• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of jcmPermissionsJournals.ASM.orgJournalJCM ArticleJournal InfoAuthorsReviewers
J Clin Microbiol. May 1994; 32(5): 1172–1178.
PMCID: PMC263635

Humoral immune responses to Shiga-like toxins and Escherichia coli O157 lipopolysaccharide in hemolytic-uremic syndrome patients and healthy subjects.


Shiga-like-toxin (SLT)-producing Escherichia coli strains, especially serotype O157:H7, are important causes of bloody diarrhea and are associated with the development of hemolytic-uremic syndrome (HUS). Enzyme-linked immunosorbent assays (ELISAs) were developed for the serologic detection of immunoglobulin M (IgM), IgG, and IgA to Shiga toxin (ST) and SLT-I, IgG to SLT-II, and IgM and IgG reactive against E. coli O157 lipopolysaccharide (LPS). Serum samples were collected from 27 HUS patients (25 pediatric and 2 adult) and tested in the ELISAs. Of 27 patients, 10 (37%) were positive for at least one class of antibody to ST/SLT-I. None of the patients were positive for IgG antibody to SLT-II. Twenty-one of the 27 patients (78%) were positive for antibody to E. coli O157 LPS; 19 of 27 (70%) were positive for IgM, and 20 of 27 (74%) were positive for IgG. None of 48 control serum samples were positive in any of the toxin assays, and only 1 of 48 (2%) and 2 of 48 (4%) were positive for IgM and IgG, respectively, to E. coli O157 LPS. Twelve of the 24 patients (50%) from whom stool specimens were collected were positive by culture for E. coli O157. Overall, serology and culture produced confirmation of infection by SLT-producing organisms in 23 of 27 (85%) HUS patients. A combination of ELISA for antibodies to E. coli O157 LPS and culture provided evidence for 22 of 27 (82%) of these patients. The results indicate that while ELISAs for ST/SLT-I and SLT-II antibodies were of limited diagnostic value, the ELISAs for IgM and IgG to E. coli O157 LPS provided valuable and sensitive adjuncts to culture.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.2M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Images in this article

Click on the image to see a larger version.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Acheson DW, Keusch GT, Lightowlers M, Donohue-Rolfe A. Enzyme-linked immunosorbent assay for Shiga toxin and Shiga-like toxin II using P1 glycoprotein from hydatid cysts. J Infect Dis. 1990 Jan;161(1):134–137. [PubMed]
  • Basta M, Karmali M, Lingwood C. Sensitive receptor-specified enzyme-linked immunosorbent assay for Escherichia coli verocytotoxin. J Clin Microbiol. 1989 Jul;27(7):1617–1622. [PMC free article] [PubMed]
  • Bitzan M, Karch H. Indirect hemagglutination assay for diagnosis of Escherichia coli O157 infection in patients with hemolytic-uremic syndrome. J Clin Microbiol. 1992 May;30(5):1174–1178. [PMC free article] [PubMed]
  • Brian MJ, Frosolono M, Murray BE, Miranda A, Lopez EL, Gomez HF, Cleary TG. Polymerase chain reaction for diagnosis of enterohemorrhagic Escherichia coli infection and hemolytic-uremic syndrome. J Clin Microbiol. 1992 Jul;30(7):1801–1806. [PMC free article] [PubMed]
  • Brown JE, Sethabutr O, Jackson MP, Lolekha S, Echeverria P. Hybridization of Escherichia coli producing Shiga-like toxin I, Shiga-like toxin II, and a variant of Shiga-like toxin II with synthetic oligonucleotide probes. Infect Immun. 1989 Sep;57(9):2811–2814. [PMC free article] [PubMed]
  • Carter AO, Borczyk AA, Carlson JA, Harvey B, Hockin JC, Karmali MA, Krishnan C, Korn DA, Lior H. A severe outbreak of Escherichia coli O157:H7--associated hemorrhagic colitis in a nursing home. N Engl J Med. 1987 Dec 10;317(24):1496–1500. [PubMed]
  • Chart H, Scotland SM, Rowe B. Serum antibodies to Escherichia coli serotype O157:H7 in patients with hemolytic uremic syndrome. J Clin Microbiol. 1989 Feb;27(2):285–290. [PMC free article] [PubMed]
  • Chart H, Smith HR, Scotland SM, Rowe B, Milford DV, Taylor CM. Serological identification of Escherichia coli O157:H7 infection in haemolytic uraemic syndrome. Lancet. 1991 Jan 19;337(8734):138–140. [PubMed]
  • Donohue-Rolfe A, Acheson DW, Kane AV, Keusch GT. Purification of Shiga toxin and Shiga-like toxins I and II by receptor analog affinity chromatography with immobilized P1 glycoprotein and production of cross-reactive monoclonal antibodies. Infect Immun. 1989 Dec;57(12):3888–3893. [PMC free article] [PubMed]
  • Gunzer F, Böhm H, Rüssmann H, Bitzan M, Aleksic S, Karch H. Molecular detection of sorbitol-fermenting Escherichia coli O157 in patients with hemolytic-uremic syndrome. J Clin Microbiol. 1992 Jul;30(7):1807–1810. [PMC free article] [PubMed]
  • Kaplan BS, Cleary TG, Obrig TG. Recent advances in understanding the pathogenesis of the hemolytic uremic syndromes. Pediatr Nephrol. 1990 May;4(3):276–283. [PubMed]
  • Karch H, Meyer T. Evaluation of oligonucleotide probes for identification of shiga-like-toxin-producing Escherichia coli. J Clin Microbiol. 1989 Jun;27(6):1180–1186. [PMC free article] [PubMed]
  • Karch H, Meyer T. Single primer pair for amplifying segments of distinct Shiga-like-toxin genes by polymerase chain reaction. J Clin Microbiol. 1989 Dec;27(12):2751–2757. [PMC free article] [PubMed]
  • Karmali MA. Infection by verocytotoxin-producing Escherichia coli. Clin Microbiol Rev. 1989 Jan;2(1):15–38. [PMC free article] [PubMed]
  • Karmali MA, Petric M, Lim C, Cheung R, Arbus GS. Sensitive method for detecting low numbers of verotoxin-producing Escherichia coli in mixed cultures by use of colony sweeps and polymyxin extraction of verotoxin. J Clin Microbiol. 1985 Oct;22(4):614–619. [PMC free article] [PubMed]
  • Korman SH, Le Blancq SM, Spira DT, el On J, Reifen RM, Deckelbaum RJ. Giardia lamblia: identification of different strains from man. Z Parasitenkd. 1986;72(2):173–180. [PubMed]
  • MacLeod DL, Gyles CL, Wilcock BP. Reproduction of edema disease of swine with purified Shiga-like toxin-II variant. Vet Pathol. 1991 Jan;28(1):66–73. [PubMed]
  • March SB, Ratnam S. Sorbitol-MacConkey medium for detection of Escherichia coli O157:H7 associated with hemorrhagic colitis. J Clin Microbiol. 1986 May;23(5):869–872. [PMC free article] [PubMed]
  • March SB, Ratnam S. Latex agglutination test for detection of Escherichia coli serotype O157. J Clin Microbiol. 1989 Jul;27(7):1675–1677. [PMC free article] [PubMed]
  • Newland JW, Neill RJ. DNA probes for Shiga-like toxins I and II and for toxin-converting bacteriophages. J Clin Microbiol. 1988 Jul;26(7):1292–1297. [PMC free article] [PubMed]
  • Pollard DR, Johnson WM, Lior H, Tyler SD, Rozee KR. Differentiation of Shiga toxin and Vero cytotoxin type 1 genes by polymerase chain reaction. J Infect Dis. 1990 Nov;162(5):1195–1198. [PubMed]
  • Ratnam S, March SB, Ahmed R, Bezanson GS, Kasatiya S. Characterization of Escherichia coli serotype O157:H7. J Clin Microbiol. 1988 Oct;26(10):2006–2012. [PMC free article] [PubMed]
  • Stenger KO, Windler F, Karch H, von Wulffen H, Heesemann J. Hemolytic-uremic syndrome associated with an infection by verotoxin producing Escherichia coli 0111 in a woman on oral contraceptives. Clin Nephrol. 1988 Mar;29(3):153–158. [PubMed]
  • Strockbine NA, Jackson MP, Sung LM, Holmes RK, O'Brien AD. Cloning and sequencing of the genes for Shiga toxin from Shigella dysenteriae type 1. J Bacteriol. 1988 Mar;170(3):1116–1122. [PMC free article] [PubMed]
  • Tarr PI, Neill MA, Clausen CR, Newland JW, Neill RJ, Moseley SL. Genotypic variation in pathogenic Escherichia coli O157:H7 isolated from patients in Washington, 1984-1987. J Infect Dis. 1989 Feb;159(2):344–347. [PubMed]
  • Tarr PI, Neill MA, Clausen CR, Watkins SL, Christie DL, Hickman RO. Escherichia coli O157:H7 and the hemolytic uremic syndrome: importance of early cultures in establishing the etiology. J Infect Dis. 1990 Aug;162(2):553–556. [PubMed]
  • Tison DL. Culture confirmation of Escherichia coli serotype O157:H7 by direct immunofluorescence. J Clin Microbiol. 1990 Mar;28(3):612–613. [PMC free article] [PubMed]
  • Wells JG, Davis BR, Wachsmuth IK, Riley LW, Remis RS, Sokolow R, Morris GK. Laboratory investigation of hemorrhagic colitis outbreaks associated with a rare Escherichia coli serotype. J Clin Microbiol. 1983 Sep;18(3):512–520. [PMC free article] [PubMed]

Articles from Journal of Clinical Microbiology are provided here courtesy of American Society for Microbiology (ASM)


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...