Clinical Presentation and Diagnosis of EHEC

• Incubation period of 3 to 5 days

• Bloody stools

• Fever usually absent

• Leukocytosis

• Abdominal tenderness

• HUS in 2% to 10% of patients (especially children 1-5 years of age and the elderly in nursing homes); develops on average 1 week after the onset of diarrhea.

• EHEC belonging to serotype 0157:H7 characteristically do not ferment sorbitol, whereas more than 70% of intestinal floral E. coli do. To properly screen EHEC strains in cases of diarrhea, stool should be placed on special sorbitol-MacConkey agar. Colonies of E. coli 0157:H7, which do not ferment the sorbitol, can be identified readily and confirmed by serotyping with specific antisera. In addition, stool should be tested directly for the presence of Stx I and II by enzyme immunoassay (EIA).

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