Investigation of an outbreak of bloody diarrhea complicated with hemolytic uremic syndrome

Abstract

In July-August 2009, eight patients with bloody diarrhea complicated by hemolytic uremic syndrome (HUS) were admitted to hospitals in Tbilisi, Georgia. We started active surveillance in two regions for bloody diarrhea and post-diarrheal HUS. Of 25 case-patients who developed HUS, including the initial 8 cases, half were ⩾15 years old, 67% were female and seven (28%) died. No common exposures were identified. Among 20 HUS case-patients tested, Shiga toxin was detected in the stools of 2 patients (one with elevated serum IgG titers to several Escherichia coli serogroups, including O111 and O104). Among 56 persons with only bloody diarrhea, we isolated Shiga toxin-producing E. coli (STEC) O104:H4 from 2 and Shigella from 10; 2 had serologic evidence of E. coli O26 infection. These cases may indicate a previously unrecognized burden of HUS in Georgia. We recommend national reporting of HUS and improving STEC detection capacity.

Human anthrax outbreak associated with livestock exposure: Georgia, 2012

“…Mild cases with non-specific gastroenteritis symptoms either may not seek medical care or anthrax may not be suspected [2]. Additionally, there is a high background level of diarrhoeal disease in Georgia including hemorrhagic diarrhoea [17], which could reduce the index of suspicion for anthrax as an aetiological cause. Additionally, there is a high background level of diarrhoeal disease in Georgia including hemorrhagic diarrhoea [17], which could reduce the index of suspicion for anthrax as an aetiological cause.…”

“…Moreover, hyperacute cases may avoid diagnosis as they die before receiving medical attention [2]. Additionally, there is a high background level of diarrhoeal disease in Georgia including hemorrhagic diarrhoea [17], which could reduce the index of suspicion for anthrax as an aetiological cause. There are also existing cultural preferences in Georgia against consuming raw or under-cooked meat, which may limit the occurrence of gastrointestinal anthrax.…”

Molecular Characterization of Non-O157 Shiga Toxin-producing E. coli Detected in Raw Milk and Some Dairy Products

“…Also, in an outbreak existed in August 2009, it was determined that the highest attack rate was associated with the consumption of ice cream which was accounted for six out 19 HUS cases and 2 out of 13 bloody diarrhea cases. Variable STEC (O104, O111, and O26) were detected in patient's stool [43].…”

Mixed Aetiology of Diarrhoea in Infants Attending Clinics in the North-West Province of South Africa: Potential for Sub-Optimal Treatment

“…Studies performed in other regions have reported low prevalence rates of the STEC pathotypes, such as in Argentina (6.2%), Mexico (2.5%), Colombia (1.8%), and Brazil (0.5%), while in South Africa, a rate of 3.8% has been observed in non-diarrhoea stools [61]. The expression of stx by E. coli is associated with the development of haemolytic-uremic syndrome (HUS) in up to 10% of STEC infections [80,81]. Though HUS can develop in patients of any age, it is a potential life-threatening condition and has been frequently observed in children [81,82].…”

“…The expression of stx by E. coli is associated with the development of haemolytic-uremic syndrome (HUS) in up to 10% of STEC infections [80,81]. Though HUS can develop in patients of any age, it is a potential life-threatening condition and has been frequently observed in children [81,82]. It is a recognized cause of renal failure and hypertension in children in the UK [83].…”