Twenty-nine Shiga toxin-producingShiga toxin-producing Escherichia coli (STEC) can cause a broad spectrum of human illness ranging from uncomplicated diarrhea to hemorrhagic colitis (HC) and hemolytic-uremic syndrome (HUS) (14). E. coli O157:H7 is by far the most important STEC serotype in the world and has been associated with numerous outbreaks and many sporadic cases of HC and HUS (20). However, infections with other non-O157 STEC serotypes have been increasingly reported in many countries (2,3,22). Currently more than 100 different non-O157 STEC serotypes have been isolated from human infections. Unlike with O157:H7, outbreaks caused by non-O157 STEC have rarely been reported, and these strains have been more frequently associated with sporadic cases of diarrhea, HC, and HUS. Moreover, in many countries, non-O157 strains are more commonly isolated from patients with diarrhea or HUS than are O157 STEC strains (3, 5, 23). The major virulence trait of these bacteria is the production of one or more Stx types (Stx1, Stx2, or Stx2 variants) (20). Additional factors, produced mainly by strains in straight association with human disease and collectively referred to as enterohemorrhagic E. coli (EHEC), include intimin and enterohemolysin (1,20). Other putative virulence factors include the enteroaggregative E. coli heat-stable enterotoxin (EAST-1), encoded by astA (25), particularly in O157:H7 and O26:H11 strains and in some other STEC serotypes. In Brazil, the studies conducted so far that searched for STEC in human diarrheal disease have investigated a limited number of strains and have described the isolation of a few non-O157 STEC strains (7,12,16). The isolation of O157:H7 strains from patients with bloody diarrhea as well as one with HUS related to O26:H11 infection was only recently reported in Brazil (15,19).The purpose of this study was to search for STEC in a collection of 2,607 E. coli isolates, most of them belonging to important serogroups increasingly associated with HUS and HC in other countries. The main virulence factors, biotypes, and susceptibility to antimicrobial agents of the STEC strains identified were characterized.The E. coli strains studied belonged to the collection of Instituto Adolfo Lutz, a Central Public Health Laboratory in São Paulo, Brazil, and national center for E. coli serotyping, and were isolated between 1976 and 1999, mainly from children (0 to 5 years old) with diarrhea (2,549 strains); the remaining 58 E. coli strains were isolated from immunocompromised adult patients with diarrhea (mainly human immunodeficiency virus positive) over the same period. Each strain was derived from one patient. Except for diarrhea, no other information regarding the clinical aspects of the patients were available. None of the strains belonging to the enteropathogenic E. coli (EPEC) serogroups carried the EAF sequence (EPEC adherence factor) as assayed by hybridization assays with a specific DNA probe (13). The remaining strains outside the EPEC serogroups did not belong to the enteroinvasive ...

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Brazilian spotted fever was detected for the first time in the State of S o Paulo in 1929. However, there is no systematic reporting of the disease in the State. In 1985, three cases of the disease occurred in the municipality of Pedreira, located in the Campinas Region, belonging to the 5th Administrative Region, in the Northeast part of the State, including 88 municipalities. An investigation was conducted at the time, but the lack of case registry limited its scope. The present study was undertaken with the aim of recovering the history of the disease in the Region. Data recovered from several public health services for 1985-2000 were used to analyze incidence patterns. It was observed that the transmission area expanded and the number of suspected cases increased, especially after 1996, when mandatory reporting was established. Deaths due to spotted fever were observed in most of the years under study. The study concluded that spotted fever incidence is increasing in the Campinas Region. Complementary bio-ecological studies are currently under way to better understand the epidemiology of this disease, recognized worldwide as an emerging public health problem.