Tag Archives: Hus

No antibiotics for kids with E. coli O157:H7

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Wong et al. conclude in Clinical Infectious Disease that for every four children infected with E. coli O157:H7 treated with antibiotics, one will develop hemolytic uremic syndrome (HUS). The authors state antibiotic use during E. coli O157:H7 infections is associated with a higher rate of subsequent HUS, and should be avoided.

The authors enrolled children infected with E. coli O157:H7 in this prospective cohort study in five states over 9.5 years within one week of the onset of diarrhea. The primary and secondary outcomes were HUS (hematocrit < 30% with smear evidence of hemolysis, platelet count < 150 x 103/mm3, and serum creatinine concentration > upper limit of normal for age) and oligoanuric HUS. Univariate and multivariable and ordinal multinomial regression analyses were used to test associations between factors apparent during the first week of illness and outcomes.

Of the 259 children analyzed, 36 (14%) developed HUS. Univariate analysis demonstrated that children who received antibiotics during the diarrhea phase more frequently developed HUS than those who did not (36% vs. 12%, p=0.001). The higher rate of HUS was observed across all antibiotic classes used. In multivariable analysis, a higher leukocyte count (aOR 1.10; 95%CI 1.03, 1.19), vomiting (aOR 3.05; 95%CI 1.23-7.56), and exposure to antibiotics (aOR 3.62; 95% CI 1.23-10.6) during the first week of onset of illness were each independently associated with development of HUS. Multinomial ordinal logistic regression confirmed that initial leukocyte count and antibiotic use were independently associated HUS, and, additionally, these variables were each associated with the development of oligoanuric HUS.

Risk Factors for the Hemolytic Uremic Syndrome in Children Infected with Escherichia coli O157:H7: a Multivariable Analysis
http://cid.oxfordjournals.org/content/early/2012/03/16/cid.cis299.abstract

Poultry or smoked fish and sprouts? Yes, I remember, I had lasagna; E. coli O104 in French travelers to Turkey

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I look forward to Thursdays because a new issue of Eurosurveillance appears and they always have outbreak summaries of interest.

French health-types report eight cases of diarrhea, including two cases of hemolytic uremic syndrome (HUS), identified among 22 French tourists who travelled to Turkey in September 2011. A strain of Escherichia coli O104:H4 stx2-positive,eae-negative, hlyA-negative, aggR-positive, ESBL-negative was isolated from one HUS case. Molecular analyses show this strain to be genetically similar but not indistinguishable from the E. coli O104:H4 2011 outbreak strain of France and Germany.

Although the source of infection was not identified, the authors concluded the HUS cases had probably been infected in Turkey but there was no evidence to link this STEC O104:H4 outbreak to the consumption of fenugreek sprouts, as was the case for the German and French outbreaks in May to June 2011. None of the 22 travel group members reported the consumption of sprouts before and during their trip to Turkey.

Except that over there, sprouts are added to everything, more so than a Jimmy John’s sandwich.

Turkey is among several destinations where European tourists had previously travelled before developing STEC O104 infection between 2004 and 2009 (n=4), along with Afghanistan, Egypt and Tunisia. This outbreak supports data suggesting that the STEC serogroup O104 circulates in these areas. Further evidence is provided by the three additional cases that were subsequently identified in Germany and Denmark among persons also returning from Turkey within the same approximate time frame. Public health authorities and clinicians should be vigilant for possible STEC O104 infection in individuals returning from these areas who present with post-diarrheal HUS.

The complete paper is available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20065.

Outbreak of haemolytic uraemic syndrome due to Shiga toxin-producing Escherichia coli O104:H4 among tourists returning from Turkey, September 2011
26.jan.12
Eurosurveillance, Volume 17, Issue 4
N Jourdan-da Silva, M Watrin, F X Weill, L A King , M Gouali, A Mailles, D van Cauteren, M Bataille, S Guettier, C Castrale, P Henry, P Mariani, V Vaillant, H de Valk

E. coli outbreak in Michigan

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Two children and one adult in the Maple Rapids area of Michigan have become infected with E. coli bacteria.



This story from the Morning Sun is a little all over the place, but does report that two children have developed hemolytic uremic syndrome as a result of the infections and have been hospitalized.

“This strain of E.coli is very potent and troublesome,” said Dr. Robert Graham, medical director for the Mid-Michigan District Health Department. “We urge everyone to take precautions to prevent becoming infected by this germ. What’s troublesome is that these last three cases aren’t the only ones to have this particular strain of E. coli.



Graham said that during the summer, three other cases of the same strain were reported. Those people had attended the Clinton County Fair and that strain of E. coli came from a meat packing company called McNeese, located in the thumb.

Pennsylvania lake E. coli O157 toll climbs to 13, 8 HUS

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The Pennsylvania Department of Health is now aware of at least 13 people infected with E. coli O157:H7 who swam in the lake at Cowans Gap State Park.

In a brief e-mail statement this afternoon, press aide Thomas Hostetter said the current numbers include six people from Franklin County, four from Lancaster County, and one from Huntingdon County. There are also two Maryland residents who got sick after visiting the park.

Hostetter said the E. coli outbreak at Cowans Gap remains under investigation, and that more updates will be released as they become available.
 

9 sick including 3 HUS from E. coli O157; is Pennsylvania lake the source?

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From the I-wish-I-hadn’t-said-that files, Terry Brady, a spokesperson with Pennsylvania’s Department of Conservation and Natural Resources said Monday that the lake at Cowans Gap State Park remained open, despite links to three cases of E. coli O157. “The beaches are open and actually there was a good turnout today. A link to the park has not been established."

The lake was closed Tuesday afternoon, as the number of people, primarily children, confirmed to have contracted E. coli O157:H7 rose to six, with an additional three suspect cases.

At least three of the infected have developed hemolytic uremic syndrome, including a 3-year-old Mercersburg girl who has been hospitalized since Wednesday, and a 12-year-old Chambersburg boy, who is now recovering after spending his birthday in the hospital.

Spokesman Brady said in an email Tuesday night that the closing of the lake at Cowans Gap is a precautionary measure "to protect the public’s health and safety until the investigation can be completed."

He said the decision was made after interviews showed that swimming in the lake before becoming ill was a common factor between all individuals.

Over the weekend, Nikki Gordon, a friend of the three-year-old’s family and another family friend, Amanda Stauffer, came up with the idea for a Facebook group to raise support. As of Friday evening, the group had 955 members, featuring hundreds of well wishes and regular updates on the girl’s condition.

Through her Facebook group, Stauffer has heard from several other people who say their children got sick after swimming in the lake at Cowans Gap, she said. They include a 6-year-old girl, a 15-month-old boy and several children who apparently suffered "mild symptoms" but did not require hospitalization.

"All of these kids have one thing in common, and it’s Cowans Gap. The only thing we do know is that they were all there," Stauffer said.
 

German E. coli O104 update: 16 dead, 373 HUS, 1200 sick

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The numbers of dead and dying continue to spin out of control in Europe s no one seems to know how this happened.

German Health Minister Daniel Bahr said Monday that authorities still haven’t pinned down definitively the source of the E. coli infection — and "we unfortunately still have to expect a rising number of cases."

An EU official who spoke on condition of anonymity due to standing regulations, said the transport chain was long, and the cucumbers from Spain could have been contaminated at any point along the route.

Spain, meanwhile, went on the defensive, saying there was no proof that the E. coli outbreak has been caused by Spanish vegetables.

"You can’t attribute the origin of this sickness to Spain," Spain’s Secretary of State for European Affairs, Diego Lopez Garrido told reporters in Brussels. "There is no proof and that’s why we are going to demand accountability from those who have blamed Spain for this matter."

Blame Spain: Germans finger Spanish cucumbers as source of E. coli O104 outbreak

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German health officials identified imported cucumbers from Spain Thursday as the source of a two-week E. coli O104 outbreak that has killed at least four people and made more than 100 others ill.

Three of four contaminated cucumbers analyzed by the Hamburg Institute for Hygiene and the Environment came from Spain, said the state health minister for Hamburg, Cornelia Pruefer-Storcks.

Cucumbers from the affected producers have been pulled from shelves and officials have told people to stop eating cucumbers. The country of origin of the other cucumber is not yet known.

138 now with HUS in German E. coli O104 outbreak; 3 dead, over 400 sick

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Kai Kupferschmidt, who initially reported it was E. coli O104 that has killed three and sickened over 400 in Germany, writes for Science Insider today that an initial sorta-case control study hasn’t provided any clues as to the source of the outbreak.

But Kupferschmidt does provide excellent background on E. coli O104, and notes that German authorities reported earlier today that the number of hemolytic-uremic syndrome (HUS) cases had reached 140; there are normally 60 HUS cases in Germany in a year.

Most EHEC infections are caused by a notorious serotype called O157:H7; researchers refer to that serotype and four others frequently found in Europe as the "gang of five." But the German reference laboratory for EHEC in Wernigerode has so far identified the serotype of EHEC in stool samples from five patients as O104.

Scientists have been baffled not only by the outbreak’s size and rapid spread in northern Germany but also by the fact that it affects mostly adults and females, an odd pattern because EHEC usually sickens children.

That makes the outbreak highly unusual, says Helge Karch, head of the National Consulting Laboratory on Hemolytic Uremic Syndrome in Münster. Among Karch’s E. coli isolates from 588 HUS patients collected over the past 20 years, only two are O104. In another unusual twist, Karch has found the strain to be eae-negative. The gene eae codes for the protein intimin, which the bacteria uses to attach to the intestinal wall. Most pathogenic EHEC serogroups are eae-positive.

It is still unclear whether the serotype might explain the strange pattern of infections. E. coli O104 first emerged as a pathogen in a small outbreak in Helena, Montana, in early 1994. Four people developed abdominal cramps and bloody diarrhea. Experts at the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta identified a serotype called O104:H21 as the culprit. A CDC investigation later found up to 18 patients; most of them were women and the median age was 36 years.
 

E. coli outbreak hospitalizes three children in Norway

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Three small children from Oslo, Akershus and Østfold are in hospital with a serious kidney disease following an E. coli infection.

Oslo University Hospital (Oslo Universitetssykehus) authorities confirm two have developed the potentially fatal Haemolytic-uremic syndrome (H.U.S.), which can also give acute kidney failure and change blood chemistry.

The Institute of Public Health (Folkehelseinstituttet/FHI) says the third child, admitted to Ullevål Hospital, has also developed H.U.S. Medical staff at both hospitals are refusing to give details about their conditions.

The Foreigner reports that no further details were available at this time.
 

Two children hospitalized with E. coli, maybe linked to Indiana fair

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At least two children from Rush County are critically ill after getting E. coli poisoning, and health officials are now looking into whether the children got sick at the Rush County Fair.

Four-year-old Kathleen Ragan (right) is at Peyton Manning Children’s Hospital in Indianapolis, undergoing dialysis for hemolytic-uremic syndrome. She’s one of four reported cases of E. coli. Fox59 News has received reports that Kathleen along with three other children may have contracted the disease while attending the county fair.

Kathleen’s mother says she did use hand sanitizer as she petted animals there, but her symptoms of fatigue, diarrhea and bloody stools started the day after the fair ended.