Shiga toxin-producing Escherichia coli (STEC): diagnosis and notification
Information for clinicians on diagnosis and notification of Shiga toxin-producing Escherichia coli (STEC) and haemolytic uraemic syndrome (HUS).
This document provides advice for clinicians on:
- diagnosis of STEC
- identification of children at risk
- statutory notification requirements
STEC infections may be acquired by consuming contaminated food, such as meat (for example, under-cooked burgers), salad vegetables or dairy products, or by exposure to farm animals or contaminated soil. The illness frequently presents as abdominal pain, diarrhoea with or without blood in stool, vomiting and dehydration. Up to 15% of paediatric cases of STEC progress to haemolytic uraemic syndrome (HUS), which is a triad of microangiopathic haemolytic anaemia, acute renal failure and thrombocytopenia.
HUS is the most common cause of acute renal failure in children below 5 years of age. More than 90% cases of HUS are caused by STEC (previously known as Vero cytotoxin-producing Escherichia coli, VTEC), and STEC-HUS associated fatalities, particularly in children, have occurred in the recent years.
Diagnosis of STEC-HUS is often missed due to lack of appropriate testing. It is important to test a faecal sample – or, if stool is unavailable, a rectal swab (bacterial culture swab or charcoal swab) – to facilitate a rapid diagnosis and identification of children at risk of developing HUS. Swabs or faecal samples should be sent to the local microbiology laboratory labelled as ‘suspected STEC’ or ‘suspected HUS’.
It is particularly important to obtain a faecal or rectal specimen from children below 5 years of age, the elderly and the immunocompromised, when there:
- has been admission to hospital with gastroenteritis and/or HUS
- are severe symptoms and signs of gastroenteritis, such as bloody diarrhoea
- are symptoms and signs of gastroenteritis that have not resolved by 72 hours
HUS cases must be notified to the local health protection team on clinical suspicion, regardless of the microbiology results, and suspected cases discussed with the local paediatrician and/or renal physician to arrange further blood tests.
For additional information, see NICE Clinical Knowledge Summary: child gastroenteritis.