Clinical significance of E. coli O26 isolates on urine specimen of urinary tract infection / 대한산부인과학회지

OBJECTIVE: Escherichia coli (E. coli) O26 has been the most common type of non-O157 human isolates and it has been related with urinary tract infection and its sequelae. So we investigated the clinical significance of E. coli O26 among the cases of urinary tract infection. METHODS: From January, 2005 to December, 2007, the 22 E. coli isolates that were related with urinary tract infection were analyzed. The isolates were identified biochemically by Vitek 1. We performed antisera test by O157, O26, O111 diagnostic antisera about the 22 E. coli isolates. We reviewed clinical history of the same patients retrospectively. RESULTS: 331 E. coli isolates in the urine specimen were isolated from January, 2005 to December, 2007. 175 E. coli isolates that were related with urinary tract infection were analyzed by O157, O26, O111 antisera test. As a result, 22 isolates (13.5%) were O26 antisera positive. There were 8, 3, and 2 cases of watery diarrhea, hemolytic uremic syndrome, thrombotic thrombocytopenic purpura repectively. CONCLUSION: In our study, because E. coli O26 was pathogenic and developed major complications, we concluded that patients with urinary tract infection with E. coli. should examine the antisera test about E. coli O157 and O26.

Aislamiento de Escherichia coli productor de toxina Shiga durante un brote de gastroenteritis en un Jardín Maternal de la Ciudad de Mar del Plata / Isolation of Shiga toxin-producing Escherichia coli strains during a gastrointestinal outbreak at a day care center in Mar del Plata City

Entre el 15 de octubre y el 8 de noviembre de 2003 ocurrió un brote de gastroenteritis en un Jardín Maternal de un Hospital de la ciudad de Mar del Plata. Catorce de un total de 80 niños (17,5%), edad promedio 23,6 ± 13,9 meses, presentaron diarrea, y un caso evolucionó a síndrome urémico hemolítico. La madre de uno de los afectados presentó diarrea simultáneamente. No se pudo establecer el origen del brote, pero probablemente la transmisión haya sido fundamentalmente persona a persona. Las prácticas habituales en el lactario del jardín maternal, y las condiciones inadecuadas de infraestructura y hábitos de higiene de la cocina del Hospital fueron señalados como factores de riesgo. En un caso se detectó Escherichia coli productor de toxina Shiga (STEC) O103:H2, y STEC O26:H11 en otro. En el niño infectado por STEC O26:H11, la excreción se extendió por un período de 37 días. La no detección de STEC en aquellos casos en los cuales el intervalo entre el inicio de los síntomas y la toma de muestra fue mayor a 6 días, enfatiza la necesidad de la recolección temprana de especímenes. Las principales conclusiones de este estudio fueron la necesidad de establecer normas óptimas de higiene, informar rápidamente la ocurrencia de casos de gastroenteritis y confirmar la negativización de la excreción del patógeno.

From October 15 to November 8, 2003, a gastrointestinal outbreak occurred at a day care center in a Hospital in Mar del Plata City. Fourteen out of 80 (17.5%) children, mean age 23.6 ± 13.9 months, and the mother of one of them had diarrhea. One case developed hemolytic uremic syndrome. No conclusive evidence of the origin of the outbreak was found, but the epidemic curve suggested person-to-person spread. The usual practices at the place where infant milk formula was prepared at the day care center, together with the inadequate infrastructure conditions and hygiene practices at the kitchen of the hospital, were considered risk factors. One case had Shiga toxin-producing Escherichia coli (STEC) O103:H2 infection and other STEC O26:H11.The duration of shedding for the child with O26:H11 infection was 37 days. In the other symptomatic children, the pathogen was not recovered from fecal samples collected 6 or more days after the onset of the illness. This emphasizes that the collection of early samples is necessary to recover STEC strains. In order to prevent and control enteric diseases in day care facilities the following measures are necessary: optimal hygiene standards, early case reporting, and exclusion of those who remain culture-positive.

A Case of Thrombotic Thrombocytopenic Purpura Associated with Escherichia coli O26 / 대한진단검사의학회지

Escherichia coli O26 is the most common serotype among the non-O157 E. coli strains producing shiga-toxin (ST) and the cases infected by ST-producing E. coli O26 has been reported with increasing frequency. The infection of ST-producing E. coli O26 can manifest mainly as an acute gastroenteritis and a hemorrhagic colitis, but rarely a hemolytic uremic syndrome or a thrombotic thrombocytopenic purpura (TTP). We reported the first case of TTP associated with E. coli O26 in Korea.

Clinical Significance of Escherichia coli O26 Isolated from Clinical Specimens / 대한임상미생물학회지

BACKGROUND: Non-O157 human isolates among enterohemorrhagic Escherichia coli (EHEC) serogroup have been reported with increasing frequency in recent years; the serotype O26 is the most common among the non-O157 isolates. We performed serotyping of E. coli isolates with O157, O26, and O111 antisera at Ulsan University Hospital and identified 27 isolates of O26. The purpose of this study was to investigate the clinical significance of E. coli O26 isolates. METHODS: During the 24-month period from January 2002 to December 2003, E. coli isolates were serotyped when requested by the physician because of bloody diarrhea or when blood was noted in the stool specimen at the laboratory. The isolates were identified biochemically by Vitek 1 (BioMerieux Vitek Inc., Mo., USA) and serotyped using diagnostic antisera of O157, O26, and O111 (NIH, Korea). When a positive agglutination reaction was shown, the patient's was reviewed retrospectively. RESULTS: Of 4,921 isolates of E. coli during the 2-year period, 200 isolates were serotyped and 27 (13.5%) were identified as serotype O26. These were isolated from stool (13 isolates), urine (9), pus (1), blood (1), and bile (1). Among the 13 patients whose stool specimens grew E. coli O26, 12 had watery diarrhea and 7 bloody diarrhea; two patients had thrombocytopenia and purpura simultaneously. Two patients with watey diarrhea, two with bloody diarrhea, and one with TTP were among the 7 patients with E. coli O26 in the urine. Finally, one patient each with blood isolate and bile isolate of E. coli O26 both had acute gastroenteritis. CONCLUSIONS: Most of the patients infected with E. coli O26 had clinical manifestations consistent with EHEC infections. E. coli isolates from patients with boody diarrhea should be serotyped with O157 and O26 antisera.