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Home Eurosurveillance Weekly Release  2005: Volume 10/ Issue 37 Article 2
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Eurosurveillance, Volume 10, Issue 37, 15 September 2005

Citation style for this article: Kraigher A, Seme K, Krt-Lah A, Fisher IS. Fatal case of HUS after VTEC E. coli O145 infection in Slovenia highlights importance of testing for this rare strain. Euro Surveill. 2005;10(37):pii=2792. Available online:

Fatal case of HUS after VTEC E. coli O145 infection in Slovenia highlights importance of testing for this rare strain

Alenka Kraigher1 (, Katja Seme2, Andreja Krt-Lah3 and Ian Fisher4

1Communicable Diseases Center, National Institute of Public Health, Ljubljana, Slovenia
2Medical faculty Ljubljana, Institute for Microbiology and Immunology, Slovenia
3Regional Institute for Public Health Kranj, Slovenia
4Enter-net coordinator, Health Protection Agency Centre for Infections, London, United Kingdom

The regional Institute of Public Health in Kranj, Slovenia, has reported a fatal case of bloody diarrhoea caused by verotoxin-producing Escherichia coli (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 made.

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 of cases.

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 Slovenia.

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.

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