Desperately seeking diarrhoea: outbreak of haemolytic uraemic syndrome caused by emerging sorbitol-fermenting shiga toxin-producing Escherichia coli O157:H-, Germany, 2009.
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Desperately seeking diarrhoea: outbreak of haemolytic uraemic syndrome caused by emerging sorbitol-fermenting shiga toxin-producing Escherichia coli O157:H-, Germany, 2009. / Nielsen, S; Frank, C; Fruth, A; Spode, A; Prager, R; Graff, A; Plenge-Bönig, A; Loos, Sebastian; Lütgehetmann, Marc; Kemper, Markus J.; Müller-Wiefel, Dirk E.; Werber, D.
In: ZOONOSES PUBLIC HLTH, Vol. 58, No. 8, 8, 2011, p. 567-572.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Desperately seeking diarrhoea: outbreak of haemolytic uraemic syndrome caused by emerging sorbitol-fermenting shiga toxin-producing Escherichia coli O157:H-, Germany, 2009.
AU - Nielsen, S
AU - Frank, C
AU - Fruth, A
AU - Spode, A
AU - Prager, R
AU - Graff, A
AU - Plenge-Bönig, A
AU - Loos, Sebastian
AU - Lütgehetmann, Marc
AU - Kemper, Markus J.
AU - Müller-Wiefel, Dirk E.
AU - Werber, D
PY - 2011
Y1 - 2011
N2 - Infection with sorbitol-fermenting Shiga toxin-producing Escherichia coli O157:H- (sf STEC O157:H-) is rare, but emerging in Europe. The pathogen is typically isolated from paediatric patients with life-threatening haemolytic uraemic syndrome (HUS). It is unclear whether this observation primarily reflects the pathogen's virulence or its complex laboratory diagnosis, not routinely conducted in diarrhoeal patients. In summer 2009, four boys living in the same suburb in Germany developed diarrhoea-associated HUS: three were infected by sf STEC O157:H- and one died. We conducted two analytical epidemiological studies, an extensive search for diarrhoeal cases in potentially exposed groups, and an environmental investigation. Outbreak cases were residents of the suburb diagnosed with HUS, sf STEC O157:H- infection, or both between 24 July 2009 and 25 August 2009. Overall, we ascertained eight cases with a median age of 4 years (range: from 8 months to 9 years). Stool screening of 220 persons led to the identification of only four additional cases: two asymptomatic carriers and two diarrhoeal cases. HUS was strongly associated with visiting a local playground in July, particularly on 16th July (odds ratio = 42.7, P = 0.002). No other commonality, including food, was identified, and all environmental samples (n = 24) were negative. In this localized non-foodborne outbreak, the place of likely infection was a local playground. Sf STEC O157:H- infection apparently limits itself rarely to diarrhoeal illness and progresses frequently to HUS. Therefore, detection of and response to this hypervirulent pathogen primarily relies on HUS surveillance.
AB - Infection with sorbitol-fermenting Shiga toxin-producing Escherichia coli O157:H- (sf STEC O157:H-) is rare, but emerging in Europe. The pathogen is typically isolated from paediatric patients with life-threatening haemolytic uraemic syndrome (HUS). It is unclear whether this observation primarily reflects the pathogen's virulence or its complex laboratory diagnosis, not routinely conducted in diarrhoeal patients. In summer 2009, four boys living in the same suburb in Germany developed diarrhoea-associated HUS: three were infected by sf STEC O157:H- and one died. We conducted two analytical epidemiological studies, an extensive search for diarrhoeal cases in potentially exposed groups, and an environmental investigation. Outbreak cases were residents of the suburb diagnosed with HUS, sf STEC O157:H- infection, or both between 24 July 2009 and 25 August 2009. Overall, we ascertained eight cases with a median age of 4 years (range: from 8 months to 9 years). Stool screening of 220 persons led to the identification of only four additional cases: two asymptomatic carriers and two diarrhoeal cases. HUS was strongly associated with visiting a local playground in July, particularly on 16th July (odds ratio = 42.7, P = 0.002). No other commonality, including food, was identified, and all environmental samples (n = 24) were negative. In this localized non-foodborne outbreak, the place of likely infection was a local playground. Sf STEC O157:H- infection apparently limits itself rarely to diarrhoeal illness and progresses frequently to HUS. Therefore, detection of and response to this hypervirulent pathogen primarily relies on HUS surveillance.
KW - Humans
KW - Male
KW - Female
KW - Risk Factors
KW - Child
KW - Child, Preschool
KW - Infant
KW - Interviews as Topic
KW - Germany/epidemiology
KW - Disease Outbreaks
KW - Diarrhea/complications/epidemiology/microbiology
KW - Environmental Exposure/adverse effects
KW - Escherichia coli Infections/complications/epidemiology
KW - Escherichia coli O157/isolation & purification/pathogenicity
KW - Feces/microbiology
KW - Hemolytic-Uremic Syndrome/complications/epidemiology/microbiology
KW - Play and Playthings
KW - Shiga-Toxigenic Escherichia coli
KW - Sorbitol/metabolism
KW - Humans
KW - Male
KW - Female
KW - Risk Factors
KW - Child
KW - Child, Preschool
KW - Infant
KW - Interviews as Topic
KW - Germany/epidemiology
KW - Disease Outbreaks
KW - Diarrhea/complications/epidemiology/microbiology
KW - Environmental Exposure/adverse effects
KW - Escherichia coli Infections/complications/epidemiology
KW - Escherichia coli O157/isolation & purification/pathogenicity
KW - Feces/microbiology
KW - Hemolytic-Uremic Syndrome/complications/epidemiology/microbiology
KW - Play and Playthings
KW - Shiga-Toxigenic Escherichia coli
KW - Sorbitol/metabolism
M3 - SCORING: Journal article
VL - 58
SP - 567
EP - 572
JO - ZOONOSES PUBLIC HLTH
JF - ZOONOSES PUBLIC HLTH
SN - 1863-1959
IS - 8
M1 - 8
ER -
