Escherichia coli O157:H7 Diarrhea in a Nursing Home: Clinical, Epidemiological, and Pathological Findings

Abstract

In September 1984, an outbreak of Escherichia coli O157:H7 infection occurred in a nursing home. It was the first recognized outbreak of this organism in the United States since 1982, when two outbreaks led to its recognition as a pathogen. Thirty-four of 101 residents developed a diarrheal illness; 14 were hospitalized with a severe illness characterized by crampy abdominal pain, marked abdominal distention, and grossly bloody diarrhea, and four died. The spectrum of illness associated with the infection was broad and included the following: asymptomatic infection, nonbloody diarrhea, hemorrhagic colitis, hemolytic uremic syndrome, and death. Clinical, radiographic, and postmortem pathological findings suggested involvement of the cecum and right colon. No evidence of response to antimicrobial agents could be documented, and antidiarrheal agents may have aggravated the disease. This investigation implicated hamburger as the vehicle transmission. Seventeen of 19 residents with hemorrhagic colitis, but only 28 of 67 healthy residents, had eaten hamburger on 13 September (P less than .001, Fisher's two-tailed exact test; relative risk [RR] = 7.7). Infection with E. coli O157:H7 can cause a wide range of manifestations. In the elderly these can be particularly severe and may resemble ischemic colitis.

A christening party outbreak of haemorrhagic colitis and haemolytic uraemic syndrome associated with Escherichia coli O 157. H7

“…Subsequently, outbreaks and sporadic cases have been reported from North America (2-7) and Japan (8). Some cases have developed haemolytic uraemic syndrome (HUS) (3)(4)(5)9). In England and Wales sporadic cases of HUS (10) and HC (8) and one outbreak of HC in East Anglia in 1985 (11) (12,13).…”

First recognized community outbreak of haemorrhagic colitis due to verotoxin-producingEscherichia coliO 157.H7 in the UK

“…Following the discovery that the causative agent was E. coli 0 157 . H7-producing verotoxin a wider spectrum of illness has been revealed, which ranges from asymptomatic carriage through non-bloody diarrhoea to haemorrhagic colitis and haemolytic uraemic syndrome (Ryan et al 1986;Spika et al 1986). In the outbreak in East Anglia the spectrum of cases identified was limited 88 by the use of a strict case definition for haemorrhagic colitis, but two infected patients who did not have bloody diarrhoea were identified.…”

“…Rigors and feverishness were reported by only a minority of cases. Surveys in N. America (Ratnam & March, 1986) and in England and Wales suggest that E. coli 0 157. H7 is a relatively common cause of bloody diarrhoea and common source outbreaks have been described in the USA and Canada (Ratnam & March, 1986;Ryan et al 1986;Spika et al 1986). In N. America, undercooked hamburger meat (Riley et al 1983;Ryan et al 1986) and raw milk (Martin et al 1986, Borezyk et al 1987 have been identified as vehicles of infection.…”

“…H7 is a relatively common cause of bloody diarrhoea and common source outbreaks have been described in the USA and Canada (Ratnam & March, 1986;Ryan et al 1986;Spika et al 1986). In N. America, undercooked hamburger meat (Riley et al 1983;Ryan et al 1986) and raw milk (Martin et al 1986, Borezyk et al 1987 have been identified as vehicles of infection. A reservoir of infection in cattle has recently been described (Martin et al 1986;Borczyk et al 1987) and infection with E. coli 0 157 .…”

“…H7 has been identified recently as the causal agent of outbreaks (Riley et al 1983;Pudden et al 1985;Ryan et al 1986;Spika et al 1986) and sporadic cases (Remis et al 1984;Pai et al 1984) of haemorrhagic colitis in North America, and as one of the causes of the haemolytic uraemic syndrome (HUS) (Karmali et al 1985). In England and Wales this organism has been isolated from 39% of sporadic cases of haemorrhagic colitis ) and 33 % of sporadic cases of HUS (Scotland et al 1988) and from cases in an outbreak of HUS in the West Midlands (Taylor et al 1986).…”