Hemolytic Uremic Syndrome in New York City

From the NY Bureau of Communicable Disease:

Recently three cases of E. coli O157:H7 were reported in children who attend separate daycares throughout New York City. The cases are not related to one another and no outbreaks have occurred. DNA typing has not connected these cases to a known statewide outbreak, and DOHMH wishes to remind physicians, particularly those caring for children, to include E. coli O157:H7 in the differential diagnosis of patients presenting with gastrointestinal illness (particularly bloody diarrhea or diarrhea with fever), HUS, hemolytic anemia or thrombocytopenic purpura (TTP). Note that the absence of high fever, presence of grossly bloody stools, and severity of abdominal findings in HUS can lead to the mistaken diagnosis of intussusception in children, and inflammatory bowel disease or ischemic colitis in the elderly.

We receive an average of 20 case reports per year, 29% are in children under 5. The number of case reports received in August and September has not been unusual. The ill children are 9-22 months old with illness onset between September 13th and September 29th. Two of the children have been diagnosed with HUS and were hospitalized.

Illness with E. coli O157:H7 typically begins 3 to 4 days after exposure and patients develop watery diarrhea; the diarrhea resolves without progression and the illness is mild in 25-75% of patients. In those in whom the illness progresses, bloody diarrhea usually begins on the second or third day, with the amount of blood ranging from streaks to stools that consist of gross blood. Studies have shown that treating with antibiotics may increase the risk of developing HUS. Antibiotic treatment is not recommended except in those patients who are septic...

To identify additional suspected cases of E. coli 0157:H7 or HUS and to help us determine whether there is a common source of exposure, we request that all patients, especially children, with bloody diarrhea and/or diarrhea with fever be tested for E. coli O157:H7 by culture. It is important to request a stool culture regardless of whether shiga toxin testing is also performed. Isolates should be forwarded to the DOHMH Public Health Laboratory for confirmation and molecular typing. Please report all suspected or confirmed cases of E. coli 0157:H7 or HUS to the Bureau of Communicable Disease: During business hours: 212-788-9830; After hours, contact the Poison Control Center: 212-764-7667 or 1-800-222-1222

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