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
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.
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.
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.
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