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    Pediatrics
    January 1999, VOLUME 103 / ISSUE 1
    ELECTRONIC ARTICLE

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

    Hiroyuki Hashimoto, Kumiko Mizukoshi, Masami Nishi, Tadashi Kawakita, Seiryo Hasui, Yasuhiro Kato, Yoshiki Ueno, Ryohei Takeya, Norihiko Okuda, Tae Takeda
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    • Table 1.

      Summary of Findings: Epidemic of Gastrointestinal Illness at a Junior High School in Japan

      No.(%)
      People at risk561
       Students (12Embedded Image to 15Embedded Image y)526 /56193.8
       Staff35 /5616.2
      Symptoms or signs241 /56143.0
       Asymptomatic320 /56157.0
       Symptomatic with nonbloody diarrhea* 117 /56120.9
       Symptomatic with bloody diarrhea† 9 /5611.6
       Symptomatic without diarrhea‡ 115 /56120.5
       Headache87 /24136.1
        With diarrhea44 /8750.6
        With abdominal pain only34 /8739.1
        Without other symptom9 /8710.3
       High temperature (>38.0°C)5 /2412.1
      Confirmed pathogen by RPLA131 /525‖ 25.0
       Asymptomatic49 /30316.2
       Symptomatic with nonbloody diarrhea53 /10650.0¶
       Symptomatic with bloody diarrhea4 /580.0¶
       Symptomatic without diarrhea‡ 25 /11121.6
      • ↵* 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 DiarrheaNonbloody DiarrheaP 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 AdministrationNo. of CasesAntibiotics Used
      1 (15 Cases)Pathogen (+)9N4, F3, N + F2
      Pathogen (−)6F2, M2, N1, N + F1
      2 (4 Cases)Pathogen (+)2N1, C1
      Pathogen (−)2N2
      3 (2 Cases)Pathogen (+)1N1
      Pathogen (−)1N1
      4 (2 Cases)Pathogen (+)0
      Pathogen (−)2N1, 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 CultureNo. of Cases† (502)Confirmed Pathogen‡(5)(%) (1.0)
      Asymptomatic subjects
       Pathogen (+)490
       Pathogen (−)2360
        Total28500.0
      Symptomatic subjects without antibiotic therapy
       Pathogen (+)560
       Pathogen (−)1031
       ND30
        Total16210.6
      Symptomatic subjects with antibiotic therapy
       Pathogen (+)252
       Pathogen (−)172
       ND130
        Total5547.3*
      • ↵† 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.

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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
    Hiroyuki Hashimoto, Kumiko Mizukoshi, Masami Nishi, Tadashi Kawakita, Seiryo Hasui, Yasuhiro Kato, Yoshiki Ueno, Ryohei Takeya, Norihiko Okuda, Tae Takeda
    Pediatrics Jan 1999, 103 (1) e2; DOI: 10.1542/peds.103.1.e2

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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
    Hiroyuki Hashimoto, Kumiko Mizukoshi, Masami Nishi, Tadashi Kawakita, Seiryo Hasui, Yasuhiro Kato, Yoshiki Ueno, Ryohei Takeya, Norihiko Okuda, Tae Takeda
    Pediatrics Jan 1999, 103 (1) e2; DOI: 10.1542/peds.103.1.e2
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