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 Apr;116(4):544-51. doi: 10.1016/s0022-3476(05)81600-2.


Purpose: To describe an outbreak of Escherichia coli O175:H7 infection resulting in a high rate of progression to hemolytic-uremic syndrome, and to attempt to identify predictors of and risk factors for progression.

Design: Case-control study among employees and comparison of daily clinical features in two groups: infected residents with subsequent development of HUS and those who had no complications.

Setting: Two institutions for retarded persons in Utah.

Patients: Twenty residents with E. coli O157:H7 infection (13 culture confirmed, 2 probable, and 5 possible); HUS developed in 8, and 4 died. Thirty-one infected employees (3 with culture-confirmed, 6 with probable, and 22 with possible infection).

Measurements and main results: In a case-control study among employees, infection was independently associated with eating ground beef from a single lot prepared at several barbecues and with close contact with a resident who had diarrhea. Five of eight residents in whom HUS developed had received trimethoprim-sulfamethoxazole, compared with none of seven who had no subsequent complications (p = 0.026); this finding may reflect antimicrobial treatment of patients with more severe illness. Compared with infected residents without complications, persons with HUS were younger (median age 13 vs 27 years, p = 0.043) and, by the third day of illness, had higher leukocyte counts (median 23.7 X 10(9)/L vs 9.1 X 10(9)/L, p = 0.018) and temperature (median 38.5 degrees C vs 37.0 degrees C, p = 0.016). Leukocytosis peaked on day 4, more than 24 hours before signs of HUS appeared.

Conclusions: Food-borne outbreaks of E. coli O157:H7 in institutions may have devastating effects. Leukocytosis and fever may precede and predict HUS in patients with E. coli O157:H7 infection.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Case-Control Studies
  • Child
  • Cross Infection* / blood
  • Cross Infection* / drug therapy
  • Cross Infection* / epidemiology
  • Diarrhea / etiology
  • Diarrhea / microbiology
  • Diarrhea, Infantile / etiology
  • Diarrhea, Infantile / microbiology
  • Disease Outbreaks
  • Escherichia coli / isolation & purification
  • Escherichia coli Infections* / blood
  • Escherichia coli Infections* / drug therapy
  • Escherichia coli Infections* / epidemiology
  • Feces / microbiology
  • Foodborne Diseases / complications
  • Hemolytic-Uremic Syndrome / etiology*
  • Humans
  • Institutionalization*
  • Intellectual Disability*
  • Leukocyte Count
  • Risk Factors
  • Utah / epidemiology