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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.


  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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