We compared the pathogenicity of intimin-negative non-O157:H7 Shiga toxin (Stx)-producing Escherichia coli (STEC) O91:H21 and O104:H21 strains with the pathogenicity of intimin-positive O157:H7 and O157:H ؊ strains in neonatal pigs. We also examined the role of Stx2d-activatable genes and the large hemolysinencoding plasmid of O91:H21 strain B2F1 in the pathogenesis of STEC disease in pigs. We found that all E. coli strains that made wild-type levels of Stx caused systemic illness and histological lesions in the brain and intestinal crypts, whereas none of the control Stx-negative E. coli strains evoked comparable central nervous system signs or intestinal lesions. By contrast, the absence of intimin, hemolysin, or motility had little impact on the overall pathogenesis of systemic disease during STEC infection. The most striking differences between pigs inoculated with non-O157 STEC strains and pigs inoculated with O157 STEC strains were the absence of attaching and effacing intestinal lesions in pigs inoculated with non-O157:H7 strains and the apparent association between the level of Stx2d-activatable toxin produced by an STEC strain and the severity of lesions.Serotype O157:H7 Shiga toxin (Stx)-producing Escherichia coli (STEC) strains cause the majority of sporadic and multiperson outbreaks of bloody diarrhea in the United States (15). However, non-O157 STEC strains were the source of three such outbreaks of bloody diarrhea (1) and an apparent cluster of three cases of hemolytic-uremic syndrome (HUS) (5, 26) and may be responsible for 20% (2) or even 50% (13) of all STEC infections. Up to 10% of patients with hemorrhagic colitis due to infection with an O157 strain develop HUS, a sequela that includes serious kidney damage. The risk of HUS for patients infected with non-O157 STEC is not as clear, but it could be as high as that for patients infected with O157 strains (29).STEC can be grouped by the array of potential virulence factors that they express. All STEC strains produce one or more Stxs. There are two main groups of Stxs (also called verotoxins), Stx1 and Stx2, which have the same enzymatic activity and general structure but are not cross-neutralized by heterologous antisera (34). The Stx2 group contains variants that include Stx2c (39), Stx2d-activatable (whose toxicity is increased by elastase from intestinal mucus [31]) (23, 43), Stx2d-nonactivatable (36), Stx2e (associated with edema disease in weaned pigs [48]), and Stx2f (isolated from feral pigeons and from a child with diarrhea [33,38]).A number of STEC strains have the same general constellation of pathogenic factors as the O157:H7 isolates. These strains not only produce Stxs but also have the capacity to cause attaching and effacing (A/E) lesions in the intestines of animals or in tissue culture models (8). A/E lesion formation is mediated by products of the locus of enterocyte effacement (LEE) found in enterohemorrhagic E. coli O157 strains and some non-O157 STEC strains, such as all O26:H11 strains and most O111:H ؊ strains (20). The LEE...