A community outbreak of haemolytic-uraemic syndrome in children occurring in a large area of Northern Italy over a period of several months

Abstract

From March to October 1993, 15 cases of haemolytic-uraemic syndrome (HUS) in children were detected in a large area of northern Italy, where only 8 cases had occurred in the previous 5 years. Analysis of stool and serum specimens obtained from 14 cases showed evidence of Verotoxin-producing Escherichia coli (VTEC) infection in 13. Serum antibodies to the E. coli O157 lipopolysaccharide (LPS) were found in 8 patients and to the O111 LPS in 2. An O86 VTEC was isolated from another patient. Fourteen children needed dialysis, and 1 died. No obvious epidemiologic link was observed among cases, most of whom lived in small townships. A case-control study did not show an association between HUS and food or exposure to cattle, but suggested an association with contact with chicken coops (OR = 6.5, 95% C.I. 1.2-34.9). However, VTEC were not isolated from stool samples obtained from the chicken coops involved. The risk factors for VTEC infection related to living in rural settlements, including the exposure to live poultry, should be considered in outbreak investigations.

Phenotypic and Genotypic Characterization of Avian Escherichia coli O86:K61 Isolates Possessing a Gamma-Like Intimin

“…Other workers have reported that classical EPEC strains possess alpha or beta intimin, whereas E. coli O86 isolates are commonly positive for epsilon intimin (1,42). The presence of gamma-like intimin in the isolates described in this paper confirms not only the heterogeneity of this serotype (13,34,57) but also the heterogeneity of the family of intimin proteins (1). It is possible that intimins, which are outer membrane proteins, may be subjected to strong selective pressure for amino acid diversity, either through adaptive shifts in tropism or through antigenic shifts to evade the immune system (42).…”

Escherichia coli Serotype O157:H7: Novel Vehicles of Infection and Emergence of Phenotypic Variants

“…A puzzling incident was reported from northern Italy, where 15 cases of HUS, caused by serotype O157 and other EHEC serotypes, was recorded over a 5-month period in 1993 (17). These cases occurred in small towns scattered over a large area with little apparent connection to each other; therefore, common food vehicles and exposure to cattle were eliminated as possible sources of infection.…”

Characterization of Shiga Toxin-Producing Escherichia coli O157:H7 Isolated in Italy and in France

“…The prevalence of E. coli O157 carriage in North American and European cattle varies according to the country and the detection method, ranging from 0 to 10% (1,8,11,12,13). In Italy, strains of E. coli belonging to serogroup O157 have been isolated from cattle in some northern regions (4,9), where human cases of hemolytic-uremic syndrome have been observed (7,21). In southern Italy, isolations from neither cattle of local farms nor humans have been reported so far.…”