Campylobacter enterocolitis.

BACKGROUND: Escherichia coli O157:H7 is increasingly recognized as a cause of bacterial diarrhea in the United States, but the frequency of its isolation and the clinical and epidemiologic features of E. coli O157:H7 infection in a large, geographically diverse population of patients have not been well described. OBJECTIVE: To determine the frequency of isolation of E. coli O157:H7 relative to that of other bacterial enteric pathogens in a nationwide sample of patients and to identify the clinical and epidemiologic features of E. coli O157:H7 infection. DESIGN: Population prevalence study from October 1990 to October 1992. SETTING: 10 U.S. hospitals. PATIENTS: Both inpatients and outpatients who had stool samples submitted to 1 of 10 laboratories for routine pathogen identification. MEASUREMENTS: Clinical, epidemiologic, and laboratory information was collected for infected and uninfected patients. Isolates of E. coli O157:H7 were tested for production of Shiga toxin. Patient charts were then reviewed. RESULTS: Escherichia coli O157:H7 was isolated from 118 (0.39%) of the 30463 fecal specimens tested. The proportion of fecal specimens with isolates was higher at northern sites (0.57%) than at southern sites (0.13%) (P < 0.001). Escherichia coli O157:H7 was more likely to be isolated from visibly bloody stool specimens than from specimens without visible blood (odds ratio [OR], 59.2 [95% CI, 36.6 to 96.0) and was the pathogen most commonly isolated from visibly bloody stool specimens that yielded a bacterial enteric pathogen (39% of such specimens). The highest age-specific isolation proportions from fecal specimens for E. coli O157:H7 were in patients 5 to 9 years of age (0.90%) and 50 to 59 years of age (0.89%). Clinical features independently associated with E. coli O157:H7 infection compared with the other enteric pathogens included a history of bloody diarrhea (OR, 18.6 [CI, 7.4 to 48.6]), visibly bloody stool specimens (OR, 8.1 [CI, 3.6 to 18.3]), no reported fever (OR, 8.3 [CI, 1.6 to 50.0]), leukocyte count greater than 10 x 10(9)/L (OR, 4.0 [CI, 1.7 to 9.5]), and abdominal tenderness on physical examination (OR, 2.9 [CI, 1.2 to 7.2]). CONCLUSIONS: In some geographic areas and some age groups, isolation proportions from fecal specimens for E. coli O157:H7 surpassed those of other common enteric pathogens. One third of isolates of this organism came from nonbloody specimens. Because person-to-person transmission of E. coli O157:H7 is not uncommon and infection with this organism may cause severe disease, stool specimens from all patients with a history of acute bloody diarrhea should be cultured for E. coli O157:H7.

Campylobacter Infections↗

PubMed1997

Foodborne Diseases Active Surveillance Network, 1996.

As an important strategy for addressing emerging infections in the United States, in 1994 CDC began implementing Emerging Infections Programs (EIPs) in state health departments, in collaboration with local health departments, academic institutions, and organizations of health professionals. EIPs are sites that conduct special population-based surveillance projects, emphasize collaborative epidemiologic and laboratory projects, and pilot and evaluate prevention efforts. The primary foodborne diseases component of the EIP is the Foodborne Diseases Active Surveillance Network (FoodNet)--a collaborative effort among CDC, the U.S. Department of Agriculture (USDA), the Food and Drug Administration, and the EIP sites. The objectives of FoodNet are to 1) determine more precisely the burden of foodborne diseases in the United States, 2) determine the proportion of specific foodborne diseases associated with certain contaminated foods or with other exposures, and (3) provide the framework to respond rapidly and collaboratively to emerging foodborne diseases. This report summarizes preliminary results from FoodNet for 1996, which document regional and seasonal differences in the incidences of certain bacterial foodborne diseases, and presents findings of the 1995 baseline survey of clinical laboratories, which suggests that, for some pathogens, factors other than differing laboratory practices accounted for regional variations in incidences.

Campylobacter Infections↗