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Escherichia coli ‘O’ group serological responses and clinical correlations in epidemic HUS patie

Escherichia coli ‘O’ group serological responses and clinical correlations in epidemic HUS patients. Kulkarni H, Goldwater PN, Martin A, Bettelheim KA. Comparative Immunology, Microbiology & Infectious Diseases 2002;25:249-268


A 1995 E. coli-associated hemolytic uremic syndrome (HUS) epidemic in Australia was investigated to determine the serotypes and serological responses among 21 of the affected children. These findings were used to determine the relationship of serotype and serological response to clinical findings and complications. ‘O’ group antibody responses to HUS-associated serotypes did not differ by clinical presentation of bloody versus nonbloody diarrhea or respiratory infection among HUS patients. Antibody responses to non-HUS-associated serogroups were absent in those without bloody diarrhea. A substantially greater number of seropositivities were seen in the 17 patients with bloody diarrhea compared to the four patients without bloody diarrhea. Patients with bloody diarrhea had significantly higher antibody titers against HUS-associated serotypes than non-HUS-associated serotypes. Patients with severe renal failure tended to develop antibodies to a larger number of serogroups than those with milder renal impairment. Likewise, those with central nervous system (CNS) complications had antibodies to a greater number of serogroups than those without CNS complications. In contrast, patients without gastrointestinal complications had antibodies to a significantly greater number of non-HUS serogroups. In addition, antibody types distinguished those patients with high blood pressure complications from those without these complications. Overall, as the number of complications increased, the number of seroreactive groups increased. This study suggests that co-infection with different serogroups may affect clinical outcome.