Ongoing haemolytic uraemic syndrome (HUS) outbreak caused by sorbitol-fermenting (SF) Shiga toxin-producing Escherichia coli (STEC) O157, Germany, December 2016 to May 2017

We report an ongoing, protracted and geographically dispersed outbreak of haemolytic uraemic syndrome (HUS) and gastroenteritis in Germany, involving 30 cases since December 2016. The outbreak was caused by the sorbitol-fermenting immotile variant of Shiga toxin-producing (STEC) Escherichia coli O157. Molecular typing revealed close relatedness between isolates from 14 cases. One HUS patient died. Results of a case–control study suggest packaged minced meat as the most likely food vehicle. Food safety investigations are ongoing.

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Community-wide outbreak of haemolytic uraemic syndrome associated with Shiga toxin 2-producing Escherichia coli O26:H11 in southern Italy, summer 2013

Eurosurveillance ◽

10.2807/1560-7917.es.2016.21.38.30343 ◽

2016 ◽

Vol 21 (38) ◽

Cited By ~ 28

Author(s):

Cinzia Germinario ◽

Alfredo Caprioli ◽

Mario Giordano ◽

Maria Chironna ◽

Maria Serena Gallone ◽

...

Keyword(s):

Escherichia Coli ◽

Shiga Toxin ◽

Haemolytic Uraemic Syndrome ◽

Case Control Study ◽

Public Health Problem ◽

Case Control ◽

Bulk Milk ◽

Shiga Toxin 2 ◽

Local Plants ◽

Control Study

In summer 2013, an excess of paediatric cases of haemolytic uraemic syndrome (HUS) in a southern region of Italy prompted the investigation of a community-wide outbreak of Shiga toxin 2-producing Escherichia coli (STEC) O26:H11 infections. Case finding was based on testing patients with HUS or bloody diarrhoea for STEC infection by microbiological and serological methods. A case–control study was conducted to identify the source of the outbreak. STEC O26 infection was identified in 20 children (median age 17 months) with HUS, two of whom reported severe neurological sequelae. No cases in adults were detected. Molecular typing showed that two distinct STEC O26:H11 strains were involved. The case–control study showed an association between STEC O26 infection and consumption of dairy products from two local plants, but not with specific ready-to-eat products. E.coli O26:H11 strains lacking the stx genes were isolated from bulk milk and curd samples, but their PFGE profiles did not match those of the outbreak isolates. This outbreak supports the view that infections with Stx2-producing E. coli O26 in children have a high probability of progressing to HUS and represent an emerging public health problem in Europe.

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Faculty Opinions recommendation of Validation of treatment strategies for enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome: case-control study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718131010.793501519 ◽

2014 ◽

Author(s):

Neil Sheerin ◽

David Kavanagh

Keyword(s):

Escherichia Coli ◽

Haemolytic Uraemic Syndrome ◽

Case Control Study ◽

Treatment Strategies ◽

Case Control ◽

Enterohaemorrhagic Escherichia Coli ◽

Control Study

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717. Antibiotic treatment of Shiga toxin-producing Escherichia coli related gastroenteritis and the risk of hemolytic uremic syndrome: a population based matched case-control study in Japan

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.909 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S409-S410

Author(s):

Shota Myojin ◽

Kyongsun Pak ◽

Mayumi Sako ◽

Tohru Kobayashi ◽

Takuri Takahashi ◽

...

Keyword(s):

Escherichia Coli ◽

Shiga Toxin ◽

Case Control Study ◽

Conditional Logistic Regression ◽

Population Based ◽

Case Control ◽

Age Group ◽

Matched Case ◽

Matched Case Control Study ◽

Control Study

Abstract Background The role of therapeutic intervention, particularly antibiotics, for Shiga toxin-producing Escherichia coli (STEC) related infection is controversial. Methods We performed a population based matched case-control study to assess the association between treatment (antibiotics, antidiarrheal agents and probiotics) for STEC related infections and HUS development. We identified all STEC HUS patients as cases and matched five non-HUS patients as controls using the data from the National Epidemiological Surveillance of Infectious Diseases (NESID) between January 1, 2017, and December 31, 2018. Further medical information was obtained by standardized questionnaires answered by physicians who registered each patient. We used multivariate conditional logistic regression model to evaluate the association between exposures (use of antibiotics, use of antidiarrheal agents, days between disease onset and fosfomycin administration [within two or three days]) and the development of HUS, by matched odds ratios (OR) and 95% confidence intervals (CI). Covariates we used were sex, age group, area code, presence of diarrhea and other factors. We also performed subgroup analyses using age (adults and children) as a stratification factor. Results 7,760 STEC related patients were registered in the NESID. We selected patients who had a record of HUS diagnosis (n=182) and matched controls without HUS (n=910). After collecting standardized paper-based questionnaires, we enrolled 90 HUS patients and 371 non-HUS patients for analysis. In the main analysis, matched OR of fosfomycin was 0.75(0.47-1.20) in all ages, 1.41(0.51-3.88) in adults and 0.58(0.34-1.01) in children. Matched OR of antidiarrheal agents was 2.07(1.07-4.03) in all ages, 1.84(0.32-10.53) in adults, 2.65(1.21-5.82) in children. Matched OR of probiotics was 0.86(0.46-1.61) in all ages, 0.76(0.21-2.71) in adults, 1.00(0.48-2.09) in children. There was no significant association between the timing of fosfomycin use in the first two or five days of illness and HUS development in any age group. Conclusion Our results suggest that fosfomycin might decrease the risk of HUS in children younger than 15 years of age with STEC confirmed bacterial gastroenteritis. Disclosures All Authors: No reported disclosures

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A Shiga toxin-producingEscherichia coliO157 outbreak associated with consumption of rice cakes in 2011 in Japan

Epidemiology and Infection ◽

10.1017/s0950268812002439 ◽

2012 ◽

Vol 141 (9) ◽

pp. 1897-1904 ◽

Cited By ~ 7

Author(s):

K. NABAE ◽

M. TAKAHASHI ◽

T. WAKUI ◽

H. KAMIYA ◽

K. NAKASHIMA ◽

...

Keyword(s):

Escherichia Coli ◽

Shiga Toxin ◽

Manufacturing Process ◽

Environmental Samples ◽

Case Control Study ◽

Raw Materials ◽

Case Control ◽

Passive Surveillance ◽

Control Study ◽

Rice Cakes

SUMMARYIn May 2011, an outbreak of Shiga toxin-producingEscherichia coli(STEC) O157 was reported from Yamagata Prefecture, Japan. Investigations, including a case-control study, revealed that the outbreak was linked to two varieties of rice cakes produced by a local manufacturer between 2 and 7 May. Active and passive surveillance identified 136 suspected cases, 142 confirmed cases, 26 asymptomatic cases, and 25 secondary cases. While no environmental samples taken from the manufacturing premises tested positive for STEC, other than a stool sample taken from one employee, on-site and epidemiological investigations indicated that STEC was introduced during the manufacturing process of rice cakes rather than through contamination of raw materials. This was the first reported outbreak of STEC associated with cakes and confectionery in Japan, which indicates that contamination and outbreaks of STEC can occur in any food unless proper precautions are taken.

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Validation of treatment strategies for enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome: case-control study

BMJ ◽

10.1136/bmj.e4565 ◽

2012 ◽

Vol 345 (jul19 1) ◽

pp. e4565-e4565 ◽

Cited By ~ 194

Author(s):

J. Menne ◽

M. Nitschke ◽

R. Stingele ◽

M. Abu-Tair ◽

J. Beneke ◽

...

Keyword(s):

Escherichia Coli ◽

Haemolytic Uraemic Syndrome ◽

Case Control Study ◽

Treatment Strategies ◽

Case Control ◽

Enterohaemorrhagic Escherichia Coli ◽

Control Study

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678. Outbreak of Shiga Toxin-Producing Escherichia coli Infections at Marine Corps Recruit Depot (MCRD), San Diego and Camp Pendleton, California: October–November, 2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.684 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S244-S245

Author(s):

Amelia Keaton ◽

Rashida Hassan ◽

Sarah Luna ◽

Isabell Lee ◽

Richelle Magalhaes ◽

...

Keyword(s):

Escherichia Coli ◽

Shiga Toxin ◽

San Diego ◽

Case Control Study ◽

Ground Beef ◽

Marine Corps ◽

Case Control ◽

Suspected Case ◽

Control Analysis ◽

Control Study

Abstract Background Shiga toxin-producing Escherichia coli (STEC) infections are a major cause of foodborne illness and the principal cause of hemolytic-uremic syndrome (HUS). In November 2017, CDC and the US Navy responded to an outbreak of STEC illnesses in military recruits at the Marine Corps Recruit Depot in San Diego (MCRD). We investigated to determine the source of this outbreak and identify prevention and mitigation measures. Methods In October 2017, medical staff identified a high number of gastrointestinal (GI) illnesses at MCRD. Recruits with diarrhea submitted stool specimens for culture and/or culture-independent diagnostic testing (CIDT) for GI pathogens. We performed pulsed-field gel electrophoresis (PFGE) on culture isolates. Case-patients were defined as confirmed (PFGE-confirmed STEC infection matching outbreak strains), probable (diagnosis of HUS and/or CIDT evidence of STEC), or suspected (bloody diarrhea). We conducted environmental evaluations of dining facilities, training areas, and barracks. A case–control study was performed using PFGE-confirmed case-patients and platoon-matched controls. We performed product traceback for foods identified as exposure risks by interview or case–control study. Results We identified 64 confirmed, 105 probable, and 91 suspected case-patients. Thirty case-patients required hospitalization and 15 had HUS. Ages ranged from 17 to 28 years (median: 18 years). Poor hygiene practices among recruits and inconsistent cooking temperatures within dining facilities were noted. Forty-three case-patients and 135 controls were interviewed about food, hygiene, and environmental exposures. Consumption of undercooked beef was significantly associated with illness (mOR 2.40, CI 1.04–5.72, P = 0.04). We identified a single ground beef supplier for MCRD, but dining facility records did not document the dates on which specific lots of ground beef were used. Conclusion Case–control analysis and environmental observations suggested undercooked ground beef as a potential source for this outbreak. We recommended the Navy and Marine Corps retain lot information, address food handling concerns, and improve hygiene among recruits. Disclosures All authors: No reported disclosures.

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Shiga toxin-producing Escherichia coli (STEC) O157 outbreak, The Netherlands, September – October 2005

Eurosurveillance ◽

10.2807/esm.11.07.00636-en ◽

2006 ◽

Vol 11 (7) ◽

pp. 5-6 ◽

Cited By ~ 19

Author(s):

Y Doorduyn ◽

C M de Jager ◽

W K van der Zwaluw ◽

I H Friesema ◽

A E Heuvelink ◽

...

Keyword(s):

Escherichia Coli ◽

The Netherlands ◽

Shiga Toxin ◽

Case Control Study ◽

Preliminary Investigation ◽

Case Control ◽

Secondary Case ◽

Negative Results ◽

Source Contamination ◽

Control Study

In September 2005, the first national food-related outbreak of Shiga toxin (Stx)-producing Escherichia coli (STEC) O157 was investigated in the Netherlands. A total of 21 laboratory-confirmed cases (including one secondary case), and another 11 probable cases (two primary and nine secondary cases) were reported in patients who became ill between 11 September and 10 October 2005. Preliminary investigation suggested consumption of a raw beef product, steak tartare (in the Netherlands also known as 'filet américain'), and contact with other symptomatic persons as possible risk factors. A subsequent case-control study supported the hypothesis that steak tartare was the source of the outbreak (matched odds ratio (OR) 272, 95% confidence interval (CI) 3 - 23211). Consumption of ready-to-eat vegetables was also associated with STEC O157 infection (matched OR 24, 95% CI 1.1 – 528), but was considered a less likely source, as only 40% of the cases were exposed. Samples of steak tartare collected from one chain of supermarkets where it is likely that most patients (67%) bought steak tartare, all tested negative for STEC O157. However, sampling was done three days after the date of symptom onset of the last reported case. Since 88% of the cases became ill within a two week period, point source contamination may explain these negative results. It is concluded that steak tartare was the most likely cause of the first national food-related outbreak of STEC O157 in the Netherlands.

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