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Notice to Health Care Providers: Shiga Toxin-producing E. colicases in Spartanburg County The South Carolina Department of Health and Environmental Control(DHEC) is requesting heightened surveillance for persons presentingwith symptoms consistent with Shiga toxin producing E. coli (i.e.,enterohemorrhagic E. coli), including diarrhea that is oftenbloody, hemolytic uremic syndrome (HUS) in children orthrombocytopenia purpura in adults. Summary DHEC is investigating an outbreak of Shiga toxin-producingEscherichia coli (STEC) related to dining at a Spartanburg-areaMexican restaurant during the last week of April, 2012. Preliminarylab results indicate the E. coli serotype being O157:H7. Of the 3cases interviewed thus far, two reported the infection hasprogressed to hemolytic uremic syndrome (HUS), a severe conditionassociated with STEC infection that can lead to kidney failure.Interviews with an additional 8 cases are in progress. Guidance for Clinicians Symptoms DHEC recommends a high index of suspicion for STEC infection forpatients presenting with STEC symptoms and a history of dining at aSpartanburg- area Mexican restaurant near the end of April, 2012. Clinical syndromes associated with a Shiga toxin producing E. coliinfection include Gastroenteritis with diarrhea and abdominal cramps (fever andbloody stools may or may not be present), and/or Hemolytic uremic syndrome (HUS) with or without gastroenteritis, which typically develops a weekafter the onset of diarrhea. Hemolytic uremic syndrome (HUS) ischaracterized by the triad of acute onset of microangiopathichemolytic anemia, renal injury, and low platelet count. Most casesof HUS occur after an acute gastrointestinal illness (usuallydiarrheal). Management Management of STEC is typicallysupportive, as most patients recover within 5-7 days. Antibioticsfor gastroenteritis are generally not recommended, as there havebeen reports of increased incidence of post-diarrheal HUS whenantibiotics are used to manage STEC infections. The CDC doesnot recommend the use of antibiotics for patients with suspectedSTEC infections until complete diagnostic testing can be performedand STEC infection is ruled out. However, clinical decision makingmust be tailored to each individual patient. There may beindications for antibiotics in patients with severe intestinalinflammation if perforation is of concern. Testing • All stools submitted for testing from patients with acutecommunity-acquired diarrhea should be cultured for STEC O157:H7.These stools should be simultaneously assayed for non-O157 STECwith a test that detects the Shiga toxins or the genes encodingthese toxins. • Clinical laboratories should report and send E. coliO157:H7 isolates and Shiga toxin- positive samples to the SC DHECBureau of Laboratories (BOL) as soon as possible for additionalcharacterization. • Specimens or enrichment broths in which Shiga toxin or STECare detected, but from which O157:H7 STEC isolates are notrecovered should be forwarded as soon as possible to the SC DHECBOL so that non-O157:H7 STEC can be isolated. • It is often difficult to isolate STEC in stool by the timea patient presents with HUS. Immunomagnetic separation (IMS) hasbeen shown to increase recovery of STEC from HUS patients. For anypatient with HUS without a culture-confirmed STEC infection, stoolcan be sent to the SC DHEC BOL for IMS or to the CDC (through theBOL). In addition, serum can be sent to CDC (through the BOL) forserologic testing of common STEC serogroups. The benefits ofadhering to the recommended testing strategy include earlydiagnosis, improved patient outcome, and detection of all STECserotypes. Reporting of Cases Cases of bloody diarrhea or aclinical presentation consistent with STEC, coupled with theepidemiologic criteria described above, should be reported to yourlocal health department via the phone numbers listed below. DHECwill arrange for collection of stool samples for testing, asappropriate. Any laboratory confirmed acute case associatedwith Shiga toxin producing E. coli or E. coli identified asserogroup O157:H7 should be reported within 24 hours to DHEC, asper the current DHEC List of Reportable Conditions. Resources for Additional Information • www.about-ecoli.com • CDC E. coli Investigation updates ( www.cdc.gov/ecoli/2011/ecoliO104/index.html ) • CDC E. coli Resources for Clinicians ( www.cdc.gov/ecoli/clinicians.htm ) • CDC E. coli General Information ( www.cdc.gov/nczved/divisions/dfbmd/diseases/ecoli_157h7/ ) • MMWR – "Recommendations for Diagnosis of ShigaToxin–Producing Escherichia coli Infections by ClinicalLaboratories" ( www.cdc.gov/mmwr/PDF/rr/rr5812.pdf ) • WHO E. coli Investigation updates ( www.who.int/csr/don/en/index.html ) • FoodSafety.gov ( www.foodsafety.gov/ ) DHEC contact information for reportable diseases andreporting requirements Reporting of confirmed and suspectedShiga Toxin-producing E. coli cases is consistent with SouthCarolina Law requiring the reporting of diseases and conditions toyour state or local public health department. (State Law # 44-29-10and Regulation # 61-20) as per the DHEC 2011 List of ReportableConditions available at: www.scdhec.gov/administration/library/CR-009025.pdf Federal HIPAA legislation allows disclosure of protected healthinformation, without consent of the individual, to public healthauthorities to collect and receive such information for the purposeof preventing or controlling disease. (HIPAA 45 CFR §164.512). We are high quality suppliers, our products such as China Receiver Drier Accumulator , Refrigerator Replacement Part for oversee buyer. To know more, please visits Refrigerant Filter Drier.
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