Shiga toxin-producing Escherichia coli (STEC): diagnosis and notification
Information for clinicians on diagnosis and notification of Shiga toxin-producing Escherichia coli (STEC) and haemolytic uraemic syndrome (HUS).
This document provides advice for clinicians on:
- diagnosis of聽STEC
- identification of children at risk
- statutory notification requirements
STEC聽infections may be acquired by consuming contaminated food, such as meat (for example, under-cooked burgers), salad vegetables or dairy products, or by exposure to farm animals or contaminated soil. The illness frequently presents as abdominal pain, diarrhoea with or without blood in stool, vomiting and dehydration. Up to 15% of paediatric cases of聽STEC聽progress to haemolytic uraemic syndrome (HUS), which is a triad of microangiopathic haemolytic anaemia, acute renal failure and thrombocytopenia.
HUS聽is the most common cause of acute renal failure in children below 5 years of age. More than 90% cases of聽HUS聽are caused by聽STEC聽(previously known as Vero cytotoxin-producing Escherichia coli,聽VTEC), and聽STEC-HUS聽associated fatalities, particularly in children, have occurred in the recent years.
Diagnosis of STEC-HUS is often missed due to lack of appropriate testing. It is important to test a faecal sample 鈥� or, if stool is unavailable, a rectal swab (bacterial culture swab or charcoal swab) 鈥� to facilitate a rapid diagnosis and identification of children at risk of developing HUS. Swabs or faecal samples should be sent to the local microbiology laboratory labelled as 鈥榮uspected STEC鈥� or 鈥榮uspected HUS鈥�.
It is particularly important to obtain a faecal or rectal specimen from children below 5 years of age, the elderly and the immunocompromised, when there:
- has been admission to hospital with gastroenteritis and/or聽HUS
- are severe symptoms and signs of gastroenteritis, such as bloody diarrhoea
- are symptoms and signs of gastroenteritis that have not resolved by 72 hours
HUS聽cases must be notified to the local health protection team on clinical suspicion, regardless of the microbiology results, and suspected cases discussed with the local paediatrician and/or renal physician to arrange further blood tests.
For additional information, see聽.