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The leading cause of hemolytic uremic syndrome (HUS) in children is Shiga toxin-producing Escherichia coli (STEC) infection, which has a major outbreak potential. Since the early 2010s, STEC epidemiology is characterized by a decline of the historically predominant O157 serogroup and the emergence of non-O157 STEC, especially O26 and O80 in France. STEC contamination occurs through the ingestion of contaminated food or water, person-to-person transmission, or contact with ruminants or their contaminated environment. The main symptom is diarrhea, which is bloody in about 60% of patients and occurs after a median incubation period of three days. Shiga toxins released by STEC induce a cascade of thrombogenic and inflammatory changes of microvascular endothelial cells. HUS is observed in 5-15% of STEC infection cases, defined by the triad of mechanical hemolytic anemia, thrombocytopenia, and acute renal injury. The diagnosis of STEC infection relies on biological screening for Shiga toxins and STEC in stools and serology. Treatment of STEC-HUS is mainly symptomatic, as no specific drug has proved effective. The effect of antibiotics in STEC infection and STEC-HUS remains debated; however, some bacteriostatic antibiotics might have a beneficial effect. Proofs of evidence of a benefit from complement blockade therapy in STEC-HUS are also lacking. Clinical and bacteriological STEC-HUS surveillance needs to be continued. Ongoing prospective studies will document the role of bacteriostatic antibiotics in STEC infection and STEC-HUS, and of complement blockade therapy in STEC-HUS.

Introduction An outbreak of shiga-toxin producing Escherichia coli infections occurred in southwest France in June 2012. The outbreak was investigated to identify the source of infection, and guide control measures. Methods Confirmed outbreak cases were patients who developed bloody diarrhoea or haemolytic uremic syndrome (HUS) between 28 May and 6 July 2012, with E. coli O157 isolates showing indistinguishable patterns on pulse field gel electrophoresis (PFGE). A standardized questionnaire was administered to patients to document food consumption and other risk exposures. Their purchase was checked through their supermarket shopper card data. Results Six patients (four with HUS and two with bloody diarrhea) were confirmed outbreak cases. Fresh ground beef burgers from one supermarket were the only common food exposure, identified by interviews and shopper card data. The PFGE profile of shiga toxin-producing E. coli O157 isolated from the suspected beef burgers was identical to those from the human cases. The suspected beef burgers were no longer on sale at the time of investigation but three patients confirmed as outbreak cases had deep-frozen some at home. Conclusion Shopper card data was particularly useful to obtain precise and reliable information on the traceability of consumed food. Despite the expired use-by date, a recall was issued for the beef burgers. This contributed to preventing other cases among consumers who had deep-frozen the beef burgers.

International audience; Hemolytic-uremic syndrome due to enterohemorrhagic Escherichia coli, belonging to serogroup O91 hasrarely been described. We report here a case of post-diarrheal HUS due to EHEC O91 in an elderly patientfor whom diagnosis was delayed given a previously diagnosed C. difficile infection. This case highlightsthe usefulness of Shiga-toxin detection.

Introduction Le 22 juillet 2013, des cas de gastro-enterite aigue lors d’un festival musical en Ariege ont ete signales a l’Agence regionale de sante Midi-Pyrenees. Ce festival etait organise du 19 au 21 juillet et regroupait environ 300 benevoles, 150 artistes et 3500 festivaliers provenant de France et d’autres pays europeens. Methode Des investigations epidemiologiques et microbiologiques ont ete menees afin de confirmer l’existence d’une epidemie, de la decrire, d’identifier l’agent responsable, et de preciser le mode de transmission. Un cas confirme a ete defini par une coproculture positive a Shigella chez un participant du festival. Un cas possible a ete defini par la survenue d’une diarrhee aigue chez un participant au festival ou chez une personne ayant ete en contact avec un cas confirme. Compte tenu de la dispersion geographique des participants, les investigations ont implique des contacts avec differents partenaires europeens. Resultats Au total, 171 cas ont ete identifies dont 28 confirmes. La majorite (71 %) est survenue parmi les benevoles. Les symptomes rapportes–diarrhees (100 %) dont diarrhees glairo-sanglantes (13 %), douleurs abdominales (74 %), fievre (70 %), nausees/vomissements (65 %)–sont apparus entre le 18 juillet et le 10 aout, avec un pic le 21 juillet. Conclusion Plusieurs modes de transmission ont ete suspectes : alimentaire, inter-humain et environnemental, favorises par des conditions d’hygiene precaires. Un lien epidemiologique et microbiologique a ete etabli avec une epidemie de shigellose survenue lors d’un festival en Espagne du 9 au 14 juillet, presentant la meme souche de Shigella sonnei, de profil d’antibiogramme identique.