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Shiga toxin-producing Escherichia coli (STEC)
2005 Case Definition
Clinical description
An infection of variable severity characterized by diarrhea (often bloody) and abdominal cramps. Illness may be complicated by hemolytic uremic syndrome (HUS) or thrombotic thrombocytopenic purpura (TTP); asymptomatic infections also may occur and the organism may cause extraintestinal infections.
Laboratory criteria for diagnosis
- Isolation of Shiga toxin-producing Escherichia coli from a clinical specimen. Escherichia coli O157:H7 isolates may be assumed to be Shiga toxin-producing. For all other E. coli isolates, Shiga toxin production or the presence of Shiga toxin genes must be determined to be considered STEC.
Case classification
Suspect:
A case of postdiarrheal HUS or TTP (see HUS case definition), or identification of Shiga toxin in a specimen from a clinically compatible case without the isolation of the Shiga toxin-producing E. coli.
Probable:
- A case with isolation of E. coli O157 from a clinical specimen, without confirmation of H antigen or Shiga toxin production,
OR
- A clinically compatible case that is epidemiologically linked to a confirmed or probable case,
OR
- Identification of an elevated antibody titer to a known Shiga toxin-producing E. coli serotype from a clinically compatible case.
Confirmed:
A case that meets the laboratory criteria for diagnosis. When available, O and H antigen serotype characterization should be reported.
Comment
For users of the legacy National Electronic Telecommunications System for Surveillance (NETSS), laboratory-confirmed isolates are also reported via the Public Health Laboratory Information System (PHLIS), which is managed by the Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC. The National Electronic Disease Surveillance System (NEDSS) or NEDSS compatible systems will eventually replace PHLIS and NETSS; users of NEDSS or compatible systems which report to CDC should not report via PHLIS.
Both asymptomatic infections and infections at sites other than the gastrointestinal tract, if laboratory confirmed, are considered confirmed cases that should be reported. See also:
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