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Journal of Clinical Microbiology, June 2001, p. 2272-2279, Vol. 39, No. 6
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.6.2272-2279.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Antibody Response to Shiga Toxins Stx2 and Stx1 in Children with Enteropathic Hemolytic-Uremic Syndrome

Kerstin Ludwig,1,* Mohamed A. Karmali,2,dagger Volkan Sarkim,1 Christoph Bobrowski,3 Martin Petric,2 Helge Karch,4 Dirk E. Müller-Wiefel,1 and Arbeitsgemeinschaft für Pädiatrische NephrologieDagger

Klinik und Poliklinik für Kinder-und Jugendmedizin1 and Medizinische Kernklinik und Poiklinik,3 Universitäts-Krankenhaus Eppendorf, 20246 Hamburg, and Institut für Hygiene und Mikrobiologie der Universität Würzburg, 97080 Würzburg,4 Germany, and Research Institute and Division of Microbiology, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, and Department of Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada M5G 1X82

Received 31 October 2000/Returned for modification 20 December 2000/Accepted 22 February 2001

A Western blot (immunoblot) assay (WBA) for the detection of immunoglobulin G antibodies to Shiga toxins Stx2 and Stx1 in sera from 110 patients with enteropathic hemolytic-uremic syndrome (53 culture confirmed to have Shiga toxin-producing Escherichia coli [STEC] infection) and 110 age-matched controls was established by using a chemiluminescence detection system. Thirty-nine (74%) of the 53 culture-confirmed cases were infections with STEC serotype O157, and 14 (26%) were associated with infection by other STEC serotypes. The frequency of an anti-Stx2 response following infection by a Stx2-producing strain (34 of 48 cases; 71%) was higher than that of an anti-Stx1 response following Stx1-producing STEC infection (4 of 10). Furthermore, the frequency of an anti-Stx2 response in 110 control sera (10%) was significantly higher than the frequency of an anti-Stx1 response (1.8%) (P = 0.0325). For STEC O157 culture-confirmed cases WBA for toxin detection had a diagnostic sensitivity of 71% and a specificity of 90%. Because of its high specificity the assay might be a helpful tool for diagnosing suspected STEC infection when tests of stool samples or serological tests against various lipopolysaccharide antigens are negative. Furthermore, the prevalence of anti-Stx antibodies in healthy controls probably reflects the population immunity to systemic Stx-associated disease. It can thus serve as a basis for comparing immunity levels in different populations and for considering future Stx toxoid immunization strategies.

* Corresponding author. Mailing address: Universitäts-Krankenhaus Eppendorf, Klinik und Poliklinik für Kinder-und Jugendmedizin, Martinistr. 52, 20246 Hamburg, Germany. Phone: 49-40-428032702. Fax: 49-40-428035053. E-mail: kludwig{at}uke.uni-hamburg.de.

dagger Present address: Laboratory for Foodborne Zoonoses, Population and Public Health Branch, Health Canada, Stone Rd. West, Guelph, Ontario, Canada N1G 3W4.

Dagger Members of this study group who participated (from five additional University Children's Hospitals in Germany) included the following: B. Hoppe, D. Michalk, and U. Querfeld, Cologne; J. H. H. Ehrich, G. Filler, and M. von Bredow, Charité Berlin; H. Ruder, Erlangen; U. John, and J. Misselwitz, Jena; and L. B. Zimmerhackl, Freiburg.

Journal of Clinical Microbiology, June 2001, p. 2272-2279, Vol. 39, No. 6
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.6.2272-2279.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


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