Sporadic Case of Hemolytic Uremic Syndrome Associated with Verotoxin Producing Escherichia coli O2: K1: H7

Cases of enterohaemorrhagic Escherichia coli (EHEC) are being increasingly reported in Japan. Bacteriological isolation of EHEC has been a constant problem because the organism is shed for a short duration after onset on illness and generally during the prodromal stages. In order to ease the diagnosis of EHEC infections in this country, we have developed a LPS-based solid phase enzyme linked immunosorbent assay for serological diagnosis of the infection. Adequate knowledge on the prevalence of EHEC serogroups in Japan is mandatory for the success of such a diagnostic test. O157 is currently the prominent serogroup associated with EHEC infections in Japan followed by O111, O26 and O128 in that order of prevalence. In February 1992, a 1 year-old infant developed hemolytic uremic syndrome (HUS) 15 days later the prodrome of watery diarrhoea. Stool sample obtained on day 15 was cultured for detection of EHEC. Ten colonies of E. coli picked from MacConkey agar plate were examined by the polymerase chain reaction (PCR) using primers specific for both verotoxins (VT1 and VT2). Of the 10 colonies, only one was positive for the VT2 gene. The strain was confirmed to be cytotoxic on cultured Vero cells. The strain agglutinated with antisera of E. coli O2, Ki and with 117 serogroups. As of date, none of such strains of O2: K1: H7 EHEC has been reported in Japan. The patient's sera was found to be positive for antibodies against LPS from the homologous isolate as well as against VT2. The patient recovered uneventfully from HUS 40 days after the onset of the disease and was discharged from the hospital.