Published Date: 2002-11-01 23:50:00
Subject: PRO/AH> E. coli O157, sorbitol fermenting - UK (Scotland)
Archive Number: 20021101.5685
E. COLI O157, SORBITOL FERMENTING - UK (SCOTLAND)
A ProMED-mail post
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International Society for Infectious Diseases
Date: 31 Oct 2002
From: ProMED-mail <firstname.lastname@example.org>
Source: Eurosurveillance Weekly 31 Oct 2001 [edited]
HUS due to a sorbitol-fermenting verotoxigenic _E. coli_ O157 in Scotland
The Scottish _Escherichia coli_ O157 Reference Laboratory (SERL) has
reported the isolation of a sorbitol-fermenting verotoxigenic _E. coli_
(VTEC) O157 strain from a 5-year-old child with hemolytic uremic syndrome
(HUS) (1). No source of infection has yet been identified.
In addition to fermenting sorbitol, the organism is tellurite sensitive and
beta-glucuronidase positive. Consequently, laboratories should be cautious
of the over-reliance on visual identification of _E. coli_ O157 on both
SMAC and CT-SMAC plates if clinical suspicion of infection with VTEC is
high. This case also highlights the importance of forwarding
culture-negative stools from patients presenting with clinical symptoms
suggestive of a VTEC infection to the appropriate national reference
laboratory for further testing. Such action was recommended by a Scottish
task force in 2001 (2).
Although first recognized in Germany in 1988 (3), sorbitol-fermenting,
verotoxigenic _E. coli _O157 was thought to be restricted to continental
Europe (4) until a recent isolation in Australia earlier this year (5).
This is thought to be the first isolation in the United Kingdom.
We are grateful to the Laboratory of Enteric Pathogens, Public Health
Laboratory Service, London, England, for confirming the identification of
the organism. Work is continuing at both centers to further characterize
the strain. An update will be published in the Communicable Disease Report
(<http://www.phls.org.uk/publications/cdr/index.html>) in November 2002.
1. SCIEH. Sorbitol-fermenting, verotoxigenic _E. coli_ 0157. SCIEH Weekly
Report 2002; 43: 281.
Task Force on _E. coli_ O157 - Final Report - June 2001.
2. Karch H, Bohm H, Schmidt H, Gunzer F, Aleksic S, Heesemann J. Clonal
structure and pathogenicity of shiga-like toxin-producing,
sorbitol-fermenting _Escherichia coli_ O157:H-. J Clin Microbiol 1993;
3. Karch H, Bielaszewska M. Sorbitol-fermenting shiga toxin-producing
_Escherichia coli_ O157:H- strains: epidemiology, phenotypic and molecular
characteristics, and microbiological diagnosis. J Clin Microbiol 2001;39:
4. Bettleheim KA, Whipp M, Djordjevic SP, Ramachandran V. First isolation
outside Europe of sorbitol-fermenting verocytotoxigenic _Escherichia coli_
(VTEC) belonging to O group O157. J Med Microbiol 2002; 51: 713-4.
Reported by Lesley Allison (email@example.com), Scottish
_E.coli_ O157 Reference Laboratory, Edinburgh, Scotland.
[Sorbitol-positive isolates of _E. coli_ O157 present a significant problem
in screening stools for this pathogen, as the lack of sorbitol fermenting
is usually a prime criterion. As this report points out, if clinical
suspicion exists, potential isolates should be sent to reference
laboratories. Lactose-fermenting Salmonella species represent a similar
McDonough PL; Shin SJ; Lein DH: Diagnostic and public health dilemma of
lacto fermenting _Salmonella enterica_ serotype typhimurium in cattle in
the northeastern United States. J Clin Microbiol 2000 Mar;38:1221-6 - Mod.LL]