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


METHODS
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.


METHODS
Two institutions for retarded persons in Utah.


METHODS
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).


RESULTS
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.


CONCLUSIONS
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.
Pavia
A T
AT
Enteric Diseases Branch, Centers for Disease Control, Atlanta, GA 30333.
Nichols
C R
CR
Green
D P
DP
Tauxe
R V
RV
Mottice
S
S
Greene
K D
KD
Wells
J G
JG
Siegler
R L
RL
Brewer
E D
ED
Hannon
D
D
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D002648:Child; D003428:Cross Infection / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D003967:Diarrhea / Q000209:etiology / Q000382:microbiology; D003968:Diarrhea, Infantile / Q000209:etiology / Q000382:microbiology; D004196:Disease Outbreaks; D004926:Escherichia coli / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D005243:Feces / Q000382:microbiology; D005517:Foodborne Diseases / Q000150:complications; D006463:Hemolytic-Uremic Syndrome / Q000209:etiology*; D006801:Humans; D007326:Institutionalization; D008607:Intellectual Disability; D007958:Leukocyte Count; D012307:Risk Factors; D014589:Utah / Q000453:epidemiology