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Disease associations by Shiga-toxin producing Escherichia coli (STEC) serogroup and genotype

Disease associations by Shiga-toxin producing Escherichia coli (STEC) serogroup and genotype

Representative STEC serogroups or serotypes*	Shiga toxin 1 gene^¶	Shiga toxin 2 gene^¶	Common disease phenotype	HUS risk
O157:H7 Sorbitol-nonfermenting O157:NM^Δ O26^◊ O111^§ O145	+	+	Bloody diarrhea	Yes
O157:H7 Sorbitol-fermenting O157:NM^Δ O104:H4^¥ O92 O113 O121 O145	–	+	Bloody diarrhea	Yes
O26^◊ O45 O103 O145	+	–	Non-bloody diarrhea	Minimal or none

Toxin genotype-serogroup associations are rarely absolute. This table offers common clusterings of genotype and disease phenotype among major STEC serogroups identified in the United States.^[1]

STEC: Shiga-toxin-producing E. coli; HUS: hemolytic-uremic syndrome.
* Serotypes designate the O (somatic) and the H (flagellar) antigens. Serogroups designate only the O antigen. The O antigen is the organism's lipopolysaccharide side chain.
¶ Shiga toxin 2 is more potent and much more frequently associated with severe human disease (bloody diarrhea and HUS risk) than Shiga toxin 1. STEC that do not contain a gene encoding Shiga toxin 2 rarely, if ever, cause HUS.
Δ This sorbitol-fermenting nonmotile E. coli isolate is also designated E. coli O157:H negative. It is recovered mostly in Germany and Central Europe and is at least as virulent as E. coli O157:H7.
◊ E. coli O26 isolates from Europe contain genes encoding both Shiga toxin 1 and Shiga toxin 2. E. coli O26 isolates from North America generally do not contain the gene encoding Shiga toxin 2, but some are associated with bloody diarrhea.
§ The authors of this UpToDate topic on STEC have also observed bloody diarrhea caused by an E. coli O111 isolate that did not contain a gene encoding Shiga toxin 2.
¥ This strain caused a massive outbreak in Germany in 2011 but has not persisted as a major problem. It shares many features with enteroaggregative E. coli.

Reference:

Brooks JT, Sowers EG, Wells JG, et al. Non-O157 Shiga toxin-producing Escherichia coli infections in the United States, 1983-2002. J Infect Dis 2005; 192:1422.

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