title: Sorbitol-fermenting enterohaemorrhagic Escherichia coli O157:H- causes another outbreak of haemolytic uraemic syndrome in children.
abstract: An outbreak of haemolytic uraemic syndrome (HUS) among children caused by infection with sorbitol-fermenting enterohaemorrhagic Escherichia coli O157:H- (SF EHEC O157:H-) occurred in Germany in 2002. This pathogen has caused several outbreaks so far, yet its reservoir and routes of transmission remain unknown. SF EHEC O157:H- is easily missed as most laboratory protocols target the more common sorbitol non-fermenting strains. We performed active case-finding, extensive exploratory interviews and a case-control study. Clinical and environmental samples were screened for SF EHEC O157:H- and the isolates were subtyped by pulsed-field gel electrophoresis. We identified 38 case-patients in 11 federal states. Four case-patients died during the acute phase (case-fatality ratio 11%). The case-control study could not identify a single vehicle or source. Further studies are necessary to identify the pathogen's reservoir(s). Stool samples of patients with HUS should be tested with an adequate microbiological set-up to quickly identify SF EHEC O157:H-.
authors.affiliation: Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany. alpersk@rki.de
authors.forename: K
authors.initials: K
authors.lastname: Alpers
authors.forename: D
authors.initials: D
authors.lastname: Werber
authors.forename: C
authors.initials: C
authors.lastname: Frank
authors.forename: J
authors.initials: J
authors.lastname: Koch
authors.forename: A W
authors.initials: AW
authors.lastname: Friedrich
authors.forename: H
authors.initials: H
authors.lastname: Karch
authors.forename: M
authors.initials: M
authors.lastname: An DER Heiden
authors.forename: R
authors.initials: R
authors.lastname: Prager
authors.forename: A
authors.initials: A
authors.lastname: Fruth
authors.forename: M
authors.initials: M
authors.lastname: Bielaszewska
authors.forename: G
authors.initials: G
authors.lastname: Morlock
authors.forename: A
authors.initials: A
authors.lastname: Heissenhuber
authors.forename: A
authors.initials: A
authors.lastname: Diedler
authors.forename: A
authors.initials: A
authors.lastname: Gerber
authors.forename: A
authors.initials: A
authors.lastname: Ammon
mesh_terms: D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D019453:Escherichia coli O157 / Q000302:isolation & purification* / Q000378:metabolism; D005260:Female; D005506:Food Contamination; D005516:Food Microbiology; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000382:microbiology*; D005858:Germany / Q000453:epidemiology; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D013012:Sorbitol / Q000378:metabolism
chemical_list: D013012:Sorbitol