Treatment of enterohemorrhagic Escherichia coli (EHEC) infection and hemolytic uremic syndrome (HUS)

See related article: http://www.biomedcentral.com/1741-7015/10/11 webciteThe association of verotoxigenic Escherichia coli (VTEC) with human disease goes back over 30 years [1-3]. The occurrence of outbreaks due to VTEC in the USA in 1982 [4] focused the world's attention onto these pathogens. Since the discovery of verocytotoxin [1,3], and the paper by Karmali et al. [5] of cases of post-diarrheal hemolytic uremic syndrome (D+HUS) caused by VTEC, otherwise known as Shiga-toxigenic Escherichia coli (STEC), a large body of knowledge has accumulated, yet despite this information, successful treatment of these infections has remained elusive.Gut colonization of farm animals, especially ruminants such as cattle, sheep and goats is the likely origin of VTEC/STEC. From these sources derive a variety of vehicles of transmission to humans, including many different foods of animal or plant origin, and water used for swimming and drinking and for growing edible plants. Human fecal contamination of food and seeds could also play a role, especially in developing countries [6].The potential for VTEC spread is further compounded by globalization of food, which presents a great opportunity for VTEC to spread quickly to large sections of the population. Global food distribution carries an inherent risk and presents great difficulties in controlling food-borne pathogens and in identifying sources of outbreaks, as was recently witnessed in Europe. This is further discussed in the commentary by Werber et al. [7].Various strains of VTEC exist, and, as discussed in the linked commentary, O157 clones, although less prevalent than non-O157 strains, tend to be more virulent. Thus, although non-O157 VTEC strains had originally been reported and continued to be reported, albeit only by dedicated microbiologists, most researchers in the field largely ignored them. No attention appears to have been given to the generally observed fact that there is a widespread diversity of E. coli serotypes i