[Infections with verocytotoxin-producing Escherichia coli and hemolytic-uremic syndrome]

Infections with verocytotoxin-producing Escherichia coli and (VTEC), and especially with serotype O157, are the main cause of haemolytic-uraemic syndrome (HUS) in children in the Netherlands. 8% of the patients infected develop HUS; the incidence is 2/105/year in children under 5 years. The infection may be asymptomatic, but may also lead to mild to haemorrhagic diarrhoea and to haemorrhagic colitis. Up to 10% of the patients die in the acute phase of the disease and in up to another 10% the renal damage does not resolve completely. In 1993 bovine meat samples examined by polymerase chain reaction revealed VTEC in 16% of the cases; however none of the isolated serotypes was known to be pathogenic in humans. Epidemiological investigations are being carried out in the cattle population. Verocytotoxins are exotoxins that bind to surface receptors on cells after which part of the toxin is internalized where it inhibits protein synthesis. The functional receptor is glycosphingolipid globotriaosylceramide, a molecule normally only expressed in the renal glomeruli of children under three years of age.