The infectious dose of EHEC is very low, between 1 and 100 colony-forming units (CFUs).11 The two major virulence factors for EHEC are the production of two Shiga-like cytotoxins (Shiga toxin [Stx] I and II) and adhesion-causing attachment-efface-ment (A/E) lesions. These Stx cytotoxins are responsible for vascular damage and systemic effects such as HUS. Adhesion mediates initial attachment of EHEC to intestinal epithelial cells. Following attachment, these organisms produce A/E lesions on individual intestinal epithelial cells. A/E lesions infect the small or large intestine and cause diarrhea.

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