ShigaToxin EIA (E. coli) Proof-of-Cure, SHIGA  

IMPORTANT! Pre-approval needed from state or local health department. Local or State Health Department. Send approval to or call (402) 559-9444.

NPHL has moved to an electronic ordering system, NUlirt, and it is now the preferred method to order all tests. Once ordered, print a "batch list" (see NUlirt Guide).

Forms Required - Nulirt batch list or NPHL Test Request Form (completed in entirety) must accompany the specimen to include the following information: symptoms and date of onset, pregnancy status, travel and vaccine history. Testing will not be performed without all required information.

Please call NPHL Client Services at (402) 559-2440 or toll free at (800) 334-0459 for further clarification.


Test: Shigatoxin EIA (E.coli) Proof-Of-Cure, SHIGA
Order in NUlirt or complete NPHL Test Order Form  
Synonym: Shigatoxin testing, E. coli O157H7, Shiga-like toxin EIA, Non-E.coli O157  
Method: Qualitative Enzyme Immunoassay  
Availability: Test performed daily; Turnaround time 1d.  
Specimen: Stool specimen or actively growing isolate.  
Collection Device: Collect stool in a clean dry container or NPHL Stool collection kit (available at Client Services). IMMEDIATELY transfer sufficient stool to Para-Pak Enteric Plus Transport vial to bring the liquid level to the 'Fill' line or approximately 10mL of stool sample. Tighten the cap and shake firmly to ensure that the specimen is mixed. 
Specimen Labeling: Test subject to CLIA regulations and requires 2 patient identifiers and specimen source on container.  
Volume: 10mL in transport media  

Prior to and during shipment:  Ambient 15-25°C
Shipping instructions, including specimen-handling requirements during transport:  Seal screw-top tubes with Parafilm™ or tape and place in biohazard bag with absorbent material.
Place stool specimens in maintenance media inside leak proof secondary container (biohazard bag and if transporting by air, use Tyvek™ Envelope) with adsorbent material. The secondary container must be packed inside an approved Category B shipping container.  Position NUlirt packing list or NPHL Test Order form between secondary container and box lid. Seal with tape.  Label outer box as UN3373 Category B, Biological Substance. Transport by NPHL ground courier. If courier not available, ship by FedEx, UPS, or USPS (1st Class, Priority or Express Mail). Follow appropriate DOT/IATA Regulation Guidelines.  For assistance, call NPHL State Training Coordinator at (402) 559-3590.
See instructions and shipping address:

NUlirt packing list or appropriate paperwork (completed in entirety) must accompany specimens

Unacceptable: Stool received during a colonoscopy. Unpreserved stool will be rejected if greater than 1h old. Enteric Plus inoculated with stool greater than 96hr or greater than 4d. Frozen stool. Stool contaminated with urine, barium, bismuth, mineral oil, water, or other contaminants are unacceptable. Extremely 'hard' formed stools are unacceptable. Do not use the vial if beyond expiration date or contents of the vial are cloudy or yellow.  
Specimen Stability: Ambient or 2-8°C for 96hr or 4d at room temperature in Enteric Plus Vial.  
Reference Interval: Shigatoxin negative by EIA.   
Reportable Disease: Report positive Shigatoxin E.coli results within 7 days to local or state health department. Refer to Nebraska DHHS Title 173, Communicable Diseases. Ship all Shigatoxin positive E.coli isolates to NPHL.  
Comments: Pre-approval needed from state or local health department.  Send approval to or call (402) 559-9444.
All shigatoxin positive stools ( in enteric transport media or plate isolate) should be sent to the NPHL for isolation of the shigatoxin positive E. coli for whole genome sequencing.  Stool specimens can be sent as a Category B, biological substance. All shigatoxin positive isolates must be shipped as Category A, Infectious Substance. Order as E. coli (Hemorrhagic) Culture, Stool, HECCU.
This test will identify the presence of Shiga-like toxin E. coli in stool; however, it cannot determine the specific strain of E. coli (ie. O157:H7).
The Shiga-like toxin EIA can be used as a test for proof-of-cure testing following a primary diagnosis of enterohemorrhagic E. coli-caused infection.  Frequency for shigatoxin proof-of-cure testing can vary according to jurisdictional recommendations.  In general, cure is defined as 2 consecutive negative stools taken 24 hours apart that have been collected no sooner than 48 hours following discontinuation of antibiotics or 24 hours after cessation of diarrhea symptoms.

NUlirt packing list or NPHL Test Order Form (completed in entirety) must accompany the specimen
Revised: 6/21/2021 
If you have questions about proper specimen collection, please call NPHL Client Services at (402) 559-2440 or toll free at (800) 334-0459.