Published Date: 2000-04-25 23:50:00
Subject: PRO> E. coli STEC, human - USA (Texas): follow-up
Archive Number: 20000425.0617
E. COLI STEC, HUMAN - USA (TEXAS): FOLLOW-UP
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See Also
1999----
E. coli O111, diarrhea - USA (Texas) 19990707235537
E. coli O111, diarrhea - USA (Texas) (02) 19990730235352
Date: Tue 25 Apr 2000
From: ProMED-mail
Source: MMWR Vol. 49 No. 15, 21 Apr 2000 [edited
_Escherichia coli_ O111:H8 Outbreak Among Teenage Campers --- Texas, 1999
In June 1999, the Tarrant County Health Department reported to the Texas
Department of Health (TDH) that a group of teenagers attending a
cheerleading camp during June 9--11 became ill with nausea, vomiting,
severe abdominal cramps, and diarrhea, some of which was bloody. Two
teenagers were hospitalized with hemolytic uremic syndrome (HUS), and two
others underwent appendectomies.
Routine stool cultures from eight ill persons failed to yield a pathogen.
Stools subsequently were sent to laboratories at the Texas Department of
Health and CDC, where _Escherichia coli_ O111:H8 was isolated from two
specimens. This report summarizes the investigation of this outbreak...
MMWR Editorial Note:
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This was the first community outbreak of infections attributable to Shiga
toxin-producing _E. coli_ O111 reported in the United States. The findings
of the investigation suggest a point-source outbreak. Although primary
infection from eating a contaminated salad item and then secondary spread
through the barrel ice is a plausible hypothesis, the original source of
contamination and its means of spread are unknown.
Identification of non-O157 STEC requires techniques not used routinely by
clinical laboratories. In this outbreak, a commercially available EIA kit
was used to detect and isolate STEC in stool specimens; isolates were then
serotyped at CDC.
STEC cause illness in otherwise healthy persons, including severe abdominal
cramping (sometimes confused for appendicitis), bloody diarrhea, and HUS.
_E. coli_ O111 was the second most common non- O157 STEC (after _E. coli_
O26) isolated from specimens submitted to CDC for serotyping during
1983--1998 and among isolates from persons with diarrhea collected for an
ongoing survey in Minnesota initiated in 1995 (Minnesota Department of
Public Health, unpublished data, 2000). STEC cause an estimated 110 000
illnesses each year in the United States, of which more than 30% may be
attributable to non-O157 serotypes such as O111 (1); the burden of disease
attributable to non-O157 STEC is unknown.
Most STEC outbreaks in North America have resulted from infection with _E.
coli_ O157. A household cluster of _E. coli_ 0111 infection was reported in
1990 from Ohio, and outbreaks have occurred in Australia, Europe, and
Japan. Despite investigations involving large numbers of persons in
well-defined settings, the vehicle of transmission has been
epidemiologically implicated and microbiologically confirmed in only one
1995 outbreak in South Australia, which was attributable to mettwurst, a
dried fermented sausage.
As demonstrated by this outbreak, a commercially available kit could be
used to screen stool specimens for Shiga toxin and potential STEC. However,
culturing and serotyping the causative organism is critical to identify and
better understand these emerging pathogens. To facilitate diagnosis of STEC
infections, clinicians should inform health departments about clusters of
suspected illnesses that could be attributable to STEC (e.g., bloody
diarrhea and HUS). Clinical laboratories should screen stool specimens from
persons with either bloody diarrhea or HUS for STEC, routinely or when _E.
coli_ O157 is not isolated, and attempt to isolate STEC from stools that
are positive by the screening test and refer isolates to public health
laboratories for serotyping. States should consider adding STEC infections
to their notifiable disease lists.
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ProMED-mail
e-mail: promed@promedmail.org
[This is a report of the CDC investigation of outbreak reports originally
posted by ProMED-mail during July of 1999. The outbreak is of special
interest because it is the first report of an outbreak of _E. coli_ 0111
disease in the USA, and is posted to provide further confirmation and
follow-up. - Mod.ES
...............................................jw/es
--
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