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Escherichia coli O157:H7

Etiology: -> risk factors for E coli associated HUS a) age > 65 years b) age < 15 years c) low gastric acid production 1] gastrectomy 2] medication Epidemiology: 1) 1993 multi-state outbreak associated with undercooked hamburgers 2) multi-county outbreaks in California associated with raw alfalfa sprouts &/or clover-seed sprouts [4] 3) 2017 multi-state outbreak associated with soy nut butter [10] 4) most common shiga toxin-producing E coli Pathology: 1) produces shiga toxin 2) hemorrhagic colitis 3) hemolytic uremic syndrome (HUS) 10% (includes TTP -> most common cause of renal disease in children 4) neurologic complications - cognitive impairment, aphasia, seizures [9] 4) thrombotic thrombocytopenic purpura (TTP) Clinical manifestations: 1) incubation period: 6 +/- 2 days 2) abdominal cramping & diarrhea, becoming bloody 3) vomiting (50%) 4) fever (30%) 5) resolution in 1 week Laboratory: 1) laboratory indicators of hemolytic uremic syndrome (HUS) risk a) complete blood count: leukocytosis b) serum albumin < 3.5 g/dL 2) Escherichia coli O157:H7 identified by culture - E coli O157:H7 is cultured on sorbitol MacConkey agar 3) Escherichia coli O157:H7 antigen 4) Escherichia coli O157:H7 DNA 5) also see hemolytic uremic syndrome (HUS) Complications: - long term health risks of a) hypertension b) structural & functional renal impairment [7] Management: 1) treatment is generally supportive 2) avoid antimotility agents - a) slows elimination of bacteria b) may increase risk of hemolytic-uremic syndrome [5] 3) risk of hemolytic-uremic syndrome not associated with antibiotic treatment [5]

Related

hemolytic uremic syndrome (HUS)

General

enterohemorrhagic Escherichia coli (Shiga toxin-producing E coli)

Properties

KINGDOM: monera DIVISION: SCHIZOMYCETES

References

  1. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 226
  2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 498, 535
  3. Prescriber's Letter 7(8):45 2000
  4. Journal Watch 21(18):149, 2001 Mohle-Boetani JC, et al Escherichia coli O157 and Salmonella infections associated with sprouts in California, 1996-1998 Ann Intern Med 2001, 135:239 PMID: 11511138
  5. Medical Knowledge Self Assessment Program (MKSAP) 14, 15, 16. American College of Physicians, Philadelphia 2006, 2009, 2012
  6. Hamburger - Preparation Safety http://www.niehs.nih.gov/external/faq/hmbrgr.htm
  7. Clark WF et al Long term risk for hypertension, renal impairment, and cardiovascular disease after gastroenteritis from drinking water contaminated with Escherichia coli O157:H7: a prospective cohort study BMJ 2010; 341:c6020 PMID: 21084368 http://www.bmj.com/content/341/bmj.c6020.full
  8. Centers for Disease Control and Prevention (CDC) The 2013 NARMS Annual Human Isolates Report. CDC NARMS tracks antimicrobial resistance in Salmonella and other enteric (intestinal) bacteria that may cause mild or severe diarrhea or bloodstream infection. http://www.cdc.gov/narms/reports/annual-human-isolates-report-2013.html
  9. Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  10. Centers for Disease Control and Prevention (CDC). Multistate Outbreak of Shiga toxin-producing Escherichia coli O157:H7 Infections Linked to I.M. Healthy Brand SoyNut Butter. Posted March 3, 2017 https://www.cdc.gov/ecoli/2017/o157h7-03-17/index.html