Host and pathogen determinants of verocytotoxin-producing Escherichia coli-associated hemolytic uremic syndrome

Verocytotoxin (VT)-producing Escherichia coli (VTEC) infection is associated with a spectrum of clinical manifestations that includes diarrhea, hemorrhagic colitis, and the hemolytic uremic syndrome (HUS). The occurrence of HUS in a minority of individuals in outbreaks of VTEC infection is a function of several pathogen and host factors. Pathogen factors include the inoculum size and serotype of the infecting strain, horizontally acquired genetic elements known as pathogenicity islands, and probably the VT type. Host factors that increase the risk of developing HUS include age, pre-existing immunity, gastric acidity, the use of antibiotics and anti-motility agents, and, probably, stress and genetic factors that modulate host response to infection, such as innate immunity and toxin receptor type, expression, and distribution. A better understanding of the pathogen and host determinants of HUS can aid in the development of more effective public health strategies to reduce the risk of developing HUS.