“…Theoretically, this ability has clear implications for the severity of Stx-mediated disease symptoms, commensurate with an increased number of toxin gene copies and increased toxin load, but previously this had not been directly and unequivocally demonstrated. Different stx genes, associated with different prophages or prophage remnants, are regularly found in combination within a single host (Allison et al, 2003;Bielaszewska et al, 2007;Eklund et al, 2002;Muniesa et al, 2003;Zheng et al, 2008), and virulence profiles comprising two stx2 genes are frequently associated with HUS and bloody diarrhoea (Banatvala et al, 1996;Eklund et al, 2002;Elliott et al, 2001;Tozzi et al, 2003;Woodward et al, 2002). Furthermore, the presence of two stx operons can lead to increased in vitro toxin expression (Bielaszewska et al, 2006;Cornick et al, 2002;Eklund et al, 2002;Muniesa et al, 2003), though this observation is not without exceptions (Serra-Moreno et al, 2008), nor does it necessarily equate to more severe clinical disease (Bielaszewska et al, 2006;Cornick et al, 2002).…”