Escherichia coli, Shiga-toxin producing

Reportable by Laboratories and Providers

About this Reportable Disease

Infectious agent:  E.coli bacteria that produce Shiga toxin, also called verocytotoxin-producing E.coli (VTEC) or enterohemorrhagic E.coli (EHEC)

Description of illness: Symptoms of infection include diarrhea (often bloody), abdominal cramps and vomiting. Hemolytic uremic syndrome (HUS) is a complication in 5% to 10% of patients and can be life-threatening.  STEC are excreted in the stool of infected persons for up to 1 week in adults and up to 3 weeks in children.

Interactive Disease Data


Laboratory Reporting for this Disease

Escherichia coli STEC

TEST NAME Escherichia coli STEC
DISEASE/DISORDER Diarrheal disease, Hemolytic uremic syndrome (HUS)
ALTERNATE NAME(S) Enteric pathogens, stool culture, aerobic bacterial stool culture, E. coli O157:H7 stool culture, Escherichia coli O157:H7 stool culture 
METHODOLOGY Culture
SPECIAL INSTRUCTIONS
  • Isolate or specimen submission required.
  • Contact CEDEP if a foodborne outbreak is suspected.
ORDERING INFORMATION Lab Web Portal

Specimen Requirements

Patient Preparation
  • Medications: Do not use barium or bismuth before collection of specimen
Specimen Collection
  • Stool

- C&S Culture Transport Media (i.e. ParaPak)

- Semisolid or liquid transport media (i.e. Cary Blair or Amies)

- Commercially available transport system specific for recovery of enteric pathogens from fecal specimens

  • Isolate

- Pure isolate cultures
Specimen Labeling
  • Specimen should be labeled with at least two unique patient identifiers along with specimen source and match accompanying test order.
Specimen Processing
  • None
Specimen Storage and Preservation
  • Stool specimens should be stored at 2-30°C and arrive at the laboratory within 4 days of specimen collection. If possible, refrigerate at 2-8°C.
  • Isolates should be stored in ambient conditions and submitted within 2 weeks of isolation.
Specimen Transport
  • Ship stool specimens in appropriate transport media at 2-30°C with cold packs. If possible, maintain at 2-8°C.
  • Ship isolates at ambient temperature.
  • All infectious substance shipments must conform to U.S. Department of Transportation (DOT) Hazardous Materials Regulations (HMR 49 C.F.R. Parts 171-180). 
Specimen Acceptability and Rejection
  • Specimens that do not adhere to all specimen requirements will be rejected.
Testing Location
  • Nashville

Laboratory Reporting

Reporting requirements apply to all laboratories located within Tennessee, as well as laboratories outside of Tennessee that test residents of Tennessee, including laboratories located within healthcare facilities. Healthcare providers and laboratories in the same healthcare facility both have a duty to report. The type of organisms and analytes laboratories must report to TDH for 2026 are indicated, and there are several ways laboratories can report results to TDH.

 

Information about this Reportable Disease for Healthcare Providers

Clinical Summary

  • Shiga toxin–producing Escherichia coli (STEC) causes acute gastrointestinal illness, often with abdominal cramps and diarrhea that can become bloody; vomiting may occur, and fever is usually absent or low-grade. A serious complication, hemolytic uremic syndrome (HUS), occurs in about 5%–10% of patients and can be life-threatening.
  • Infection is typically acquired through contaminated food or water (classically undercooked beef, unpasteurized milk/juice, contaminated produce), contact with infected animals or their environment, or person-to-person spread in close-contact settings (e.g., childcare), with risk heightened by poor hand hygiene.
  • Diagnosis is made by stool testing that detects Shiga toxin (or its genes) and/or isolates STEC by culture. CDC recommends that stools from patients with acute community-acquired diarrhea be tested for Shiga toxin–producing strains and that Shiga toxin–positive specimens be cultured (or otherwise confirmed) for public health and outbreak detection.
  • Management is primarily supportive (early hydration and close monitoring). CDC advises avoiding antibiotics and antimotility agents in suspected/confirmed STEC because they may increase the risk of HUS; patients with signs of dehydration or evolving HUS need urgent evaluation. In Tennessee, STEC is a reportable condition to support rapid public health response.

Healthcare Provider Reporting

Healthcare reporting requirements apply to all providers located within Tennessee, as well as providers whose patients reside in Tennessee.

Providers must report cases of all diseases and conditions listed through one of these methods:

• Mail or fax a completed PH-1600 form to your local health department or fax to the state health office at (615) 741-3857

• Send automatically via electronic case reporting (eCR). See this TDH webpage for more information on eCR, register at the Trader Partner Registration website, or contact MU.Health@tn.gov for assistance.

• Submit online via NBS. NBS is TDH's reportable disease system. To request an NBS account for reporting Complete this user survey to request an NBS account for reporting. 

• Blood lead levels can be sent via fax ( (615) 741-3857), entered online, or reported using the instructions at this link. 

Information about this Reportable Disease for the Public

What It Is

Shiga toxin–producing Escherichia coli (STEC) are strains of E. coli that make Shiga toxins and can cause severe intestinal illness. Some infections can lead to a serious complication called hemolytic uremic syndrome (HUS), which can cause kidney failure and other long-term health problems. 

Signs and Symptoms

Symptoms often include diarrhea (frequently bloody), stomach cramps, and vomiting. HUS develops in about 5%–10% of patients and can be life-threatening; seek urgent medical care if symptoms are severe, dehydration is developing, or there are signs of worsening illness.

How It Spreads

STEC spreads through swallowing contaminated food or water and through contact with contaminated environments or infected animals. Person-to-person spread can occur, especially when hand hygiene is poor (for example, in households or childcare settings).

Diagnosis and Treatment

Diagnosis is made with stool testing that can detect Shiga toxin (or the genes that produce it) and/or identify STEC. Treatment is usually supportive (especially rehydration). CDC advises that antibiotics may increase the risk of HUS in suspected or confirmed STEC infection, so clinical management should be guided by a healthcare provider.

Reporting in Tennessee

In Tennessee, STEC is a reportable condition, which helps public health identify outbreaks and prevent additional illnesses.

This Page Last Updated: March 25, 2026 at 8:53 PM