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Clin Microbiol Rev. Jan 1989; 2(1): 15–38.
PMCID: PMC358098

Infection by verocytotoxin-producing Escherichia coli.


Verocytotoxin (VT)-producing Escherichia coli (VTEC) are a newly recognized group of enteric pathogens which are increasingly being recognized as common causes of diarrhea in some geographic settings. Outbreak studies indicate that most patients with VTEC infection develop mild uncomplicated diarrhea. However, a significant risk of two serious and potentially life-threatening complications, hemorrhagic colitis and the hemolytic uremic syndrome, makes VTEC infection a public health problem of serious concern. The main reservoirs of VTEC appear to be the intestinal tracts of animals, and foods of animal (especially bovine) origin are probably the principal sources for human infection. The term VT refers to a family of subunit exotoxins with high biological activity. Individual VTEC strains elaborate one or both of at least two serologically distinct, bacteriophage-mediated VTs (VT1 and VT2) which are closely related to Shiga toxin and are thus also referred to as Shiga-like toxins. The holotoxins bind to cells, via their B subunits, to a specific receptor which is probably the glycolipid, globotriosyl ceramide (Gb3). Binding is followed by internalization of the A subunit, which, after it is proteolytically nicked and reduced to the A1 fragment, inhibits protein synthesis in mammalian cells by inactivating 60S ribosomal subunits through selective structural modification of 28S ribosomal ribonucleic acid. The mechanism of VTEC diarrhea is still controversial, and the relative roles of locally acting VT and "attaching and effacing adherence" of VTEC to the mucosa have yet to be resolved. There is increasing evidence that hemolytic uremic syndrome and possibly hemorrhagic colitis result from the systemic action of VT on vascular endothelial cells. The role of antitoxic immunity in preventing the systemic complications of VTEC infection is being explored. Antibiotics appear to be contraindicated in the treatment of VTEC infection. The most common VTEC serotype associated with human disease is O157:H7, but over 50 different VT-positive O:H serotypes have now been identified. The best strategies for diagnosing human VTEC infection include testing for the presence of free VT in fecal filtrates and examining fecal cultures for VTEC by means of deoxyribonucleic acid probes that specify genes encoding VT1 and VT2. Both methods are currently confined to specialized laboratories and await commercial development for wider use. In the meantime, most laboratories should continue to screen for the most common human VTEC serotype, O157:H7, using a sorbitol-containing MacConkey medium.

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  • Ahmed R, Bopp C, Borczyk A, Kasatiya S. Phage-typing scheme for Escherichia coli O157:H7. J Infect Dis. 1987 Apr;155(4):806–809. [PubMed]
  • Baker NM, Mills AE, Rachman I, Thomas JE. Haemolytic-uraemic syndrome in typhoid fever. Br Med J. 1974 Apr 13;2(5910):84–87. [PMC free article] [PubMed]
  • Baldini MM, Kaper JB, Levine MM, Candy DC, Moon HW. Plasmid-mediated adhesion in enteropathogenic Escherichia coli. J Pediatr Gastroenterol Nutr. 1983;2(3):534–538. [PubMed]
  • Bar-Ziv J, Ayoub JI, Fletcher BD. Hemolytic uremic syndrome: a case presenting with acute colitis. Pediatr Radiol. 1974;2(3):203–206. [PubMed]
  • Björk S, Breimer ME, Hansson GC, Karlsson KA, Leffler H. Structures of blood group glycosphingolipids of human small intestine. A relation between the expression of fucolipids of epithelial cells and the ABO, Le and Se phenotype of the donor. J Biol Chem. 1987 May 15;262(14):6758–6765. [PubMed]
  • Bokkenheuser VD, Richardson NJ, Bryner JH, Roux DJ, Schutte AB, Koornhof HJ, Freiman I, Hartman E. Detection of enteric campylobacteriosis in children. J Clin Microbiol. 1979 Feb;9(2):227–232. [PMC free article] [PubMed]
  • BRAIN MC, DACIE JV, HOURIHANE DO. Microangiopathic haemolytic anaemia: the possible role of vascular lesions in pathogenesis. Br J Haematol. 1962 Oct;8:358–374. [PubMed]
  • BRIDGWATER FA, MORGAN RS, ROWSON KE, WRIGHT GP. The neurotoxin of Shigella shigae: morphological and functional lesions produced in the central nervous system of rabbits. Br J Exp Pathol. 1955 Oct;36(5):447–453. [PMC free article] [PubMed]
  • Brown CB, Clarkson AR, Robson JS, Cameron JS, Thomson D, Ogg CS. Haemolytic uraemic syndrome in women taking oral contraceptives. Lancet. 1973 Jun 30;1(7818):1479–1481. [PubMed]
  • Brown JE, Griffin DE, Rothman SW, Doctor BP. Purification and biological characterization of shiga toxin from Shigella dysenteriae 1. Infect Immun. 1982 Jun;36(3):996–1005. [PMC free article] [PubMed]
  • Brown JE, Obrig TG, Ussery MA, Moran TP. Shiga toxin from Shigella dysenteriae 1 inhibits protein synthesis in reticulocyte lysates by inactivation of aminoacyl-tRNA binding. Microb Pathog. 1986 Aug;1(4):325–334. [PubMed]
  • Brown JE, Rothman SW, Doctor BP. Inhibition of protein synthesis in intact HeLa cells by Shigella dysenteriae 1 toxin. Infect Immun. 1980 Jul;29(1):98–107. [PMC free article] [PubMed]
  • Brown JE, Ussery MA, Leppla SH, Rothman SW. Inhibition of protein synthesis by Shiga toxin: activation of the toxin and inhibition of peptide elongation. FEBS Lett. 1980 Aug 11;117(1):84–88. [PubMed]
  • Butler T, Islam MR, Azad MA, Jones PK. Risk factors for development of hemolytic uremic syndrome during shigellosis. J Pediatr. 1987 Jun;110(6):894–897. [PubMed]
  • Byrnes JJ, Moake JL. Thrombotic thrombocytopenic purpura and the haemolytic-uraemic syndrome: evolving concepts of pathogenesis and therapy. Clin Haematol. 1986 May;15(2):413–442. [PubMed]
  • Cahoon FE, Thompson JS. Frequency of Escherichia coli O157:H7 isolation from stool specimens. Can J Microbiol. 1987 Oct;33(10):914–915. [PubMed]
  • Calderwood SB, Auclair F, Donohue-Rolfe A, Keusch GT, Mekalanos JJ. Nucleotide sequence of the Shiga-like toxin genes of Escherichia coli. Proc Natl Acad Sci U S A. 1987 Jul;84(13):4364–4368. [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]
  • CAVANAGH JB, HOWARD JG, WHITBY JL. The neurotoxin of Shigella shigae; a comparative study of the effects produced in various laboratory animals. Br J Exp Pathol. 1956 Jun;37(3):272–278. [PMC free article] [PubMed]
  • Chamovitz BN, Hartstein AI, Alexander SR, Terry AB, Short P, Katon R. Campylobacter jejuni-associated hemolytic-uremic syndrome in a mother and daughter. Pediatrics. 1983 Feb;71(2):253–256. [PubMed]
  • Chan JC, Eleff MG, Campbell RA. The hemolytic-uremic syndrome in nonrelated adopted siblings. J Pediatr. 1969 Dec;75(6):1050–1053. [PubMed]
  • Chanter N, Morgan JH, Bridger JC, Hall GA, Reynolds DJ. Dysentery in gnotobiotic calves caused by atypical Escherichia coli. Vet Rec. 1984 Jan 21;114(3):71–71. [PubMed]
  • Churg J, Koffler D, Paronetto F, Rorat E, Barnett RN. Hemolytic uremic syndrome as a cause of postpartum renal failure. Am J Obstet Gynecol. 1970 Sep 15;108(2):253–261. [PubMed]
  • Clark AW, Lloyd-Mostyn RH, de Sadler MR. "Ischaemic" colitis in young adults. Br Med J. 1972 Oct 14;4(5832):70–72. [PMC free article] [PubMed]
  • Clugston RE, Nielsen NO, Smith DL. Experimental edema disease of swine (E. coli enterotoxemia). 3. Pathology and pathogenesis. Can J Comp Med. 1974 Jan;38(1):34–43. [PMC free article] [PubMed]
  • Cohen A, Hannigan GE, Williams BR, Lingwood CA. Roles of globotriosyl- and galabiosylceramide in verotoxin binding and high affinity interferon receptor. J Biol Chem. 1987 Dec 15;262(35):17088–17091. [PubMed]
  • De Grandis S, Ginsberg J, Toone M, Climie S, Friesen J, Brunton J. Nucleotide sequence and promoter mapping of the Escherichia coli Shiga-like toxin operon of bacteriophage H-19B. J Bacteriol. 1987 Sep;169(9):4313–4319. [PMC free article] [PubMed]
  • Denneberg T, Friedberg M, Holmberg L, Mathiasen C, Nilsson KO, Takolander R, Walder M. Combined plasmapheresis and hemodialysis treatment for severe hemolytic-uremic syndrome following Campylobacter colitis. Acta Paediatr Scand. 1982 Mar;71(2):243–245. [PubMed]
  • Dobrescu L. New biological effect of edema disease principle (Escherichia coli-neurotoxin) and its use as an in vitro for this toxin. Am J Vet Res. 1983 Jan;44(1):31–34. [PubMed]
  • Donohue-Rolfe A, Keusch GT, Edson C, Thorley-Lawson D, Jacewicz M. Pathogenesis of Shigella diarrhea. IX. Simplified high yield purification of Shigella toxin and characterization of subunit composition and function by the use of subunit-specific monoclonal and polyclonal antibodies. J Exp Med. 1984 Dec 1;160(6):1767–1781. [PMC free article] [PubMed]
  • Downes FP, Barrett TJ, Green JH, Aloisio CH, Spika JS, Strockbine NA, Wachsmuth IK. Affinity purification and characterization of Shiga-like toxin II and production of toxin-specific monoclonal antibodies. Infect Immun. 1988 Aug;56(8):1926–1933. [PMC free article] [PubMed]
  • Doyle MP, Schoeni JL. Isolation of Escherichia coli O157:H7 from retail fresh meats and poultry. Appl Environ Microbiol. 1987 Oct;53(10):2394–2396. [PMC free article] [PubMed]
  • Drummond KN. Hemolytic uremic syndrome--then and now. N Engl J Med. 1985 Jan 10;312(2):116–118. [PubMed]
  • Edelman R, Karmali MA, Fleming PA. From the National Institutes of Health. Summary of the International Symposium and Workshop on Infections due to Verocytotoxin (Shiga-like toxin)-producing Escherichia coli. J Infect Dis. 1988 May;157(5):1102–1104. [PubMed]
  • Eiklid K, Olsnes S. Interaction of Shigella shigae cytotoxin with receptors on sensitive and insensitive cells. J Recept Res. 1980;1(2):199–213. [PubMed]
  • Eiklid K, Olsnes S. Animal toxicity of Shigella dysenteriae cytotoxin: evidence that the neurotoxic, enterotoxic, and cytotoxic activities are due to one toxin. J Immunol. 1983 Jan;130(1):380–384. [PubMed]
  • Eiklid K, Olsnes S. Entry of Shigella dysenteriae toxin into HeLa cells. Infect Immun. 1983 Nov;42(2):771–777. [PMC free article] [PubMed]
  • ENGLEY FB., Jr The neurotoxin of Shigella dysenteriae (shiga). Bacteriol Rev. 1952 Sep;16(3):153–178. [PMC free article] [PubMed]
  • Farmer JJ, 3rd, Davis BR. H7 antiserum-sorbitol fermentation medium: a single tube screening medium for detecting Escherichia coli O157:H7 associated with hemorrhagic colitis. J Clin Microbiol. 1985 Oct;22(4):620–625. [PMC free article] [PubMed]
  • Fong JS, de Chadarevian JP, Kaplan BS. Hemolytic-uremic syndrome. Current concepts and management. Pediatr Clin North Am. 1982 Aug;29(4):835–856. [PubMed]
  • Francis DH, Collins JE, Duimstra JR. Infection of gnotobiotic pigs with an Escherichia coli O157:H7 strain associated with an outbreak of hemorrhagic colitis. Infect Immun. 1986 Mar;51(3):953–956. [PMC free article] [PubMed]
  • Fuchs G, Mobassaleh M, Donohue-Rolfe A, Montgomery RK, Grand RJ, Keusch GT. Pathogenesis of Shigella diarrhea: rabbit intestinal cell microvillus membrane binding site for Shigella toxin. Infect Immun. 1986 Aug;53(2):372–377. [PMC free article] [PubMed]
  • GASSER C, GAUTIER E, STECK A, SIEBENMANN RE, OECHSLIN R. Hämolytisch-urämische Syndrome: bilaterale Nierenrindennekrosen bei akuten erworbenen hämolytischen Anämien. Schweiz Med Wochenschr. 1955 Sep 20;85(38-39):905–909. [PubMed]
  • Gianantonio CA, Vitacco M, Mendilaharzu F, Gallo GE, Sojo ET. The hemolytic-uremic syndrome. Nephron. 1973;11(2):174–192. [PubMed]
  • Giannella RA, Broitman SA, Zamcheck N. Influence of gastric acidity on bacterial and parasitic enteric infections. A perspective. Ann Intern Med. 1973 Feb;78(2):271–276. [PubMed]
  • Giugliano LG, Mann GF, Drasar BS. Response of mammalian cell lines to the toxins of Escherichia coli. J Med Microbiol. 1982 Nov;15(4):531–539. [PubMed]
  • Glasgow LA, Balduzzi P. Isolation of Coxsackie virus group A, type 4, from a patient with hemolytic-uremic syndrome. N Engl J Med. 1965 Sep 30;273(14):754–756. [PubMed]
  • Gransden WR, Damm MA, Anderson JD, Carter JE, Lior H. Further evidence associating hemolytic uremic syndrome with infection by Verotoxin-producing Escherichia coli O157:H7. J Infect Dis. 1986 Sep;154(3):522–524. [PubMed]
  • Hall GA, Reynolds DJ, Chanter N, Morgan JH, Parsons KR, Debney TG, Bland AP, Bridger JC. Dysentery caused by Escherichia coli (S102-9) in calves: natural and experimental disease. Vet Pathol. 1985 Mar;22(2):156–163. [PubMed]
  • Harari I, Donohue-Rolfe A, Keusch G, Arnon R. Synthetic peptides of Shiga toxin B subunit induce antibodies which neutralize its biological activity. Infect Immun. 1988 Jun;56(6):1618–1624. [PMC free article] [PubMed]
  • Hardas UD, Jalgaonkar SV, Kulkarni VK. Cytotoxic effect of culture filtrate of enteropathogenic Escherichia coli from diarrhoea in children on Vero cell culture. Indian J Med Res. 1982 Jul;76:86–88. [PubMed]
  • Harris AA, Kaplan RL, Goodman LJ, Doyle M, Landau W, Segreti J, Mayer K, Levin S. Results of a screening method used in a 12-month stool survey for Escherichia coli O157:H7. J Infect Dis. 1985 Oct;152(4):775–777. [PubMed]
  • HOWARD JG. Observations on the intoxication produced in mice and rabbits by the neurotoxin of Shigella shigae. Br J Exp Pathol. 1955 Oct;36(5):439–446. [PMC free article] [PubMed]
  • Huang A, de Grandis S, Friesen J, Karmali M, Petric M, Congi R, Brunton JL. Cloning and expression of the genes specifying Shiga-like toxin production in Escherichia coli H19. J Bacteriol. 1986 May;166(2):375–379. [PMC free article] [PubMed]
  • Jacewicz M, Clausen H, Nudelman E, Donohue-Rolfe A, Keusch GT. Pathogenesis of shigella diarrhea. XI. Isolation of a shigella toxin-binding glycolipid from rabbit jejunum and HeLa cells and its identification as globotriaosylceramide. J Exp Med. 1986 Jun 1;163(6):1391–1404. [PMC free article] [PubMed]
  • Jackson MP, Newland JW, Holmes RK, O'Brien AD. Nucleotide sequence analysis of the structural genes for Shiga-like toxin I encoded by bacteriophage 933J from Escherichia coli. Microb Pathog. 1987 Feb;2(2):147–153. [PubMed]
  • Kaplan BS, Chesney RW, Drummond KN. Hemolytic uremic syndrome in families. N Engl J Med. 1975 May 22;292(21):1090–1093. [PubMed]
  • Kaplan BS, Thomson PD, de Chadarévian JP. The hemolytic uremic syndrome. Pediatr Clin North Am. 1976 Nov;23(4):761–777. [PubMed]
  • Karch H, Heesemann J, Laufs R, O'Brien AD, Tacket CO, Levine MM. A plasmid of enterohemorrhagic Escherichia coli O157:H7 is required for expression of a new fimbrial antigen and for adhesion to epithelial cells. Infect Immun. 1987 Feb;55(2):455–461. [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]
  • Karmali MA, Petric M, Lim C, Fleming PC, Arbus GS, Lior H. The association between idiopathic hemolytic uremic syndrome and infection by verotoxin-producing Escherichia coli. J Infect Dis. 1985 May;151(5):775–782. [PubMed]
  • Karmali MA, Steele BT, Petric M, Lim C. Sporadic cases of haemolytic-uraemic syndrome associated with faecal cytotoxin and cytotoxin-producing Escherichia coli in stools. Lancet. 1983 Mar 19;1(8325):619–620. [PubMed]
  • Keenan KP, Sharpnack DD, Collins H, Formal SB, O'Brien AD. Morphologic evaluation of the effects of Shiga toxin and E coli Shiga-like toxin on the rabbit intestine. Am J Pathol. 1986 Oct;125(1):69–80. [PMC free article] [PubMed]
  • Kelly JK, Pai CH, Jadusingh IH, Macinnis ML, Shaffer EA, Hershfield NB. The histopathology of rectosigmoid biopsies from adults with bloody diarrhea due to verotoxin-producing Escherichia coli. Am J Clin Pathol. 1987 Jul;88(1):78–82. [PubMed]
  • Keusch GT, Grady GF, Mata LJ, McIver J. The pathogenesis of Shigella diarrhea. I. Enterotoxin production by Shigella dysenteriae I. J Clin Invest. 1972 May;51(5):1212–1218. [PMC free article] [PubMed]
  • Keusch GT, Jacewicz M. Pathogenesis of Shigella diarrhea. VII. Evidence for a cell membrane toxin receptor involving beta1 leads to 4-linked N-acetyl-D-glucosamine oligomers. J Exp Med. 1977 Aug 1;146(2):535–546. [PMC free article] [PubMed]
  • Kibel MA, Barnard PJ. The haemolytic-uraemic syndrome: a survey in Southern Africa. S Afr Med J. 1968 Jul 13;42(27):692–698. [PubMed]
  • Kilpatrick ZM, Silverman JF, Betancourt E, Farman J, Lawson JP. Vascular occlusion of the colon and oral contraceptives. Possible relation. N Engl J Med. 1968 Feb 22;278(8):438–440. [PubMed]
  • Kirks DR. The radiology of enteritis due to hemolytic-uremic syndrome. Pediatr Radiol. 1982;12(4):179–183. [PubMed]
  • Knutton S, Baldini MM, Kaper JB, McNeish AS. Role of plasmid-encoded adherence factors in adhesion of enteropathogenic Escherichia coli to HEp-2 cells. Infect Immun. 1987 Jan;55(1):78–85. [PMC free article] [PubMed]
  • Knutton S, Lloyd DR, McNeish AS. Adhesion of enteropathogenic Escherichia coli to human intestinal enterocytes and cultured human intestinal mucosa. Infect Immun. 1987 Jan;55(1):69–77. [PMC free article] [PubMed]
  • Kongmuang U, Honda T, Miwatani T. Enzyme-linked immunosorbent assay to detect Shiga toxin of Shigella dysenteriae and related toxins. J Clin Microbiol. 1987 Jan;25(1):115–118. [PMC free article] [PubMed]
  • Konowalchuk J, Dickie N, Stavric S, Speirs JI. Comparative studies of five heat-labile toxic products of Escherichia coli. Infect Immun. 1978 Dec;22(3):644–648. [PMC free article] [PubMed]
  • Konowalchuk J, Dickie N, Stavric S, Speirs JI. Properties of an Escherichia coli cytotoxin. Infect Immun. 1978 May;20(2):575–577. [PMC free article] [PubMed]
  • Konowalchuk J, Speirs JI, Stavric S. Vero response to a cytotoxin of Escherichia coli. Infect Immun. 1977 Dec;18(3):775–779. [PMC free article] [PubMed]
  • Koster F, Levin J, Walker L, Tung KS, Gilman RH, Rahaman MM, Majid MA, Islam S, Williams RC., Jr Hemolytic-uremic syndrome after shigellosis. Relation to endotoxemia and circulating immune complexes. N Engl J Med. 1978 Apr 27;298(17):927–933. [PubMed]
  • Krishnan C, Fitzgerald VA, Dakin SJ, Behme RJ. Laboratory investigation of outbreak of hemorrhagic colitis caused by Escherichia coli O157:H7. J Clin Microbiol. 1987 Jun;25(6):1043–1047. [PMC free article] [PubMed]
  • Levine MM. Escherichia coli that cause diarrhea: enterotoxigenic, enteropathogenic, enteroinvasive, enterohemorrhagic, and enteroadherent. J Infect Dis. 1987 Mar;155(3):377–389. [PubMed]
  • Levine MM, Edelman R. Enteropathogenic Escherichia coli of classic serotypes associated with infant diarrhea: epidemiology and pathogenesis. Epidemiol Rev. 1984;6:31–51. [PubMed]
  • Levine MM, Nataro JP, Karch H, Baldini MM, Kaper JB, Black RE, Clements ML, O'Brien AD. The diarrheal response of humans to some classic serotypes of enteropathogenic Escherichia coli is dependent on a plasmid encoding an enteroadhesiveness factor. J Infect Dis. 1985 Sep;152(3):550–559. [PubMed]
  • Levine MM, Xu JG, Kaper JB, Lior H, Prado V, Tall B, Nataro J, Karch H, Wachsmuth K. A DNA probe to identify enterohemorrhagic Escherichia coli of O157:H7 and other serotypes that cause hemorrhagic colitis and hemolytic uremic syndrome. J Infect Dis. 1987 Jul;156(1):175–182. [PubMed]
  • Lindberg AA, Brown JE, Strömberg N, Westling-Ryd M, Schultz JE, Karlsson KA. Identification of the carbohydrate receptor for Shiga toxin produced by Shigella dysenteriae type 1. J Biol Chem. 1987 Feb 5;262(4):1779–1785. [PubMed]
  • Lingwood CA, Law H, Richardson S, Petric M, Brunton JL, De Grandis S, Karmali M. Glycolipid binding of purified and recombinant Escherichia coli produced verotoxin in vitro. J Biol Chem. 1987 Jun 25;262(18):8834–8839. [PubMed]
  • Linton AL, Gavras H, Gleadle RI, Hutchison HE, Lawson DH, Lever AF, Macadam RF, McNicol GP, Robertson JI. Microangiopathic haemolytic anaemia and the pathogenesis of malignant hypertension. Lancet. 1969 Jun 28;1(7609):1277–1282. [PubMed]
  • Loirat C, Sonsino E, Varga Moreno A, Pillion G, Mercier JC, Beaufils F, Mathieu H. Hemolytic-uremic syndrome: an analysis of the natural history and prognostic features. Acta Paediatr Scand. 1984 Jul;73(4):505–514. [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]
  • Marques LR, Moore MA, Wells JG, Wachsmuth IK, O'Brien AD. Production of Shiga-like toxin by Escherichia coli. J Infect Dis. 1986 Aug;154(2):338–341. [PubMed]
  • Marston A, Pheils MT, Thomas ML, Morson BC. Ischaemic colitis. Gut. 1966 Feb;7(1):1–15. [PMC free article] [PubMed]
  • Mathewson JJ, Johnson PC, DuPont HL, Morgan DR, Thornton SA, Wood LV, Ericsson CD. A newly recognized cause of travelers' diarrhea: enteroadherent Escherichia coli. J Infect Dis. 1985 Mar;151(3):471–475. [PubMed]
  • McLean MM, Jones CH, Sutherland DA. Haemolytic-uraemic syndrome. A report of an outbreak. Arch Dis Child. 1966 Feb;41(215):76–81. [PMC free article] [PubMed]
  • Mettler NE. Isolation of a microtatobiote from patients with hemolytic-uremic syndrome and thrombotic thrombocytopenic purpura and from mites in the United States. N Engl J Med. 1969 Nov 6;281(19):1023–1027. [PubMed]
  • Middlebrook JL, Dorland RB. Bacterial toxins: cellular mechanisms of action. Microbiol Rev. 1984 Sep;48(3):199–221. [PMC free article] [PubMed]
  • Miller WT, De Poto DW, Scholl HW, Raffensperger EC. Evanescent colitis in the young adult: a new entity? Radiology. 1971 Jul;100(1):71–78. [PubMed]
  • Mobassaleh M, Donohue-Rolfe A, Jacewicz M, Grand RJ, Keusch GT. Pathogenesis of shigella diarrhea: evidence for a developmentally regulated glycolipid receptor for shigella toxin involved in the fluid secretory response of rabbit small intestine. J Infect Dis. 1988 May;157(5):1023–1031. [PubMed]
  • Monnens L, van de Meer W, Langenhuysen C, van Munster P, van Oostrom C. Platelet aggregating factor in the epidemic form of hemolytic-uremic syndrome in childhood. Clin Nephrol. 1985 Sep;24(3):135–137. [PubMed]
  • Moon HW, Whipp SC, Argenzio RA, Levine MM, Giannella RA. Attaching and effacing activities of rabbit and human enteropathogenic Escherichia coli in pig and rabbit intestines. Infect Immun. 1983 Sep;41(3):1340–1351. [PMC free article] [PubMed]
  • Morrison DM, Tyrrell DL, Jewell LD. Colonic biopsy in verotoxin-induced hemorrhagic colitis and thrombotic thrombocytopenic purpura (TTP). Am J Clin Pathol. 1986 Jul;86(1):108–112. [PubMed]
  • Moxley RA, Francis DH. Natural and experimental infection with an attaching and effacing strain of Escherichia coli in calves. Infect Immun. 1986 Aug;53(2):339–346. [PMC free article] [PubMed]
  • Nataro JP, Baldini MM, Kaper JB, Black RE, Bravo N, Levine MM. Detection of an adherence factor of enteropathogenic Escherichia coli with a DNA probe. J Infect Dis. 1985 Sep;152(3):560–565. [PubMed]
  • Nataro JP, Scaletsky IC, Kaper JB, Levine MM, Trabulsi LR. Plasmid-mediated factors conferring diffuse and localized adherence of enteropathogenic Escherichia coli. Infect Immun. 1985 May;48(2):378–383. [PMC free article] [PubMed]
  • Neill MA, Tarr PI, Clausen CR, Christie DL, Hickman RO. Escherichia coli O157:H7 as the predominant pathogen associated with the hemolytic uremic syndrome: a prospective study in the Pacific Northwest. Pediatrics. 1987 Jul;80(1):37–40. [PubMed]
  • Newland JW, Strockbine NA, Miller SF, O'Brien AD, Holmes RK. Cloning of Shiga-like toxin structural genes from a toxin converting phage of Escherichia coli. Science. 1985 Oct 11;230(4722):179–181. [PubMed]
  • Novillo AA, Voyer LE, Cravioto R, Freire MC, Castaño G, Wainstein R, Binztein N. Haemolytic uraemic syndrome associated with faecal cytotoxin and verotoxin neutralizing antibodies. Pediatr Nephrol. 1988 Jul;2(3):288–290. [PubMed]
  • O'Brien AD, Chen ME, Holmes RK, Kaper J, Levine MM. Environmental and human isolates of Vibrio cholerae and Vibrio parahaemolyticus produce a Shigella dysenteriae 1 (Shiga)-like cytotoxin. Lancet. 1984 Jan 14;1(8368):77–78. [PubMed]
  • O'Brien AD, Holmes RK. Shiga and Shiga-like toxins. Microbiol Rev. 1987 Jun;51(2):206–220. [PMC free article] [PubMed]
  • O'Brien AD, LaVeck GD. Purification and characterization of a Shigella dysenteriae 1-like toxin produced by Escherichia coli. Infect Immun. 1983 May;40(2):675–683. [PMC free article] [PubMed]
  • O'Brien AD, LaVeck GD, Griffin DE, Thompson MR. Characterization of Shigella dysenteriae 1 (Shiga) toxin purified by anti-Shiga toxin affinity chromatography. Infect Immun. 1980 Oct;30(1):170–179. [PMC free article] [PubMed]
  • O'Brien AD, LaVeck GD, Thompson MR, Formal SB. Production of Shigella dysenteriae type 1-like cytotoxin by Escherichia coli. J Infect Dis. 1982 Dec;146(6):763–769. [PubMed]
  • O'Brien AD, Newland JW, Miller SF, Holmes RK, Smith HW, Formal SB. Shiga-like toxin-converting phages from Escherichia coli strains that cause hemorrhagic colitis or infantile diarrhea. Science. 1984 Nov 9;226(4675):694–696. [PubMed]
  • Obrig TG, Moran TP, Brown JE. The mode of action of Shiga toxin on peptide elongation of eukaryotic protein synthesis. Biochem J. 1987 Jun 1;244(2):287–294. [PMC free article] [PubMed]
  • Olsnes S, Eiklid K. Isolation and characterization of Shigella shigae cytotoxin. J Biol Chem. 1980 Jan 10;255(1):284–289. [PubMed]
  • Olsnes S, Reisbig R, Eiklid K. Subunit structure of Shigella cytotoxin. J Biol Chem. 1981 Aug 25;256(16):8732–8738. [PubMed]
  • O'Regan S, Robitaille P, Mongeau JG, McLaughlin B. The hemolytic uremic syndrome associated with ECHO 22 infection. Clin Pediatr (Phila) 1980 Feb;19(2):125–127. [PubMed]
  • Padhye VV, Beery JT, Kittell FB, Doyle MP. Colonic hemorrhage produced in mice by a unique vero cell cytotoxin from an Escherichia coli strain that causes hemorrhagic colitis. J Infect Dis. 1987 Jun;155(6):1249–1253. [PubMed]
  • Padhye VV, Kittell FB, Doyle MP. Purification and physicochemical properties of a unique Vero cell cytotoxin from Escherichia coli O157:H7. Biochem Biophys Res Commun. 1986 Sep 14;139(2):424–430. [PubMed]
  • Pai CH, Ahmed N, Lior H, Johnson WM, Sims HV, Woods DE. Epidemiology of sporadic diarrhea due to verocytotoxin-producing Escherichia coli: a two-year prospective study. J Infect Dis. 1988 May;157(5):1054–1057. [PubMed]
  • Pai CH, Gordon R, Sims HV, Bryan LE. Sporadic cases of hemorrhagic colitis associated with Escherichia coli O157:H7. Clinical, epidemiologic, and bacteriologic features. Ann Intern Med. 1984 Dec;101(6):738–742. [PubMed]
  • Pai CH, Kelly JK, Meyers GL. Experimental infection of infant rabbits with verotoxin-producing Escherichia coli. Infect Immun. 1986 Jan;51(1):16–23. [PMC free article] [PubMed]
  • Peterson RB, Meseroll WP, Shrago GG, Gooding CA. Radiographic features of colitis associated with the hemolytic-uremic syndrome. Radiology. 1976 Mar;118(3):667–671. [PubMed]
  • Petric M, Karmali MA, Arbus GS, Roscoe M, Louie S, Cheung R. Effects of cycloheximide and puromycin on cytotoxic activity of Escherichia coli verocytotoxin (Shiga-like toxin). J Clin Microbiol. 1987 Jul;25(7):1265–1268. [PMC free article] [PubMed]
  • Pittman FE, Pittman JC, Humphrey CD. Colitis following oral lincomycin therapy. Arch Intern Med. 1974 Aug;134(2):368–372. [PubMed]
  • Potter ME, Kaufmann AF, Thomason BM, Blake PA, Farmer JJ., 3rd Diarrhea due to Escherichia coli O157:H7 in the infant rabbit. J Infect Dis. 1985 Dec;152(6):1341–1343. [PubMed]
  • Prober CG, Tune B, Hoder L. Yersinia pseudotuberculosis septicemia. Am J Dis Child. 1979 Jun;133(6):623–624. [PubMed]
  • Raghupathy P, Date A, Shastry JC, Sudarsanam A, Jadhav M. Haemolytic-uraemic syndrome complicating shigella dystentery in south Indian children. Br Med J. 1978 Jun 10;1(6126):1518–1521. [PMC free article] [PubMed]
  • Ratnam S, March SB. Sporadic occurrence of hemorrhagic colitis associated with Escherichia coli O157:H7 in Newfoundland. CMAJ. 1986 Jan 1;134(1):43–49. [PMC free article] [PubMed]
  • Ray CG, Tucker VL, Harris DJ, Cuppage FE, Chin TD. Enteroviruses associated with the hemolytic-uremic syndrome. Pediatrics. 1970 Sep;46(3):378–388. [PubMed]
  • Reisbig R, Olsnes S, Eiklid K. The cytotoxic activity of Shigella toxin. Evidence for catalytic inactivation of the 60 S ribosomal subunit. J Biol Chem. 1981 Aug 25;256(16):8739–8744. [PubMed]
  • Remis RS, MacDonald KL, Riley LW, Puhr ND, Wells JG, Davis BR, Blake PA, Cohen ML. Sporadic cases of hemorrhagic colitis associated with Escherichia coli O157:H7. Ann Intern Med. 1984 Nov;101(5):624–626. [PubMed]
  • Riley LW. The epidemiologic, clinical, and microbiologic features of hemorrhagic colitis. Annu Rev Microbiol. 1987;41:383–407. [PubMed]
  • Riley LW, Remis RS, Helgerson SD, McGee HB, Wells JG, Davis BR, Hebert RJ, Olcott ES, Johnson LM, Hargrett NT, et al. Hemorrhagic colitis associated with a rare Escherichia coli serotype. N Engl J Med. 1983 Mar 24;308(12):681–685. [PubMed]
  • Rimmer MJ, Freeman AH, Low FM. The barium enema diagnosis of penicillin associated colitis. Clin Radiol. 1982 Sep;33(5):529–533. [PubMed]
  • Robins-Browne RM. Traditional enteropathogenic Escherichia coli of infantile diarrhea. Rev Infect Dis. 1987 Jan-Feb;9(1):28–53. [PubMed]
  • Rogers MF, Budnick LD, Kirson I, Hurwitz ES, Hatch MH, Bopp CA, Karmali MA, Gary GW, Layne R, Schonberger LB. Hemolytic-uremic syndrome--an outbreak in Sacramento, California. West J Med. 1986 Feb;144(2):169–173. [PMC free article] [PubMed]
  • Rogers MF, Rutherford GW, Alexander SR, DiLiberti JH, Foster L, Schonberger LB, Hurwitz ES. A population-based study of hemolytic-uremic syndrome in Oregon, 1979-1982. Am J Epidemiol. 1986 Jan;123(1):137–142. [PubMed]
  • Rose PE, Enayat SM, Sunderland R, Short PE, Williams CE, Hill FG. Abnormalities of factor VIII related protein multimers in the haemolytic uraemic syndrome. Arch Dis Child. 1984 Dec;59(12):1135–1140. [PMC free article] [PubMed]
  • Rothbaum R, McAdams AJ, Giannella R, Partin JC. A clinicopathologic study of enterocyte-adherent Escherichia coli: a cause of protracted diarrhea in infants. Gastroenterology. 1982 Aug;83(2):441–454. [PubMed]
  • Rowe B. The role of Escherichia coli in gastroenteritis. Clin Gastroenterol. 1979 Sep;8(3):625–644. [PubMed]
  • Ryan CA, Tauxe RV, Hosek GW, Wells JG, Stoesz PA, McFadden HW, Jr, Smith PW, Wright GF, Blake PA. Escherichia coli O157:H7 diarrhea in a nursing home: clinical, epidemiological, and pathological findings. J Infect Dis. 1986 Oct;154(4):631–638. [PubMed]
  • Sack RB. Enterohemorrhagic Escherichia coli. N Engl J Med. 1987 Dec 10;317(24):1535–1537. [PubMed]
  • Sakurai Y, Tsuchiya H, Ikegami F, Funatomi T, Takasu S, Uchikoshi T. Acute right-sided hemorrhagic colitis associated with oral administration of ampicillin. Dig Dis Sci. 1979 Dec;24(12):910–915. [PubMed]
  • Sandvig K, Brown JE. Ionic requirements for entry of Shiga toxin from Shigella dysenteriae 1 into cells. Infect Immun. 1987 Feb;55(2):298–303. [PMC free article] [PubMed]
  • Sawaf H, Sharp MJ, Youn KJ, Jewell PA, Rabbani A. Ischemic colitis and stricture after hemolytic-uremic syndrome. Pediatrics. 1978 Feb;61(2):315–317. [PubMed]
  • Scaletsky IC, Silva ML, Trabulsi LR. Distinctive patterns of adherence of enteropathogenic Escherichia coli to HeLa cells. Infect Immun. 1984 Aug;45(2):534–536. [PMC free article] [PubMed]
  • Scheer RL, Jones DB. Malignant nephrosclerosis in women post partum. A note on microangiopathic hemolytic anemia. JAMA. 1967 Aug 21;201(8):600–604. [PubMed]
  • Scotland SM, Rowe B, Smith HR, Willshaw GA, Gross RJ. Vero cytotoxin-producing strains of Escherichia coli from children with haemolytic uraemic syndrome and their detection by specific DNA probes. J Med Microbiol. 1988 Apr;25(4):237–243. [PubMed]
  • Scotland SM, Willshaw GA, Smith HR, Rowe B. Properties of strains of Escherichia coli belonging to serogroup O157 with special reference to production of Vero cytotoxins VT1 and VT2. Epidemiol Infect. 1987 Dec;99(3):613–624. [PMC free article] [PubMed]
  • Seidah NG, Donohue-Rolfe A, Lazure C, Auclair F, Keusch GT, Chrétien M. Complete amino acid sequence of Shigella toxin B-chain. A novel polypeptide containing 69 amino acids and one disulfide bridge. J Biol Chem. 1986 Oct 25;261(30):13928–13931. [PubMed]
  • Shashaty GG, Atamer MA. Hemolytic uremic syndrome associated with infectious mononucleosis. Am J Dis Child. 1974 May;127(5):720–722. [PubMed]
  • Sherman P, Soni R, Karmali M. Attaching and effacing adherence of Vero cytotoxin-producing Escherichia coli to rabbit intestinal epithelium in vivo. Infect Immun. 1988 Apr;56(4):756–761. [PMC free article] [PubMed]
  • Sherman P, Soni R, Petric M, Karmali M. Surface properties of the Vero cytotoxin-producing Escherichia coli O157:H7. Infect Immun. 1987 Aug;55(8):1824–1829. [PMC free article] [PubMed]
  • Sherwood D, Snodgrass DR, O'Brien AD. Shiga-like toxin production from Escherichia coli associated with calf diarrhoea. Vet Rec. 1985 Feb 23;116(8):217–218. [PubMed]
  • Smith HR, Rowe B, Gross RJ, Fry NK, Scotland SM. Haemorrhagic colitis and Vero-cytotoxin-producing Escherichia coli in England and Wales. Lancet. 1987 May 9;1(8541):1062–1065. [PubMed]
  • Smith HR, Scotland SM, Willshaw GA, Wray C, McLaren IM, Cheasty T, Rowe B. Vero cytotoxin production and presence of VT genes in Escherichia coli strains of animal origin. J Gen Microbiol. 1988 Mar;134(3):829–834. [PubMed]
  • Smith HW, Green P, Parsell Z. Vero cell toxins in Escherichia coli and related bacteria: transfer by phage and conjugation and toxic action in laboratory animals, chickens and pigs. J Gen Microbiol. 1983 Oct;129(10):3121–3137. [PubMed]
  • Smith HW, Linggood MA. The transmissible nature of enterotoxin production in a human enteropathogenic strain of Escherichia coli. J Med Microbiol. 1971 Aug;4(3):301–305. [PubMed]
  • Spika JS, Parsons JE, Nordenberg D, Wells JG, Gunn RA, Blake PA. Hemolytic uremic syndrome and diarrhea associated with Escherichia coli O157:H7 in a day care center. J Pediatr. 1986 Aug;109(2):287–291. [PubMed]
  • Steele BT, Murphy N, Arbus GS, Rance CP. An outbreak of hemolytic uremic syndrome associated with ingestion of fresh apple juice. J Pediatr. 1982 Dec;101(6):963–965. [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]
  • Strockbine NA, Marques LR, Holmes RK, O'Brien AD. Characterization of monoclonal antibodies against Shiga-like toxin from Escherichia coli. Infect Immun. 1985 Dec;50(3):695–700. [PMC free article] [PubMed]
  • Strockbine NA, Marques LR, Newland JW, Smith HW, Holmes RK, O'Brien AD. Two toxin-converting phages from Escherichia coli O157:H7 strain 933 encode antigenically distinct toxins with similar biologic activities. Infect Immun. 1986 Jul;53(1):135–140. [PMC free article] [PubMed]
  • Stuart FA, Corbel MJ. Identification of a serological cross-reaction between Brucella abortus and Escherichia coli 0:157. Vet Rec. 1982 Feb 27;110(9):202–203. [PubMed]
  • Taylor CM, White RH, Winterborn MH, Rowe B. Haemolytic-uraemic syndrome: clinical experience of an outbreak in the West Midlands. Br Med J (Clin Res Ed) 1986 Jun 7;292(6534):1513–1516. [PMC free article] [PubMed]
  • Thompson MR, Steinberg MS, Gemski P, Formal SB, Doctor BP. Inhibition of in vitro protein synthesis by Shigella dysenteriae 1 toxin. Biochem Biophys Res Commun. 1976 Aug 9;71(3):783–788. [PubMed]
  • Toffler RB, Pingoud EG, Burrell MI. Acute colitis related to penicillin and penicillin derivatives. Lancet. 1978 Sep 30;2(8092 Pt 1):707–709. [PubMed]
  • Totani T. [Acute hemorrhagic enteritis with Klebsiella oxytoca]. Nihon Rinsho. 1978 May;Suppl:1308–1309. [PubMed]
  • Trompeter RS, Schwartz R, Chantler C, Dillon MJ, Haycock GB, Kay R, Barratt TM. Haemolytic-uraemic syndrome: an analysis of prognostic features. Arch Dis Child. 1983 Feb;58(2):101–105. [PMC free article] [PubMed]
  • Tzipori S, Karch H, Wachsmuth KI, Robins-Browne RM, O'Brien AD, Lior H, Cohen ML, Smithers J, Levine MM. Role of a 60-megadalton plasmid and Shiga-like toxins in the pathogenesis of infection caused by enterohemorrhagic Escherichia coli O157:H7 in gnotobiotic piglets. Infect Immun. 1987 Dec;55(12):3117–3125. [PMC free article] [PubMed]
  • Tzipori S, Wachsmuth IK, Chapman C, Birden R, Brittingham J, Jackson C, Hogg J. The pathogenesis of hemorrhagic colitis caused by Escherichia coli O157:H7 in gnotobiotic piglets. J Infect Dis. 1986 Oct;154(4):712–716. [PubMed]
  • Tzipori S, Wachsmuth KI, Smithers J, Jackson C. Studies in gnotobiotic piglets on non-O157:H7 Escherichia coli serotypes isolated from patients with hemorrhagic colitis. Gastroenterology. 1988 Mar;94(3):590–597. [PubMed]
  • Upadhyaya K, Barwick K, Fishaut M, Kashgarian M, Siegel NJ. The importance of nonrenal involvement in hemolytic-uremic syndrome. Pediatrics. 1980 Jan;65(1):115–120. [PubMed]
  • VAN HEYNINGEN WE, GLADSTONE GP. The neurotoxin of Shigella shigae. I. Production, purification and properties of the toxin. Br J Exp Pathol. 1953 Apr;34(2):202–216. [PMC free article] [PubMed]
  • van Wieringen PM, Monnens LA, Schretlen ED. Haemolytic-uraemic syndrome. Epidemiological and clinical study. Arch Dis Child. 1974 Jun;49(6):432–437. [PMC free article] [PubMed]
  • VICARI G, OLITZKI AL, OLITZKI Z. The action of the thermolabile toxin of Shigella dysenteriae on cells cultivated in vitro. Br J Exp Pathol. 1960 Apr;41:179–189. [PMC free article] [PubMed]
  • Vitsky BH, Suzuki Y, Strauss L, Churg J. The hemolytic-uremic syndrome: a study of renal pathologic alterations. Am J Pathol. 1969 Dec;57(3):627–647. [PMC free article] [PubMed]
  • Waddell T, Head S, Petric M, Cohen A, Lingwood C. Globotriosyl ceramide is specifically recognized by the Escherichia coli verocytotoxin 2. Biochem Biophys Res Commun. 1988 Apr 29;152(2):674–679. [PubMed]
  • Weinstein DL, Jackson MP, Samuel JE, Holmes RK, O'Brien AD. Cloning and sequencing of a Shiga-like toxin type II variant from Escherichia coli strain responsible for edema disease of swine. J Bacteriol. 1988 Sep;170(9):4223–4230. [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]
  • Whittam TS, Wachsmuth IK, Wilson RA. Genetic evidence of clonal descent of Escherichia coli O157:H7 associated with hemorrhagic colitis and hemolytic uremic syndrome. J Infect Dis. 1988 Jun;157(6):1124–1133. [PubMed]
  • Willshaw GA, Smith HR, Scotland SM, Field AM, Rowe B. Heterogeneity of Escherichia coli phages encoding Vero cytotoxins: comparison of cloned sequences determining VT1 and VT2 and development of specific gene probes. J Gen Microbiol. 1987 May;133(5):1309–1317. [PubMed]
  • Willshaw GA, Smith HR, Scotland SM, Rowe B. Cloning of genes determining the production of vero cytotoxin by Escherichia coli. J Gen Microbiol. 1985 Nov;131(11):3047–3053. [PubMed]
  • Yutsudo T, Honda T, Miwatani T, Takeda Y. Characterization of purified Shiga toxin from Shigella dysenteriae 1. Microbiol Immunol. 1986;30(11):1115–1127. [PubMed]

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