The Emerging Clinical Importance of Non-O157 Shiga Toxin?Producing Escherichia coli
Clin Infect Dis. (2006) 43(12): 1587-1595 doi:10.1086/509573
James M. Hughes, Mary E. Wilson, Kristine E. Johnson, Cheleste M. Thorpe, and Cynthia L. Sears
Non-O157 Stec Clinical Disease: Subtle to Deadly
Non-O157 STEC pose a substantial dilemma for the clinician, because these bacteria cause illnesses indistinguishable from O157-induced disease and many other foodborne enteric infections. Data defining the overall frequency of non-O157 STEC compared with that of other enteric pathogens are limited. In this review, we analyzed nonoutbreak studies to try to define the community base of non-O157 STEC?associated disease. In 2 studies involving 11 sites in the United States in 1997 and 4 sites during the period 1998?1999, screening of 13,798 stool samples by EIA for STEC yielded a frequency of 0.9% (120 cases of STEC) [5]. Of these 120 cases, isolates were available from 104; 48 (46%) of the isolates were non-O157 STEC, and 56 (54%) were O157 STEC. These isolation rates are similar to rates for Shigella species in some locales. Such data suggest that there is a significant burden of non-O157 STEC?associated disease in the United States that is underappreciated. Further, global ?hot spots? exist in which non-O157 STEC serogroups dominate over O157 serogroups, including Argentina, Australia, and Germany (table 1). For example, in Germany, non-O157 STEC account for up to 80% of STEC-associated diarrheal illnesses [14].
