A 3-year-old case died of hemolytic uremic syndrome and encephalophathy due to EHEC O86 infection, October 1999 - Kagoshima
(IASR 1999; 20: 271-272)

Case:

On September 26, 1999, a 3-year old boy presented soft stool. Following day, he developed bloody diarrhea and abdominal pain, and he admitted a nearby hospital. He deteriorated hemolytic uremic syndrome (HUS) and convulsion on September 28, and he was transferred to a general hospital for intensive HUS treatment. On the same day, stool specimen was forwarded from the general hospital to the Department of Pediatrics, Faculty of Medicine, Kagoshima University, where Escherichia coli O86 was isolated and Polymerase Chain Reaction (PCR) detected the Vero toxin 2 (VT2) fragment. On October 1, the Dept. of Pediatrics requested the Kagoshima Prefectural Institute of Public Health to reconfirm Vero toxin type. On October 2, the Institute detected the VT2 gene and characterized biochemical and serological types. The patient died from HUS and encephalopathy on the day. On October 3 Reversed Passive Latex Agglutination test (RPLA) confirmed that the isolate produces VT2.

Laboratory findings:

For growth, TSB, GN BROTH grow the isolate, but mEC-NB does not.
For isolation, SS and MAC develop white colony. DHL develops red colony. CT-SMAC, CT-RMAC, CT-SorboseMAC do not develop colony.
For confirmation, each agar characterizes the isolate as follows:
TSI; yellow on slope, otherwise similar with E. coli 's.
LIM; L=intermediate color, I=positive, M=non-mobile.
VP; negative, SC; negative.
CLIG; red/orange, fluorescent positive.
Beutin culture; non-hemolytic

Epidemiological investigation:

Due to above results, GN BROTH (for growth), Dynabeads M-280 (for selection), and SS and DHL (for isolation) were used for transmission investigation. Since October 4, specimens were collected from family, the those closed, and food items etc. E. coli O86:H-, which has the same character, was isolated from few persons, but those isolates did not produce the Vero toxin.

Reported by Nobuhiro Ueno, Ken-ichiro Yoshikuni, Naomi Shinkawa, Tadayuki Arima, and Kohji Nagata from the Kagoshima Prefectural Institute of Public Health;
Jun-ichiro Nishi from the Dept. Pediatrics, Faculty of Medicine, Kagoshima University.

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