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Update: Sporadic Hemorrhagic Colitis

In 1983, CDC reported on investigations in Michigan and Oregon of two 1982 outbreaks of a gastrointestinal illness designated hemorrhagic colitis (1). The illness was caused by a previously unrecognized pathogen, Escherichia coli O157:H7. Since August 1982, sporadic cases of this illness have been reported to CDC, and stool specimens have been examined from patients meeting the following case definition: a person with bloody diarrhea, abdominal cramps, and low-grade or no fever, whose stool culture is negative for recognized pathogens including Salmonella, Shigella, Campylobacter, and Yersinia and for ova and parasites.

During 1983, stool specimens were examined from 35 ill persons in 16 states. E. coli O157:H7 was identified in 10 specimens collected a mean of 4.7 days after onset of illness. The culture-negative specimens were collected a mean of 7.6 days after onset. Culture-positive specimens were received from Wisconsin (three), California (two), Alabama, Florida, Illinois, Massachusetts, and Minnesota (one each). Patients ranged in age from 2 to 80 years (median 15 years), and both sexes were equally affected. The average duration of illness was 10 days, and nine of the 10 patients were hospitalized. Barium enemas of two patients revealed spasm in one and "thumbprinting" in the ascending colon in the other. Sigmoidoscopy performed in two other patients revealed erythema, edema, and friable mucosa. None of the patients required transfusions, and four were treated with antibiotics. Reported by WE Birch, DVM, State Epidemiologist, Alabama Dept of Public Health, JJ Sacks, MD, Acting State Epidemiologist, Florida Dept of Health & Rehabilitative Svcs; J Chin, MD, State Epidemiologist, California State Dept of Health Svcs; BJ Francis, MD, State Epidemiologist, Illinois Dept of Public Health; NJ Fiumara, MD, State Epidemiologist, Massachusetts Dept of Public Health; AG Dean, MD, Minnesota State Dept of Health; JP Davis, MD, State Epidemiologist, Wisconsin State Dept of Health and Social Svcs; Enteric Diseases Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: The frequency with which E. coli O157:H7 causes hemorrhagic colitis in the United States is unknown. Isolation of this pathogen from 29% of submitted specimens suggests that it is an important cause of bloody diarrhea in patients in whom no other pathogens are detected. The organism is cleared rapidly from the stool (1); since the stool specimens were collected earlier for culture-positive cases than for culture-negative cases, E. coli O157:H7 may also have been the responsible pathogen in some of the culture-negative cases.

Disease caused by E. coli O157:H7 has not been limited to the United States nor to gastrointestinal manifestations. Sporadic cases of hemorrhagic colitis were also identified in Canada during 1983 (2). Three of these patients subsequently developed hemolytic-uremic syndrome. E. coli O157:H7 was isolated from stools of two of these patients and from the stools of two ill siblings of the third patient, who had typical symptoms of hemorrhagic colitis before developing hemolytic-uremic syndrome.

Since early stool collection is important for identifying this organism, physicians encountering typical cases should obtain the specimen as quickly as possible and then hold a portion frozen while their laboratories perform examinations for other recognized pathogens. If these test results are negative, arrangements can be made through state epidemiologists and state laboratory directors to examine the frozen portion of the specimen for E. coli O157:H7.

Although the outbreak cases were caused by eating hamburger products, no common exposures have yet been identified among sporadic cases. The sources of E. coli O157:H7 for sporadic cases are currently under investigation through an ongoing case-control study.

References

  1. Riley LW, Remis RS, Helgerson SD, et al. Hemorrhagic colitis associated with a rare Escherichia coli serotype. N Engl J Med 1983;308:681-5.

  2. Sporadic cases of hemorrhagic colitis associated with Escherichia coli O157:H7--Calgary, Alberta. Canada Diseases Weekly Report 1983;9:181-4.



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