A Cluster of Escherichia coli O157: Nonmotile Infections Associated with Recreational Exposure to Lake Water

Abstract

SYNOPSISObjectives. To identify cases and determine risk factors for an outbreak of Escherichia coli (E. coli) O157:nonmotile (NM) infections in children attending a summer day care program in California.Methods. The authors conducted a retrospective cohort study; the cohort comprised first and second graders who attended the day care program during the last week in August 1999. Shiga toxin testing and molecular subtyping using pulsed-field gel electrophoresis were performed on isolates. Lake water, lake bottom sediment samples, and waterfowl feces from the lake environs were cultured for E. coli O157.Results. Three cases of Shiga toxin-producing E. coli O157:NM infections with matching pulsed-field gel electrophoresis patterns and four probable cases were found. Children who swallowed more than a mouthful of water had a higher attack rate than those who swallowed less than a mouthful or none at all (43% vs. 10%, relative risk = 4.43, 95% confidence interval 1.12, 17.50).Conclusions. E. coli O157:NM infections were associated with swallowing water from a freshwater lake. Potential sources of contamination include feces from humans, cattle, or deer. This outbreak illustrates the value in screening patients with diarrhea for E. coli O157, submitting isolates to public health laboratories, and using molecular techniques to identify related cases. Outbreaks associated with contaminated freshwater could be averted by prevention and early detection of contamination.

Pathogenic members of Escherichia coli & Shigella spp. Shigellosis

“…Shigella was also detected in lakes and rivers from Bangladesh, United States, or Taiwan (Table 3). (Table 3 and 4) In these cases the source of contamination of recreational water is frequently related to the bathers themselves, but also to the poor microbiological conditions of the bathing waters or unchlorinated water in swimming pools and pad pools that become contaminated with sewage and wild or domestic animal feces (McCarthy et al, 2001;Feldman et al, 2002;Lee et al, 2002;Craun et al, 2005). Structural problems and inadequate filtration or disinfection of recirculating water at children's spray parks have also been related to E. coli O157:H7 and S. sonnei outbreaks (Gilbert and Blake, 1998;CDC, 2006).…”

Microbiological Quality of Finfish and Shellfish with Special Reference to Shiga Toxin‐Producing Escherichia coli O157

“…In India, E. coli O157 has not been identified as a significant etiological agent of diarrhea, and presence of this pathogen has been recorded from cattle stool, milk, and meat recently (Dutta and others 2000; Manna and others 2006a, 2006b). Although E. coli O157 is principally associated with ruminants and foods originated from them, waterborne transmission and outbreaks of E. coli O157 infection have been recorded (Keene and others 1994; Feldman and others 2002; Olsen and others 2002), indicating that the pathogen can well contaminate surface water or even ground water and infect man. Cattle stool was the most probable source of contamination to waters in such incidences.…”

“…Recently, E. coli O157 has been detected in the river Ganga, the major river system in India, indicating that the pathogen may be a significant but under‐recognized public health concern in the country (Hamner and others 2007). The threat perception of environmental contamination and environment‐induced zoonosis (Asai and others 1999; Chattopadhyay and others 2001; Feldman and others 2002; Hamner and others 2007) warrants enhanced surveillance of this deadly pathogen in food items like fish. The objective of this study was to evaluate the hygienic sanitary quality of raw finfish and shrimp from Kolkata, India, with special emphasis on the E. coli serotype O157.…”

Gene and Antigen Markers of Shiga‐toxin Producing E. coli from Michigan and Indiana River Water: Occurrence and Relation to Recreational Water Quality Criteria

“…Of the reported EC O157:H7 outbreaks in the United States between 1982 and 2005, 9% were from waterborne sources and 21% were from unknown sources (Rangel et al, 2005). In addition, EC O157:NM was implicated in a recreational water outbreak in California in 1999 (Feldman et al, 2002). Because the infectious dose of STEC may be <100 cells (Tuttle et al, 1999), surface water contaminated with STEC might pose a specific health threat, especially where recreational contact occurs.…”