Role of Non‐O157:H7Escherichia coliin Hemolytic Uremic Syndrome

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Abstract
SIR—We read with interest the article by Dundas et al. [1] but were surprised that the authors neglected to look for other, non-O157:H7 verocytotoxigenic Escherichia coli (VTEC) or to test serum samples from the patients for antibodies to these microorganisms. We have shown, in our serological studies of serum samples collected during an outbreak of hemolytic uremic syndrome, that “multiple strain infection may be the rule rather than the exception” [2]. We have further shown that such multiple infections, involving a variety of VTEC, contributed significantly to the outbreak and that the greater the variety of infecting VTEC, the greater the possibility that clinical complications will occur [3]. In addition, Dundas et al. [1] report that culture of fecal samples for VTEC O157 yielded positive results in only 81% of cases, which strongly suggests that other VTEC serotypes were involved as well. Cases in which fecal cultures did not yield VTEC O157 (19% of the total) were included in the data analysis as “probable” cases. However, because culture-confirmed cases were not compared with probable cases, the complication rate among patients with probable cases cannot be determined from the data presented.

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