A large outbreak of hemolytic uremic syndrome caused by an unusual sorbitol-fermenting strain of Escherichia coli O157:H-

J Infect Dis. 1999 May;179(5):1274-7. doi: 10.1086/314715.

Abstract

Escherichia coli O157:H7 does not ferment sorbitol, a factor used to differentiate it from other E. coli. From December 1995 to March 1996, 28 children with hemolytic uremic syndrome in Bavaria, Germany, were identified; many had a sorbitol-fermenting (sf) E. coli O157:H- cultured. A case-control study showed a dose-response relationship between sausage consumption and illness. A second case-control study showed a relationship between mortadella and teewurst consumption and illness, particularly during December (mortadella odds ratio [OR], 10.5, P=.004; teewurst OR, 6.2, P=.02). Twelve sf O157:H- were characterized to determine clonality and virulence traits. The strains possessed the Stx2, eae, and EHEC-hlyA genes but were nonhemolytic on blood agar plates. The O157:H- isolates belonged to phage type 88 and had identical pulsed-field gel electrophoresis patterns. This outbreak was caused by sf E. coli O157:H-, which is not detectable by culture on sorbitol MacConkey's agar. Consumption of two sausages, including a raw beef-containing sausage, was statistically related to illness.

MeSH terms

  • Case-Control Studies
  • Child
  • Child, Preschool
  • Disease Outbreaks*
  • Escherichia coli Infections / epidemiology*
  • Escherichia coli Infections / microbiology
  • Escherichia coli O157 / classification
  • Escherichia coli O157 / isolation & purification*
  • Escherichia coli O157 / metabolism*
  • Fermentation
  • Food Microbiology
  • Germany / epidemiology
  • Hemodialysis Units, Hospital
  • Hemolytic-Uremic Syndrome / epidemiology*
  • Hemolytic-Uremic Syndrome / microbiology
  • Hospital Records
  • Humans
  • Infant
  • Meat Products / microbiology
  • Sorbitol / metabolism*

Substances

  • Sorbitol