Epidemic of Gastrointestinal Tract Infection Including Hemorrhagic Colitis Attributable to Shiga Toxin 1-producingEscherichia coli O118:H2 at a Junior High School in Japan
Open Access
- 1 January 1999
- journal article
- Published by American Academy of Pediatrics (AAP)
- Vol. 103 (1) , e2
- https://doi.org/10.1542/peds.103.1.e2
Abstract
Background. An epidemic of gastrointestinal disturbances related to food ingestion occurred at a junior high school in Komatsu, Japan, and was caused by specifically Shiga toxin (Stx) 1-producing Escherichia coli O118:H2, which has not been reported previously in humans. No outbreak ofE coli-producing Stx 1 alone had occurred. Methods. A total of 526 students and 35 adult staff members who ate the same food at lunch in the school were investigated. Questionnaires about food consumption at lunch were given to all 561 subjects as well as to clinics and hospitals that had treated 79 patients. Stool specimens from 525 subjects, and food, water, and environmental specimens, including cooking utensils, were collected in an attempt to identify the pathogen. Results. A total of 126 subjects (22.5%) developed a diarrheal illness. The pathogen was isolated from the stool in 131 subjects, 49 of which were asymptomatic, and from a dipper. Salads served over several days were identified as high-risk from food analysis. Gastrointestinal symptoms resembled those associated with previous infections of Stx-producing E coli, but were mild. No cases of the hemolytic–uremic syndrome developed. Headache was present in 87 patients. Three patients underwent surgery for acute appendicitis during this epidemic. Four of five carriers had received an antibiotic effective against the pathogen. Conclusions. This outbreak of E coliO118:H2 demonstrated the clinical and epidemiologic features of infection by E coli that produces Stx 1 alone. Infections with such organisms are being recognized increasingly, and the pattern of disease observed may differ from the pattern observed with E coli O157:H7.Keywords
This publication has 12 references indexed in Scilit:
- Immune Response to Non-O157 Vero Toxin--Producing Escherichia coli in Patients with Hemolytic Uremic SyndromeThe Journal of Infectious Diseases, 1996
- Hemolytic–Uremic Syndrome in a Six-Year-Old Girl after a Urinary Tract Infection with Shiga-Toxin–ProducingEscherichia coliO103:H2New England Journal of Medicine, 1996
- Serogroups of Escherichia coli isolated from piglets in SpainVeterinary Microbiology, 1996
- Communitywide Outbreak of Hemolytic-Uremic Syndrome Associated with Non-O157 Verocytotoxin-Producing Escherichia coliThe Journal of Infectious Diseases, 1994
- Serological identification of infection by Vero cytotoxin producing Escherichia coli in patients with haemolytic uraemic syndromeSerodiagnosis and Immunotherapy in Infectious Disease, 1990
- Primer-Directed Enzymatic Amplification of DNA with a Thermostable DNA PolymeraseScience, 1988
- A Severe Outbreak ofEscherichia coliO157:H7–Associated Hemorrhagic Colitis in a Nursing HomeNew England Journal of Medicine, 1987
- Hemolytic uremic syndrome and diarrhea associated with Escherichia coli 0157:H7 in a day care centerThe Journal of Pediatrics, 1986
- Hemorrhagic Colitis Associated with a RareEscherichia coliSerotypeNew England Journal of Medicine, 1983
- Acute right-sided hemorrhagic colitis associated with oral administration of ampicillinDigestive Diseases and Sciences, 1979