Hemolytic-uremic syndrome during an outbreak of Escherichia coli O157:H7 infections in institutions for mentally retarded persons: clinical and epidemiologic observations

• Published in: The Journal of pediatrics Vol. 116; no. 4; p. 544
• Main Authors: Pavia, A T, Nichols, C R, Green, D P, Tauxe, R V, Mottice, S, Greene, K D, Wells, J G, Siegler, R L, Brewer, E D, Hannon, D
• Format: Journal Article
• Language: English
• Published: United States 01-04-1990
• Subjects: Adolescent; Adult; Age Factors; Case-Control Studies; Child; Cross Infection - blood; Cross Infection - drug therapy; Cross Infection - epidemiology; Diarrhea - etiology; Diarrhea - microbiology; Diarrhea, Infantile - etiology; Diarrhea, Infantile - microbiology; Disease Outbreaks; Escherichia coli - isolation & purification; Escherichia coli Infections - blood; Escherichia coli Infections - drug therapy; Escherichia coli Infections - epidemiology; Feces - microbiology; Foodborne Diseases - complications; Hemolytic-Uremic Syndrome - etiology; Humans; Institutionalization; Intellectual Disability; Leukocyte Count; Risk Factors; Utah - epidemiology; Utah
• ISSN: 0022-3476
• DOI: 10.1016/s0022-3476(05)81600-2

To describe an outbreak of Escherichia coli O175:H7 infection resulting in a high rate of progression to hemolytic-uremic syndrome, and to attempt to identify predictors of and risk factors for progression.
Case-control study among employees and comparison of daily clinical features in two groups: infected residents with subsequent development of HUS and those who had no complications.
Two institutions for retarded persons in Utah.
Twenty residents with E. coli O157:H7 infection (13 culture confirmed, 2 probable, and 5 possible); HUS developed in 8, and 4 died. Thirty-one infected employees (3 with culture-confirmed, 6 with probable, and 22 with possible infection).
In a case-control study among employees, infection was independently associated with eating ground beef from a single lot prepared at several barbecues and with close contact with a resident who had diarrhea. Five of eight residents in whom HUS developed had received trimethoprim-sulfamethoxazole, compared with none of seven who had no subsequent complications (p = 0.026); this finding may reflect antimicrobial treatment of patients with more severe illness. Compared with infected residents without complications, persons with HUS were younger (median age 13 vs 27 years, p = 0.043) and, by the third day of illness, had higher leukocyte counts (median 23.7 X 10(9)/L vs 9.1 X 10(9)/L, p = 0.018) and temperature (median 38.5 degrees C vs 37.0 degrees C, p = 0.016). Leukocytosis peaked on day 4, more than 24 hours before signs of HUS appeared.
Food-borne outbreaks of E. coli O157:H7 in institutions may have devastating effects. Leukocytosis and fever may precede and predict HUS in patients with E. coli O157:H7 infection.