Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-27T13:15:57.259Z Has data issue: false hasContentIssue false
  • English
  • Français

A community outbreak of haemolytic-uraemic syndrome in children occurring in a large area of Northern Italy over a period of several months

Published online by Cambridge University Press:  15 May 2009

A. E. Tozzi ,
A. Niccolini ,
A. Caprioli ,
I. Luzzi ,
G. Montini ,
G. Zacchello ,
A. Gianviti ,
F. Principato  and
G. Rizzoni
A. E. Tozzi*
Affiliation:
Laboratorio di Epdemiologia e Biostatistica, Istituto Superiors di Sanità, Rome
A. Niccolini
Affiliation:
Laboratorio di Epdemiologia e Biostatistica, Istituto Superiors di Sanità, Rome
A. Caprioli
Affiliation:
Laboratorio di Ultrastrutture, Istituto Superiors di Sanità, Rome
I. Luzzi
Affiliation:
Laboratorio di Batteriologia e Micologia Medica, Istituto Superiors di Sanità, Rome
G. Montini
Affiliation:
Clinica Pediatrica, Università di Padova, Padua
G. Zacchello
Affiliation:
Clinica Pediatrica, Università di Padova, Padua
A. Gianviti
Affiliation:
Divisione di Nefrologia e Dialixi. Ospedale Bambino Gesù, Rome, Italy
F. Principato
Affiliation:
Divisione di Nefrologia e Dialixi. Ospedale Bambino Gesù, Rome, Italy
G. Rizzoni
Affiliation:
Divisione di Nefrologia e Dialixi. Ospedale Bambino Gesù, Rome, Italy
*
* Correspondence and reprint requests to: Dr A. E. Tozzi, Istituto Superiore di Sanita. Laboratorio di Epidemiologia e Biostatistica. Viale Regina Elena. 299. 00161 ROMA. Italy.
Rights & Permissions [Opens in a new window]

Summary

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

From March to October 1993. 15 cases of haemolytic-uraemic syndrome (HUS) in children were detected in a large area of northern Italy, where only 8 cases had occurred in the previous 5 years. Analysis of stool and serum specimens obtained from 14 cases showed evidence of Verotoxin-producing Escherichia coli (VTEC) infection in 13. Serum antibodies to the E. coli O157 lipopolysaccharide (LPS) were found in 8 patients and to the O111 LPS in 2. An O86 VTEC was isolated from another patient. Fourteen children needed dialysis, and 1 died. No obvious epidemiologic link was observed among cases, most of whom lived in small townships. A case-control study did not show an association between HUS and food or exposure to cattle, but suggested an association with contact with chicken coops (OR = 6·5. 95% C.I. 1·2–34·9). However, VTEC were not isolated from stool samples obtained from the chicken coops involved. The risk factors for VTEC infection related to living in rural settlements, including the exposure to live poultry, should be considered in outbreak investigations.

Type
Research Article
Information
Epidemiology & Infection , Volume 113 , Issue 2 , October 1994 , pp. 209 - 219
Copyright
Copyright © Cambridge University Press 1994

References

REFERENCES

1.Griffin, PM, Tauxe, RVThe epidemiology of infections caused by Escherichia coli O157:H7. other enterohemorrhagic E. coli. and the associated hemolytic uremic syndrome. Epidemiol Rev 1991; 13: 60–98.CrossRefGoogle ScholarPubMed
2.Ostroff, SM, Griffin, PM, Tauxe, RV et al. . A statewide outbreak of Escherichia coli O157:H7 infections in Washington state. Am J Epidemiol 1990; 132: 239–47.CrossRefGoogle ScholarPubMed
3.Pavia, AT, Nichols, CR, Green, DP et al. . Hemolytic-uremic syndrome during an outbreak of Escherichia coli O157:H7 infections in institutions for mentally retarded persons: clinical and epidemiologic observations. J Pediatr 1990; 116: 544–51.CrossRefGoogle ScholarPubMed
4.Belongia, EA, MacDonald, KL, Parham, GL et al. . An outbreak of Escherichia coli O157:H7 colitis associated with consumption of precooked meat patties. J Infect Dis 1991; 194: 338–43.CrossRefGoogle Scholar
5.Swerdlow, DL, Woodruff, BA, Brady, RC et al. . A waterborne outbreak in Missouri of Escherichia coli O157:H7 associated with bloody diarrhea and death. Ann Int Med 1992; 117: 812–9.CrossRefGoogle ScholarPubMed
6.Morgan, GM, Newman, C, Palmer, SR et al. , First recognized community outbreak of haemorrhagic colitis due to verotoxin-producing Escherichia coli O157:H7 in the UK. Epidemiol Infect 1988; 101: 83–91.CrossRefGoogle Scholar
7.Thomas, A, Chart, H, Cheasty, T, Smith, HR, Frost, JA, Rowe, BVero cytotoxin-producing Escherichia coli. particularly serogroup O157. associated with human infections in the United Kingdom: 1989–91. Epidemiol Infect 1993; 110: 591–600.CrossRefGoogle Scholar
8.Centres for Disease Control. Multistate outbreak of Escherichia coli O157:H7 infections from hamburgers – Western United States. 1992–1993. MMWR 1993; 42: 258–63.Google Scholar
9.Caprioli, A, Luzzi, I, Rosmini, F et al. . Hemolytic-uremic syndrome and veroevtotoxin-producing Escherichia coli infection in Italy. J Infect Dis 1992; 166: 154–8.CrossRefGoogle ScholarPubMed
10.Morgan, D, Newman, CP, Hutchinson, DN, Walker, AM, Rowe, B, Majid, FVerotoxin producing Escherichia coli O157 infections associated with the consumption of yoghurt. Epidemiol Infect; 111: 181–7.CrossRefGoogle Scholar
11.Besser, RE, Lett, SM, Weber, JT, Doyle, MP, Barrett, TJ, Wells, JG, Griffin, PMAn outbreak of diarrhea and hemolytic uremic syndrome from Escherichia coli O157:H7 in fresh-pressed apple cider. JAMA 1993; 269: 2217–20.CrossRefGoogle ScholarPubMed
12.Caprioli, A, Luzzi, I, Rosmini, F et al. . Communitywide outbreak of heinolvtic-uremic syndrome associated with non-O157 verocytotoxin-producing Escherichia coli. J Infect Dis 1994; 169: 208–11.CrossRefGoogle ScholarPubMed
13.Caprioli, A, Nigrelli, A, Gatti, R et al. , Characterisation of verocytotoxin-producing Escherichia coli isolated from pigs and cattle in northern Italy. Vet Rec 1993; 133: 323–4.CrossRefGoogle ScholarPubMed
14.Conedera, G, Caprioli, A, Zuin, A, De Biasi, G, Cancellotti, FMEscherichia coli produttori di verocitotossine: indagine su prodotti earnei. Archivio Veterinario Italiano 1992; 43: 245–52.Google Scholar
15.Walter, SDMatched case-control studies with a variable number of controls per case. Biometrika 1979; 66: 181–3.Google Scholar
16.Chart, E, Smith, HR, Scotland, SM, Rowe, B, Milford, DV, Taylor, CMSerological identification of Escherichia coli O157:H7 infection in haetnolytie-uraemie syndrome. Lancet 1991; 337: 138–40.CrossRefGoogle ScholarPubMed
17.Karmali, MA, Arbus, GS, Ish-Shalom, N et al. . A family outbreak of hemolytic-uremic syndrome associated with verotoxin-producing Escherichia coli serotype O157:H7. Pediatr Nephrol 1988; 2: 409–14.CrossRefGoogle ScholarPubMed
18.Beautin, L, Geier, D, Steinruck, H, Zimmermann, S, Scheutz, FPrevalence and some properties of verotoxin (Shiga-like toxin)-producing Escherichia coli in seven different species of healthy domestic animals. J Clin Microbiol 1993; 31: 2483–8.CrossRefGoogle Scholar
19.Doyle, MP, Schoeni, JLIsolation of Escherichia coli O157:H7 from retail fresh meats and poultry. Appl Environ Microbiol 1987; 53: 2394–6.CrossRefGoogle ScholarPubMed
20.Berry, JT, Doyle, MP, Schoeni, JLColonization of chicken caecae by Escherichia coli associated with hemorragic colitis. Appl Environ Microbiol 1985; 49: 310–5.CrossRefGoogle Scholar
21.Dev, VJ, Main, M, Gould, IWaterborne outbreak of Escherichia coli O157. Lancet 1991; 337: 1412.CrossRefGoogle ScholarPubMed
22.Bitzan, M, Ludwig, K, Klemt, M, Konig, H, Buren, J, Muller-Wiefel, DEThe role of Escherichia coli O157 infections in the classical (entheropatic) haemolytic uraemic syndrome: results of a central European multicentre study. Epidemiol Infect 1993; 110: 183–96.CrossRefGoogle Scholar
23.Cieslak, PR, Barrett, TJ, Griffin, PM et al. . Escherichia coli O157:H7 infection from a manured garden. Lancet 1993; 342: 367.CrossRefGoogle ScholarPubMed
24.Rowe, PC, Orrbine, E, Lior, H, Wells, GA, McLaine, PN, and the CPKDRC co-investigators. Diarrhoea in close contacts as a risk factor for childhood haemolytic uraemic syndrome. Epidemiol Infect 1993; 110: 9–16.CrossRefGoogle ScholarPubMed