Identification of a Clone of Escherichia Coli O103:H2 As a Potential Agent of Hemolytic-uremic Syndrome in France

In a French multicenter study, six verocytotoxin-producing Escherichia coli strains were isolated from the stools of 6 of 69 children suffering from hemolytic-uremic syndrome. All strains belonged to serotype O103:H2, a serotype commonly associated with diarrhea in weaned rabbits in France. To determine whether the strains from humans and rabbits were genetically related, they were compared by analyzing their esterase electropherotypes and the restriction fragment length polymorphisms of the ribosomal DNA regions. A common clonal origin of these pathogenic strains was suggested by their identical esterase electropherotypes and their identical ribotypes, in addition to their identical serotypes. However, strains from humans, which are cytotoxic for HeLa cells through the production of verocytotoxin type 1, do not show adhesion in vitro to HeLa 229 cells and cannot infect rabbits. On the other hand, strains from rabbits do not carry the verocytotoxin type 1 gene, are not cytotoxic for Hela cells, and adhere to ileal villi and HeLa 229 cells because of the expression of their 32-kDa adhesin. Our results therefore identify a clone of verocytotoxin-producing E. coli O103:H2 as a potential agent of hemolytic uremic syndrome in France. They further suggest that clones from humans and rabbits probably have a common origin but that adaptation to the two species occurred by different mechanisms. Thus, they eliminate the hypothesis that the species is horizontally transmitted between rabbits and humans.