title: 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.
authors.affiliation: South Caucasus Field Epidemiology and Laboratory Training Program, 9 M. Asatiani Str., Tbilisi 0177, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, 16 Al. Kazbegi Ave, Tbilisi 0160, Georgia. Electronic address: ochokoshvili@gmail.com.
authors.forename: Otar
authors.initials: O
authors.lastname: Chokoshvili
authors.affiliation: South Caucasus Field Epidemiology and Laboratory Training Program, 9 M. Asatiani Str., Tbilisi 0177, Georgia.
authors.forename: Khatuna
authors.initials: K
authors.lastname: Lomashvili
authors.affiliation: South Caucasus Field Epidemiology and Laboratory Training Program, 9 M. Asatiani Str., Tbilisi 0177, Georgia; U.S. Centers for Diseases Control and Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333, USA.
authors.forename: Naile
authors.initials: N
authors.lastname: Malakmadze
authors.affiliation: South Caucasus Field Epidemiology and Laboratory Training Program, 9 M. Asatiani Str., Tbilisi 0177, Georgia.
authors.forename: Marika
authors.initials: M
authors.lastname: Geleishvil
authors.affiliation: U.S. Centers for Diseases Control and Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333, USA.
authors.forename: Jonas
authors.initials: J
authors.lastname: Brant
authors.affiliation: National Center for Diseases Control and Public Health of Georgia, 9 M. Asatiani Str., Tbilisi 0177, Georgia.
authors.forename: Paata
authors.initials: P
authors.lastname: Imnadze
authors.affiliation: National Center for Diseases Control and Public Health of Georgia, 9 M. Asatiani Str., Tbilisi 0177, Georgia.
authors.forename: Nazibrola
authors.initials: N
authors.lastname: Chitadze
authors.affiliation: National Center for Diseases Control and Public Health of Georgia, 9 M. Asatiani Str., Tbilisi 0177, Georgia.
authors.forename: Lia
authors.initials: L
authors.lastname: Tevzadze
authors.affiliation: National Center for Diseases Control and Public Health of Georgia, 9 M. Asatiani Str., Tbilisi 0177, Georgia.
authors.forename: Gvantsa
authors.initials: G
authors.lastname: Chanturia
authors.affiliation: National Center for Diseases Control and Public Health of Georgia, 9 M. Asatiani Str., Tbilisi 0177, Georgia.
authors.forename: Tea
authors.initials: T
authors.lastname: Tevdoradze
authors.affiliation: Infectious Diseases, AIDS and Clinical Immunology Research Center, 16 Al. Kazbegi Ave, Tbilisi 0160, Georgia.
authors.forename: Tengiz
authors.initials: T
authors.lastname: Tsertsvadze
authors.affiliation: U.S. Centers for Diseases Control and Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Talkington
authors.affiliation: U.S. Centers for Diseases Control and Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333, USA.
authors.forename: Rajal K
authors.initials: RK
authors.lastname: Mody
authors.affiliation: U.S. Centers for Diseases Control and Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Strockbine
authors.affiliation: U.S. Centers for Diseases Control and Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333, USA.
authors.forename: Russell A
authors.initials: RA
authors.lastname: Gerber
authors.affiliation: South Caucasus Field Epidemiology and Laboratory Training Program, 9 M. Asatiani Str., Tbilisi 0177, Georgia; U.S. Centers for Diseases Control and Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333, USA.
authors.forename: Edmond
authors.initials: E
authors.lastname: Maes
authors.affiliation: South Caucasus Field Epidemiology and Laboratory Training Program, 9 M. Asatiani Str., Tbilisi 0177, Georgia; U.S. Centers for Diseases Control and Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rush
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000097:blood* / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D005243:Feces / Q000382:microbiology; D005260:Female; D005846:Georgia (Republic) / Q000453:epidemiology; D006463:Hemolytic-Uremic Syndrome / Q000150:complications* / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D008297:Male; D062486:Public Health Surveillance; D012189:Retrospective Studies; D022621:Shiga Toxin / Q000032:analysis; D054323:Shiga-Toxigenic Escherichia coli / Q000302:isolation & purification* / Q000378:metabolism; D055815:Young Adult
chemical_list: D022621:Shiga Toxin
keywords: Bloody diarrhea; E. coli; HUS; Hemolytic uremic syndrome; O104:H4; STEC