Highly Virulent E. coli O26, Scotland | CDC EID

Escherichia coliKevin G.J.Pollock, Sheetal Bhojani, T.James Beattie, Lesley Allison, Mary Hanson, Mary E.Locking, and John M.Cowden
Author affiliations: Health Protection Scotland, Glasgow, Scotland (K.G.J.Pollock, M.E.Locking, J.M.Cowden); Yorkhill Hospital, Glasgow (T.J.Beattie, S.Bhojani); and Scottish E.coli O157/VTEC Reference Laboratory, Edinburgh, Scotland (L.Allison, M.Hanson)
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To the Editor: Hemolytic uremic syndrome (HUS) is a rare disorder characterized by microangiopathic hemolytic anemia, microthrombi, and multiorgan injury.HUS is one of the commonest causes of acute renal failure in children worldwide and is most frequently precipitated by infection with verotoxin-producing Escherichia coli (VTEC) such as E.coli O157 (1).However, non-O157 VTEC serotypes have been increasingly found in the development of HUS (24).
Although previous surveillance of childhood HUS in Scotland identified E.coli O157 in >90% of cases, non-O157 serotypes have also been a*sociated with HUS (5).In 2010, several particularly severe cases of HUS were reported to Health Protection Scotland by a consultant pediatric nephrologist.Subsequent tests identified the pathogen in these cases as E.coli O26.However, in a recent study of pediatric HUS cases in Europe, children infected with E.coli O26 did not exhibit different clinical signs and symptoms from patients infected with other VTEC serotypes (6). To establish whether the host pathophysiologic responses to E.coli O157 and E.coli O26 strains differed, we analyzed a cohort of children with HUS who were infected with these VTEC serotypes.
In Scotland, most patients with pediatric thrombotic microangiopathy are referred to a specialist pediatric hospital, which immediately reports cases of HUS to Health Protection Scotland as part of national surveillance.To test the hypothesis that E.coli O26 was more virulent than E.coli O157, we performed an age-matched, nested casecase study of HUS patients and compared host clinical markers, treatment, and outcomes from pediatric cases in 2010.Data collection has been described elsewhere (5).The statistical significances of a*sociations between categorical variables were investigated by using П