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PEDIATRICS Vol. 103 No. 1 January 1999, p. e2

ELECTRONIC ARTICLE:
Epidemic of Gastrointestinal Tract Infection Including Hemorrhagic Colitis Attributable to Shiga Toxin 1-producing Escherichia coli O118:H2 at a Junior High School in Japan

Received Mar 24, 1998; accepted Jul 27, 1998.

Hiroyuki Hashimoto*, Kumiko MizukoshiDagger , Masami Nishi§, Tadashi Kawakitaparallel , Seiryo Hasuiparallel , Yasuhiro Katoparallel , Yoshiki Ueno, Ryohei Takeya, Norihiko Okuda*, and Tae Takeda#

From the * Department of Pediatrics, Kanazawa National Hospital, Kanazawa, Japan; Dagger  Minami Kaga Public Health Center, Ishikawa Prefectural Government, Komatsu, Japan; § Ishikawa Prefectural Institute of Public Health and Environmental Science, Kanazawa, Japan; parallel  Komatsu City Medical Association, Komatsu, Japan;  Department of Pediatrics, Komatsu City Hospital, Komatsu, Japan; and # Department of Infectious Disease Research, National Children's Medical Research Center, Tokyo, Japan.

Background.    An epidemic of gastrointestinal disturbances related to food ingestion occurred at a junior high school in Komatsu, Japan, and was caused by specifically Shiga toxin (Stx) 1-producing Escherichia coli O118:H2, which has not been reported previously in humans. No outbreak of E coli-producing Stx 1 alone had occurred.

Methods.    A total of 526 students and 35 adult staff members who ate the same food at lunch in the school were investigated. Questionnaires about food consumption at lunch were given to all 561 subjects as well as to clinics and hospitals that had treated 79 patients. Stool specimens from 525 subjects, and food, water, and environmental specimens, including cooking utensils, were collected in an attempt to identify the pathogen.

Results.    A total of 126 subjects (22.5%) developed a diarrheal illness. The pathogen was isolated from the stool in 131 subjects, 49 of which were asymptomatic, and from a dipper. Salads served over several days were identified as high-risk from food analysis. Gastrointestinal symptoms resembled those associated with previous infections of Stx-producing E coli, but were mild. No cases of the hemolytic-uremic syndrome developed. Headache was present in 87 patients. Three patients underwent surgery for acute appendicitis during this epidemic. Four of five carriers had received an antibiotic effective against the pathogen.

Conclusions.    This outbreak of E coli O118:H2 demonstrated the clinical and epidemiologic features of infection by E coli that produces Stx 1 alone. Infections with such organisms are being recognized increasingly, and the pattern of disease observed may differ from the pattern observed with E coli O157:H7.  Key words:  Escherichia coli O118:H2, Shiga-toxin 1, outbreak.


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