Abstract
In 1990, an outbreak ofEscherichia coli 0157: H7 infection occurred in 174 children in a nursery school in Saitama, Japan. The organism was isolated from tap water supplied from the well in the school. Clinical manifestations varied from asymptomatic infection to non-bloody diarrhoea, haemorrhagic colitis, haemolytic uraemic syndrome (HUS) and death. Among culture-confirmed 42 cases ofE. coli 0157: H7, 7 children were asymptomatic, 21 children had only diarrhoea, and 14 children developed HUS. Bloody diarrhoea with abdominal pain following initial frequent diarrhoea appeared to be associated with subsequent HUS. In patients with HUS, both leucocyte count and lactate dehydrogenase activity continued to increase in the early phase of the disease, and on day 3 of illness attained markedly higher levels than in patients without HUS. These two parameters seemed to be important as predictors of the development of HUS.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- HUS :
-
Haemolytic uraemic syndrome
- LDH :
-
Lactate dehydrogenase
References
Bale JF, Brasher C, Siegler RL (1980) CNS manifestations of the hemolyticuremic syndrome. Am J Dis Child 134:869–872
Carter AO, Borczyk AA, Carlson JAK, Harvey B, Hockin JC, Karmen MA, Krishman C, Korn DA, Lior H (1987) A severe outbreak ofEscherichia coli 0157:147 associated hemorrhagic colitis in a nursing home. N Engl J Med 317:1496–1500
Endo Y, Tsurugi K, Yutsudo T, Takeda Y, Ogasawara T, Igarashi K (1988) Site of action of a verotoxin fromEscherichia coli 0157:147 and of Shiga toxin on eukaryotic ribosomes. Eur J Biochem 171:45–50
Griffin PM, Ostroff SM, Tauxe RV, Greene KD, Wells JG, Lewis JH, Blake PA (1988) Illnesses associated with Escherichia coli 0157:117 infections. Ann Intern Med 109:705–712
Hamano S, Nakanishi Y, Nara T, Seki T, Ohtani T, Oishi T, Joh K, Muramatsu Y, Ogawa Y, Akashi S (1993) Neurological manifestations of hemorrhagic colitis in the outbreak of Escherichia coli 0157: H7 infection in Japan. Acta Paediatr 62:454–458
Johnson WM, Lior H, Bezanson GS (1983) CytotoxicEscherichia coli 0157:147 associated with hemorrhagic colitis in Canada. Lancet 1:76
Karmali MA (1989) Infection by verocytotoxin-producingEscherichia coli. Clin Microbiol Rev 2:15–38
Martin DL, MacDonald KL, White KE, Soler JT, Osterholm MT (1990) The epidemiology and clinical aspects of hemolytic uremic syndrome in Minnesota. N Engl J Med 323:1161–1167
O'Brien AD, Lively TA, Chen ME, Rothman SW, Formal SB (1983) Escherichia coli 0157:147 strains associated with hemorrhagic colitis in the United States produce a shigella dysenteria I (Shiga) like cytotoxin. Lancet 1:702
Pavia AT, Nichols CR, Green DP, Tauxe RV, Mottice S, Greene KD, Wells JG, Siegler RL, Brewer ED, Hannon D, Blake PA (1990) He molytic-uremic syndrome during an outbreak ofEscherichia coli 0157:147 infections in institutions for mentally retarded persons: clinical and epidemiologic observations. J Pediatr 116:544–551
Riley LW, Remis RS, Helgerson SD, McGee HB, Wells JG, Davis BR, Hebert RJ, Olcott ES, Johnson LM, Hargrett NT, Blake PA, Cohen ML (1983) Hemorrhagic colitis associated with a rareEscherichia Coli serotype. N Engl J Med 308:681–685
Ryan CA, Tauxe RV, Hosek GW, Wells JG, Stoesz PA, McFadden HW, Smith PW, Wright GF, Blake PA (1986)Escherichia coli 0157:H7 diarrhea in a nursing home: clinical epidemiological and pathological findings. J Infec Dis 154:631–638
Spika KS, Parsons JE, Nordenberg D, Wells JG, Gunn RA, Blake PA (1986) Hemolytic uremic syndrome and diarrhea associated with Escherichia coli 0157:H7 in a day care center. J Pediatr 109:287–291
Strockbine NA, Marques LRM, Newland JW, Smith HW, Holmes RK, O'Brien AD (1986) Two toxin-converting phages fromEscherichia coli 0157:H7 strain 933 encode antigenically distinct toxins with similar biological activities. Infect Immun 53:135–140
Author information
Authors and Affiliations
Additional information
Committee for epidemiological and clinical study of epidemic diarrhoea due to pathogenicE. coli in a nursery school, Saitama, Japan
Rights and permissions
About this article
Cite this article
Akashi, S., Joh, K., Mori, T. et al. A severe outbreak of haemorrhagic colitis and haemolytic uraemic syndrome associated withEscherichia coli 0157: H7 in Japan. Eur J Pediatr 153, 650–655 (1994). https://doi.org/10.1007/BF02190685
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02190685