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
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.
Sporadic cases of hemorrhagic colitis associated with
Escherichia
coli O157:H7--Calgary, Alberta. Canada Diseases Weekly Report
1983;9:181-4.
Disclaimer
All MMWR HTML documents published before January 1993 are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.
**Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.
