We have investigated 677 Shiga toxin-producing Escherichia coli (STEC) strains from humans to determine their serotypes, virulence genes, and clinical signs in patients. Six different Shiga toxin types (1, 1c, 2, 2c, 2d, and 2e) were distributed in the STEC strains. Intimin (eae) genes were present in 62.6% of the strains and subtyped into intimins ␣1, 1, ␥1, , , and . Shiga toxin types 1c and 2d were present only in eae-negative STEC strains, and type 2 was significantly (P < 0.001) more frequent in eae-positive STEC strains. Enterohemorrhagic E. coli hemolysin was associated with 96.2% of the eae-positive strains and with 65.2% of the eae-negative strains. Clinical signs in the patients were abdominal pain (8.7%), nonbloody diarrhea (59.2%), bloody diarrhea (14.3%), and hemolytic-uremic syndrome (HUS) (3.5%), and 14.3% of the patients had no signs of gastrointestinal disease or HUS. Infections with eae-positive STEC were significantly (P < 0.001) more frequent in children under 6 years of age than in other age groups, whereas eae-negative STEC infections dominated in adults. We identified 41 STEC strains belonging to 31 serotypes which had not previously been described as human STEC. Twenty-six of these were positive for intimins ␣1 (one serotype), 1 (eight serotypes), (two serotypes), and (three serotypes). Our study indicates that different types of STEC strains predominate in infant and adult patients and that new types of STEC strains are present among human isolates.The association of Shiga (Vero) toxin production in Escherichia coli with human pathogenicity was first described in 1979 (82, 85). However, it was the investigation of an outbreak caused by Shiga toxin-producing E. coli (STEC) O157 which provided the major impetus to study these pathogens (65). In the following years, STEC strains were increasingly isolated from humans with diarrhea and hemolytic-uremic syndrome (HUS) and from farm animals, which serve as a natural reservoir for STEC (52,86). Today, more than 200 different E. coli O:H serotypes are known to be associated with the production of Shiga toxins (86; K. A. Bettelheim's VTEC table, May 2003 update, www.sciencenet.com.au/vtectable.htm). Certain STEC strains belonging to serogroups O26, O103, O111, O145, and O157 were more frequently isolated from humans with severe diseases such as hemorrhagic colitis and HUS. Accordingly, these highly virulent STEC strains were also designated as enterohemorrhagic E. coli (EHEC) (42, 52). The search for additional virulence markers in these pathogens revealed that most EHEC strains carry a plasmid which encodes a hemolysin (EHEC hemolysin) and the chromosomally located locus of enterocyte effacement (LEE) pathogenicity island (16,43,70,84). The genes carried by the LEE enable the bacteria to produce attaching and effacing lesions in the host intestinal mucosa cells, which increases the virulence of the bacteria for humans (35,44,60). Intimate attachment of bacteria to the host cell is mediated by the binding of intimin, the product of the eae gene...