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Epidemiologic Notes and Reports Isolation of E. coli 0157:H7 from Sporadic Cases of Hemorrhagic Colitis -- United States

Since the beginning of August 1982, stool isolates of Escherichia coli serotype 0157:H7 have been identified at CDC from specimens obtained from four patients in two states. Three of four patients had an unusual bloody diarrheal illness; each illness began suddenly with severe crampy abdominal pain followed within 24 hours by watery diarrhea, which subsequently became markedly bloody. One patient underwent a laparotomy to rule out appendicitis. All patients recovered within 7 days without complications or specific therapy. In one instance, E. coli 0157:H7 was isolated from the stool of a patient's spouse. This fourth patient had abdominal cramps and non-bloody diarrhea. Since early August, 25 additional sporadic cases of this unusual illness have been reported to CDC, but appropriately collected stool specimens were available in only two of these. E. coli 0157:H7 was not isolated from either specimen. The four patients with sporadic cases in which E. coli was isolated from stools and 24 of the remaining 25 patients with sporadic cases had eaten hamburgers from a variety of sources (including homes and/or local or national-chain restaurants) within the week before they became ill.

Examination of stool samples from sporadic cases of this recently recognized diarrheal illness, currently designated "hemorrhagic colitis," began at CDC after E. coli 0157:H7 was isolated from patients in two separate outbreaks of this illness earlier this year in Oregon and Michigan. Illness was associated with eating hamburgers at restaurants of one national chain.

Hemorrhagic colitis appears to be a distinct clinical entity, characterized by severe crampy abdominal pain, grossly bloody diarrhea, little or no fever, a characteristic barium-enema finding of marked edema involving the cecum, ascending and/or transverse colon, and the absence of usual pathogens in stool. Reported by RR Uyeyama, MD, Good Samaritan Hospital, San Jose, SB Werner, MD, S Chin, MD, State Epidemiologist, California Dept of Health Svcs; SF Pearce, MD, CL Kollip, MD, Portland Adventist Medical Center, Portland, LP Williams, DVM, JA Googins, MD, State Epidemiologist, Oregon State Health Div; Enteric Diseases Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: The diagnoses of hemorrhagic colitis are based on the typical clinical presentation and isolation of E. coli 0157:H7 from the stool specimens. Early stool collection (within 4 days after onset of illness and before any antibiotic exposure) is crucial for detecting the E. coli, so physicians encountering typical cases need to ensure that stool samples are obtained and a portion held frozen (preferably at -70 C (-94 F) or on dry ice) while their laboratories perform routine examinations for Salmonella, Shigella, Campylobacter, Yersinia, and parasites. If these test results are negative, arrangements can be made through the state epidemiologist and state laboratory director to look for E. coli 0157:H7 in the frozen specimen. Those state laboratories that do not have the antisera to identify E. coli 0157:H7 may wish to send either the whole frozen stool or 10 picks (if possible) of E. coli colonies to CDC. This strain of E. coli 0157:H7 does not ferment sorbitol, and this biochemical property may facilitate screening for this serotype. Further studies are under way at CDC to better characterize the epidemiology of hemorrhagic colitis, the reservoir of E. coli 0157:H7, and serologic methods to confirm infection.

Epidemiologic investigation of the outbreaks showed that one source of E. coli 0157:H7 is hamburger. Other enteric diseases, such as salmonellosis, have been reported following consumption of hamburger (1). Careful handling and adequate cooking of raw meat products should minimize or eliminate the risk of contracting infectious diseases from this source.

Reference

  1. Fontaine RE, Arnon S, Martin WT, et al. Raw hamburger: an interstate common source of human salmonellosis. Am J Epidemiol l978;107:36-45.

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