ArticlePloS one2007
Shiga toxin-mediated hemolytic uremic syndrome: time to change the diagnostic paradigm?
Article in PloS one, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 62 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
62 citing papers in PubMed, 1 synthesis or guideline pooled it, 146 citations in OpenAlex.
- Guideline for the investigation and initial therapy of diarrhea-negative hemolytic uremic syndrome.Pediatric nephrology (Berlin, Germany) · 2009Guideline
- Surveillance of enteropathogenicJournal of medical microbiology · 2026Article
- Shiga Toxin-ProducingMicroorganisms · 2025Article
- Acute renal injury from thrombotic microangiopathy associated with enteritis in New Zealand white rabbits.Journal of veterinary diagnostic investigation : official publication of the American Association of Veterinary Laboratory Diagnosticians, Inc · 2022Article
- Whole-Genome Sequencing Analysis of aDiagnostics (Basel, Switzerland) · 2021Article
- Improved Genomic Identification, Clustering, and Serotyping of Shiga Toxin-ProducingFrontiers in cellular and infection microbiology · 2021Article
- Comparative Whole Genome Analysis ofFrontiers in microbiology · 2021Article
- Integrating evolutionary aspects into dual-use discussion: the cases of influenza virus and enterohemorrhagicEvolution, medicine, and public health · 2021Review
- Review
- High-Zinc Supplementation of Weaned Piglets Affects Frequencies of Virulence and Bacteriocin Associated Genes Among IntestinalFrontiers in veterinary science · 2020Article
- Implications of stx loss for clinical diagnostics of Shiga toxin-producing Escherichia coli.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2018Article
- Case definitions of hemolytic uremic syndrome following Escherichia coli O157:H7 infection vary in validity.International journal of medical microbiology : IJMM · 2018Article
- Strength of the association between antibiotic use and hemolytic uremic syndrome following Escherichia coli O157:H7 infection varies with case definition.International journal of medical microbiology : IJMM · 2018Article
- The effect of transportation and lairage on faecal shedding and carcass contamination with Escherichia coli O157 and O26 in very young calves in New Zealand.Epidemiology and infection · 2018Article
- DiarrheagenicThe Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale · 2018Article
- Characteristics of Shigatoxin-ProducingFrontiers in microbiology · 2017Article
- Development of a real-time PCR assay and comparison to CHROMagarAfrican journal of laboratory medicine · 2017Article
- Molecular Characterization of Human Atypical Sorbitol-Fermenting Enteropathogenic Escherichia coli O157 Reveals High Diversity.Journal of clinical microbiology · 2016Article
- Is Shiga Toxin-Negative Escherichia coli O157:H7 Enteropathogenic or Enterohemorrhagic Escherichia coli? Comprehensive Molecular Analysis Using Whole-Genome Sequencing.Journal of clinical microbiology · 2015Article
- Highly Virulent Non-O157 Enterohemorrhagic Escherichia coli (EHEC) Serotypes Reflect Similar Phylogenetic Lineages, Providing New Insights into the Evolution of EHEC.Applied and environmental microbiology · 2015Article
2 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundHemolytic uremic syndrome (HUS) is caused by enterohemorrhagic Escherichia coli (EHEC) which possess genes encoding Shiga toxin (stx), the major virulence factor, and adhesin intimin (eae). However, the frequency of stx-negative/eae-positive E. coli in stools of HUS patients and the clinical significance of such strains are unknown. METHODOLOGY/PRINCIPAL
findingsBetween 1996 and 2006, we sought stx-negative/eae-positive E. coli in stools of HUS patients using colony blot hybridization with the eae probe and compared the isolates to EHEC causing HUS. stx-negative/eae-positive E. coli were isolated as the only pathogens from stools of 43 (5.5%) of 787 HUS patients; additional 440 (55.9%) patients excreted EHEC. The majority (90.7%) of the stx-negative/eae-positive isolates belonged to serotypes O26:H11/NM (nonmotile), O103:H2/NM, O145:H28/NM, and O157:H7/NM, which were also the most frequent serotypes identified among EHEC. The stx-negative isolates shared non-stx virulence and fitness genes with EHEC of the corresponding serotypes and clustered with them into the same clonal complexes in multilocus sequence typing, demonstrating their close relatedness to EHEC. CONCLUSIONS/SIGNIFICANCE: At the time of microbiological analysis, approximately 5% of HUS patients shed no longer the causative EHEC, but do excrete stx-negative derivatives of EHEC that lost stx during infection. In such patients, the EHEC etiology of HUS is missed using current methods detecting solely stx or Shiga toxin; this can hamper epidemiological investigations and lead to inappropriate clinical management. While maintaining the paradigm that HUS is triggered by Shiga toxin, our data demonstrate the necessity of considering genetic changes of the pathogen during infection to adapt appropriately diagnostic strategies.
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