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Cho, Cho, Noh, Kim, and Kim: A Case of Verotoxin-producing Escherichia coli O157:H7 with Hemorrhagic Colitis in an Infant, Diagnosed by Multiplex PCR
Original Article

Korean J Clin Microbiol 2010;13(2):85-89.

Published online: 21 June 2010

DOI: https://doi.org/10.5145/KJCM.2010.13.2.85

A Case of Verotoxin-producing Escherichia coli O157:H7 with Hemorrhagic Colitis in an Infant, Diagnosed by Multiplex PCR

Hae-Sun Cho1, Min-Chul Cho1, Shinae Noh1, Mi-Na Kim1, Kyoung-Mo Kim2

1Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea

2Department of Pediatrics, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea

Correspondence: Mi-Na Kim, Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Soeul 138-736, Korea. (Tel) 82-2-3010-4511, (Fax) 82-2-478-0884, (E-mail) mnkim@amc.seoul.kr

Received 15 October 2009       Revised 23 February 2010       Accepted 25 March 2010

Copyright © 2010 Korean Journal of Clinical Microbiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Enterohemorrhagic Escherichia coli (EHEC) is an important cause of bloody diarrhea in children, but is considered to be rare in infants. Herein, a case of infant hemorrhagic colitis of verotoxin-producing E. coli O157:H7 diagnosed by multiplex PCR is reported. A nine-month-old boy was admitted to our hospital with bloody diarrhea for the previous two days. Multiplex PCR using SeeplexⓇ Diarrhea ACE Detection Kit (Seegene, Seoul, Korea) was directly applied to the stool specimens. Amplified bands specific for verotoxin, O157, and H7 indicated the presence of O157:H7 EHEC. The stool specimens were inoculated on sorbitol-MacConkey agar (SMA) and tryptic soy broth containing mitomycin C (TSB-M). Colorless colonies on sorbitol-MacConkey agar were O157-positive. TSB-M enrichment cultures of the stool specimen and the isolates were positive for verotoxin according to an enzyme immunoassay (EIA). The prepared ingredients of baby foods for the patient including ground meat, chopped carrot, chopped cabbage, and white rice porridge showed no EHEC on TSB-M and SMA. The patient's parents and three-year-old sister did not recently have any gastrointestinal symptoms. Cefdinir was administered for one day and was ceased after diagnosis of EHEC colitis. The stool culture and verotoxin assay were negative on the second day of hospitalization. Application of multiplex PCR and verotoxin EIA directly to diarrheal stool warrants the rapid diagnosis and appropriate treatment of EHEC colitis.

Keywords: Eshcherichia coli O157, H7, Enterohemorrhagic Eshcherichia coli, Verotoxin, Multiplex PCR

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Fig. 1.
Two sets of multiplex PCR assay using SeeplexⓇ Diarrhea ACE Detection Kit revealed amplicons specific for O157, H7, and verotoxin. Lane M: Synthetic size markers tailored for this kit. Lane 1: Negative control showed internal control band. Lane 2: PCR of patient's specimen revealed ampicons specific for O157, H7, and verotoxin.
kjcm-13-85f1.tif
Fig. 2.
Mixtures of colorless (arrow) and pink colonies grown on sorbitol-MacConkey agar after overnight incubation at 35°C.
kjcm-13-85f2.tif
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