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Epidemiologic Notes and Reports Hemolytic-Uremic Syndrome Associated with Escherichia coli O157:H7 Enteric Infections -- United States, 1984

During the first 11 months of 1984, seven cases of hemolytic-uremic syndrome (HUS) associated with Escherichia coli O157:H7 gastroenteritis were identified in the United States. All patients had microangiopathic hemolytic anemia, thrombocytopenia, and evidence of renal disease; none had new onset of neurologic abnormalities to suggest thrombotic thrombocytopenic purpura. A diarrheal illness preceded onset of HUS in all seven patients. The cases occurred in Washington, Nebraska, and North Carolina.

Washington: Three cases occurred between March and October. The first two patients (women ages 25 and 36) had a prodrome of hemorrhagic colitis; the third patient (a 3-year-old boy) had a prodrome of watery, nonbloody diarrhea. E. coli O157:H7 was isolated from the stool of each patient. No exposures common to all patients were identified.

Nebraska: During an outbreak in September of diarrheal illness caused by E. coli O157:H7 among residents of a nursing home, one of the patients with hemorrhagic colitis, a 63-year-old woman, subsequently developed HUS.

North Carolina: During an outbreak of gastroenteritis (both bloody and nonbloody diarrhea) in a day-care center in September and October, three children who had bloody diarrhea subsequently developed HUS; they were 11 months, 31 months, and 35 months of age. E. coli 0157:H7 was isolated from the stools of four ill children, including one with HUS. Reported by Washington Dept of Social and Health Svcs; Div of Health, Nebraska State Dept of Human Resources; Div of Health Svcs, North Carolina Dept Human Resources; Enteric Diseases Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: E. coli O157:H7 was first recognized as an enteric pathogen during the investigation of two outbreaks of hemorrhagic colitis that occurred in Oregon and Michigan in 1982 (1). Since then, E. coli O157:H7 has also been associated with sporadic cases of hemorrhagic colitis and HUS in the United States, Canada, and Great Britain (2-4). Isolation of this very rare E. coli serotype from stools of patients with HUS suggests that this pathogen may be one important cause of HUS; however, further epidemiologic and laboratory studies are needed.

Since E. coli isolates from stool cultures are not routinely serotyped, the diagnosis of E. coli O157:H7 infection cannot be made unless physicians consider it and arrange for serotyping. Stools from HUS patients who present with a diarrheal prodrome should be collected as soon after onset of illness as possible and held frozen at -70 C (-94 F). Arrangements for examination of the stools and/or E. coli isolates from such stools at state laboratories or CDC can be made through state laboratory directors.

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. Remis RS, MacDonald KL, Riley LW, et al. Sporadic cases of hemorrhagic colitis associated with Escherichia coli O157:H7. Ann Intern Med 1984;101:624-6.

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

  4. PHLS Communicable Disease Surveillance Centre. Haemolytic uraemic syndrome. Communicable Disease Report 1983;36:1.



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