, J. Bürena1 and D. E. Müller-Wiefela1

a1 Kinderklinik, Universitätskrankenhaus Hamburg-Eppendorf, Martinistraβe 52, D-2000 Hamburg 20, Federal Republic of Germany


To assess the importance of infection by Verotoxin (VT) producing Escherichia coli (VTEC) in children with HUS in Central Europe, stool and/or serum samples obtained from 147 patients from 28 paediatric centres were prospectively examined for the presence of VTEC and the kinetics of faecal VT titres (FVT), and for VT neutralization titres and antibodies against E. coli O 157 lipopolysaccharide, respectively. Ninety-two percent of the patients had classic (enteropathic) HUS (E+ HUS). Evidence of VTEC infection was obtained in 86% of them. VTEC/FVT were identified in 55/118 E+ cases (47%). A prominent feature was the frequent isolation of sorbitol-fermenting, VT2-producing E. coli O 157. H. VT1 (C600/H19) was neutralized by 9%, and VT2 (C600/933W) by 99% of the initial serum samples from E+ patients, compared to 3% (VT1) and 100% (VT2) from age-related controls. Fourfold titre rises against VT1 and/or VT2 were observed in 13/70 (19%), and significantly elevated O 157 LPS IgM and/or IgA antibodies in 106/128 (83%) of the E+ patients. The ubiquitous VT2 neutralizing principle in the serum of HUS patients as of healthy controls warrants further investigations.

(Accepted October 12 1992)


p1 Present address and reprint requests: Dr Martin Bitzan, The Hospital for Siek Children, Department of Microbiology, 555 University Avenue, Toronto, Ontario. Canada M5G 1X8.