Communitywide outbreak of hemolytic-uremic syndrome associated with non-O157 verotoxinproducing Escherichia coli

syndrome in Lombardia, Italy, where only 14 cases ofthis syndrome had occurred in the preced-ing 4 years. Cases were scattered in a large area encompassing five provinces, and the source of the outbreak was not identified. Eight patients needed dialysis, and there was 1 death. Seven of the 9 cases were examined for evidence of infection by Vero cytotoxin (VT)-producing Esche-richiacoli (VTEC). Six children had serum antibodies to the lipopolysaccharide ofE. coli 0 111, and a VT-producing E. coli0111:NM was isolated from stool in 1 case. This is the first outbreak of VTEC infection recognized in Italy and the first associated with an E. coliserotype other than OI57:H7. Hemolytic-uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, renal failure, and central nervous system symptoms, often with a prodrome of diarrhea [1]. The association between HUS and infection by Vero cytotoxin (VT)-producing Esche-richia coli (VTEC), particularly strains of serogroup 0157, was first demonstrated in Canada in 1983-1985 [2] and ha