The regional Institute of Public Health in Kranj, Slovenia,
has reported a fatal case of bloody diarrhoea caused by verotoxin-producing
(VTEC) O145. On 8 August 2005, a 22 month old, previously
healthy girl died of myocarditis associated with haemolytic uraemic syndrome
(HUS). She had become ill on 3 August with bloody diarrhoea, but no fever
or pain. She was admitted to hospital for two days and received symptomatic
therapy. The day after she was discharged, her condition worsened, with neurological
symptoms, and she was readmitted to hospital where the diagnosis of HUS was
E. coli was isolated from a stool sample using standard procedures.
Serogroup O145 was determined using serogroup-specific antibodies. The isolate
was tested with an ELISA test for verotoxin (Premier EHEC, Meridian Bioscience,
United States), and VTEC O145 infection was confirmed before the child’s
death. During the epidemiological investigation, seven samples of meat and
water from two butchers’ shops were taken. E. coli was isolated
from most of the samples, but serogroup O145 was not.
The girl lived in a rural area and had never travelled abroad. She had
very limited contacts with other children and adults. The family used drinking
water from a controlled local water supply. E. coli was never detected
in this water during regular testing. The family did not keep farm animals,
although the child had frequent contact with a domestic cat. The family
made their own meals with meat bought from the local butchers in the village,
and had bought minced meat to eat a few days before the child became ill.
This is thought to be the most likely source of infection, but no meat was
left over to test for E. coli.
Gastrointestinal symptoms are relatively common in this region during the
summer. No known links with any other cases have yet been identified. None
of the other household members had any gastrointestinal symptoms.
Only 18 E. coli O145 isolates have been diagnosed in Slovenia
in the past five years. However, many laboratories do not test for E.
coli O145, so this is likely to be an underestimate of the true number
Data from Enter-net,
the international surveillance network for the enteric infections Salmonella
and VTEC O157, show that this serogroup is not common. E. coli
O145 infections make up only 224 of 9358 reports (2.4%) in the Enter-net
VTEC database between the years 2000-2004. When data from the United Kingdom
and Ireland (where O157 infections predominate) are excluded, O145 is the
fourth most common serogroup reported in mainland Europe, making up 224
of 5123 cases (4.4%). The database does not currently include data from
Underascertainment of non-O157 VTECs is thought to be common, as stool
samples are not routinely tested for VTEC strains other than serogroup O157.
However, more extensive testing should be encouraged throughout Europe,
as non-O157 infections can be a significant cause of morbidity and mortality,
as reported here.