Epidemiologic Notes and Reports
Isolation of E. coli 0157:H7 from Sporadic Cases of Hemorrhagic
Colitis -- United States
Since the beginning of August 1982, stool isolates of
Escherichia
coli serotype 0157:H7 have been identified at CDC from specimens
obtained from four patients in two states. Three of four patients
had
an unusual bloody diarrheal illness; each illness began suddenly
with
severe crampy abdominal pain followed within 24 hours by watery
diarrhea, which subsequently became markedly bloody. One patient
underwent a laparotomy to rule out appendicitis. All patients
recovered within 7 days without complications or specific therapy.
In
one instance, E. coli 0157:H7 was isolated from the stool of a
patient's spouse. This fourth patient had abdominal cramps and
non-bloody diarrhea. Since early August, 25 additional sporadic
cases
of this unusual illness have been reported to CDC, but
appropriately
collected stool specimens were available in only two of these. E.
coli 0157:H7 was not isolated from either specimen. The four
patients
with sporadic cases in which E. coli was isolated from stools and
24
of the remaining 25 patients with sporadic cases had eaten
hamburgers
from a variety of sources (including homes and/or local or
national-chain restaurants) within the week before they became ill.
Examination of stool samples from sporadic cases of this
recently
recognized diarrheal illness, currently designated "hemorrhagic
colitis," began at CDC after E. coli 0157:H7 was isolated from
patients in two separate outbreaks of this illness earlier this
year
in Oregon and Michigan. Illness was associated with eating
hamburgers
at restaurants of one national chain.
Hemorrhagic colitis appears to be a distinct clinical entity,
characterized by severe crampy abdominal pain, grossly bloody
diarrhea, little or no fever, a characteristic barium-enema finding
of
marked edema involving the cecum, ascending and/or transverse
colon,
and the absence of usual pathogens in stool.
Reported by RR Uyeyama, MD, Good Samaritan Hospital, San Jose, SB
Werner, MD, S Chin, MD, State Epidemiologist, California Dept of
Health Svcs; SF Pearce, MD, CL Kollip, MD, Portland Adventist
Medical
Center, Portland, LP Williams, DVM, JA Googins, MD, State
Epidemiologist, Oregon State Health Div; Enteric Diseases Br, Div
of
Bacterial Diseases, Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: The diagnoses of hemorrhagic colitis are based on
the
typical clinical presentation and isolation of E. coli 0157:H7 from
the stool specimens. Early stool collection (within 4 days after
onset of illness and before any antibiotic exposure) is crucial for
detecting the E. coli, so physicians encountering typical cases
need
to ensure that stool samples are obtained and a portion held frozen
(preferably at -70 C (-94 F) or on dry ice) while their
laboratories
perform routine examinations for Salmonella, Shigella,
Campylobacter,
Yersinia, and parasites. If these test results are negative,
arrangements can be made through the state epidemiologist and state
laboratory director to look for E. coli 0157:H7 in the frozen
specimen. Those state laboratories that do not have the antisera
to
identify E. coli 0157:H7 may wish to send either the whole frozen
stool or 10 picks (if possible) of E. coli colonies to CDC. This
strain of E. coli 0157:H7 does not ferment sorbitol, and this
biochemical property may facilitate screening for this serotype.
Further studies are under way at CDC to better characterize the
epidemiology of hemorrhagic colitis, the reservoir of E. coli
0157:H7,
and serologic methods to confirm infection.
Epidemiologic investigation of the outbreaks showed that one
source of E. coli 0157:H7 is hamburger. Other enteric diseases,
such
as salmonellosis, have been reported following consumption of
hamburger (1). Careful handling and adequate cooking of raw meat
products should minimize or eliminate the risk of contracting
infectious diseases from this source.
Reference
Fontaine RE, Arnon S, Martin WT, et al. Raw hamburger: an
interstate common source of human salmonellosis. Am J
Epidemiol
l978;107:36-45.
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