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Epidemic of Gastrointestinal Tract Infection Including Hemorrhagic Colitis Attributable to Shiga Toxin 1-producingEscherichia coli O118:H2 at a Junior High School in Japan
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Tables
- Table 1.
Summary of Findings: Epidemic of Gastrointestinal Illness at a Junior High School in Japan
No. (%) People at risk 561 Students (12 
to 15
y)526 /561 93.8 Staff 35 /561 6.2 Symptoms or signs 241 /561 43.0 Asymptomatic 320 /561 57.0 Symptomatic with nonbloody diarrhea* 117 /561 20.9 Symptomatic with bloody diarrhea† 9 /561 1.6 Symptomatic without diarrhea‡ 115 /561 20.5 Headache 87 /241 36.1 With diarrhea 44 /87 50.6 With abdominal pain only 34 /87 39.1 Without other symptom 9 /87 10.3 High temperature (>38.0°C) 5 /241 2.1 Confirmed pathogen by RPLA 131 /525‖ 25.0 Asymptomatic 49 /303 16.2 Symptomatic with nonbloody diarrhea 53 /106 50.0¶ Symptomatic with bloody diarrhea 4 /5 80.0¶ Symptomatic without diarrhea‡ 25 /111 21.6 ↵* Nonbloody diarrhea with vomiting in 4 patients, headache in 40, and high temperature in 5.
↵† Bloody diarrhea with headache in 4 patients.
↵‡ Abdominal pain, vomiting, and/or headache without diarrhea.
↵‖ Stool culture was performed in 525 of 561 subjects at risk.
↵¶ P < .005 compared with the asymptomatic and symptomatic subjects without diarrhea.
- Table 2.
Laboratory Findings During Acute Phase of Disease in Patients With and Without Bloody Diarrhea
Bloody Diarrhea Nonbloody Diarrhea P Value Leukocyte (× 103/μL) 7.3 ± 1.4 (9) 6.4 ± 2.0 (15) .254 Neutrophil (× 103/μL) 5.5 ± 1.7 (8) 4.0 ± 1.1 (11) .028 Hemoglobin (g/dL) 14.3 ± 1.1 (9) 13.6 ± 2.2 (15) .388 Platelet (× 104/μL) 23.2 ± 6.7 (9) 28.9 ± 5.9 (15) .039 CRP (mg/dL) 0.6 ± 0.3 (9) 0.5 ± 1.1 (11) .784 Blood urea nitrogen (mg/dL) 10.7 ± 4.7 (9) 12.0 ± 2.7 (10) .450 Creatinine (mg/dL) 0.8 ± 0.2 (8) 0.6 ± 0.1 (10) .035 LDH (U/L) 348.8 ± 59.3 (9) 354.4 ± 38.3 (10) .807 AST (U/L) 19.8 ± 7.6 (8) 17.5 ± 3.9 (11) .401 ALT (U/L) 16.9 ± 18.2 (8) 11.2 ± 2.6 (11) .315 The number of patients is noted in the parentheses. CRP indicates C-reactive protein; LDH, lactate dehydrogenase; AST, asparate aminotransferase; ALT, alanine aminotransferase. For conversion to SI units: leukocyte count, 1/μL = 1 × 106/L; hemoglobin, 1 g/dL = 0.155 mmol/L; platelet count, 1/μL = 1 × 106/L; CRP, 1 mg/dL = 1 × 104 μg/L; blood urea nitrogen, 1 mg/dL = 0.375 mmol urea/L; creatinine, 1 mg/dL = 88.4 μmol/L; LDH, AST, and ALT, 1U/L = 1U/L.
- Table 3.
Detection of Stx1-producing E coli in Stool Cultures After the Administration of Antibiotics
Days after Administration No. of Cases Antibiotics Used 1 (15 Cases) Pathogen (+) 9 N4, F3, N + F2 Pathogen (−) 6 F2, M2, N1, N + F1 2 (4 Cases) Pathogen (+) 2 N1, C1 Pathogen (−) 2 N2 3 (2 Cases) Pathogen (+) 1 N1 Pathogen (−) 1 N1 4 (2 Cases) Pathogen (+) 0 Pathogen (−) 2 N1, M + N1 Pathogen (+) indicates confirmed pathogen in stool; pathogen (−), no confirmed pathogen in stool; C, cephems (cefteram piroxil); F, fosfomycin; M, macrolides (clarithromycin and josamycin); N, new quinolones (norfloxacin, levofloxacin, lomefloxacin, and enoxacin). Numbers to the right of these capital letters are the number of the patients using these antibiotics.
- Table 4.
Results of the Reexamination of Stools for Stx 1-producing E coli by RPLA
Result of First Stool Culture No. of Cases† (502) Confirmed Pathogen‡(5) (%) (1.0) Asymptomatic subjects Pathogen (+) 49 0 Pathogen (−) 236 0 Total 285 0 0.0 Symptomatic subjects without antibiotic therapy Pathogen (+) 56 0 Pathogen (−) 103 1 ND 3 0 Total 162 1 0.6 Symptomatic subjects with antibiotic therapy Pathogen (+) 25 2 Pathogen (−) 17 2 ND 13 0 Total 55 4 7.3* ↵† The number of subjects whose stools were reexamined approximately 1 month after the onset of this outbreak.
↵‡ Confirmed pathogen by the reexamination of stools.
Pathogen (+) indicates confirmed pathogen by the first stool culture; pathogen (−), no confirmed pathogen by the first stool culture; ND, the first stool culture studies not performed.
↵* P < .025 compared with the symptomatic subjects without antibiotic therapy.
