An Outbreak of HUS with Possible Person-to-Person Spread
An Outbreak of HUS with Possible Person-to-Person Spread
ABSTRACT & COMMENTARY
Synopsis: Ten cases of diarrhea-associated hemolytic uremic syndrome occurred in a group of children over a three-month period in a small geographic area in France. Investigations failed to implicate food or drink as the cause of gastroenteritis, suggesting a possible role of person-to-person contact.
Source: Boudailliez B, et al. Possible person-to-person transmission of Escherichia coli O111-associated hemolytic uremic syndrome. Pediatric Nephrol 1997;11:36-39.
The 10 children described in this report developed hemolytic uremic syndrome (HUS) over a brief period of time, and all of the children lived in a 15 km radius of each other. All 10 children came from eight families, and the first four cases occurred in children attending a school where students were experiencing an outbreak of gastroenteritis. Retrospectively, history revealed that all 10 children had direct or indirect contact among themselves. Verocytotoxin (VT2) genes were detected in seven of nine cases, while VT2-secreting E. coli strain O111 was isolated in five cases. Several family and school contacts with gastroenteritis but without HUS had similar isolates.
Careful attempts made to isolate E. coli O111 from food samples and the water supplies from homes and the school were unsuccessful. Because no link could be found, Boudailliez and colleagues propose that evidence suggests possible person-to-person transmission was likely responsible for the 10 cases of HUS.
COMMENT BY THOMAS KENNEDY, MD, FAAP
The triad of acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemiahemolytic uremic syndromeremains an intriguing, dramatic, challenging, severe, and potentially totally resolving acute illness of childhood.
Except for the well-publicized outbreaks such as the food-borne Jack-in-the-Box cluster of several years ago, we are accustomed to HUS occurring as a sporadic condition in conjunction with a diarrheal illness in young children. Although HUS had been reported in association with many common infections, from streptococcus pneumoniae to varicella, most cases in the United States have implicated the verocytotoxin-secreting E. coli O157:H7 in contaminating rare meat, apple cider, or raw milk. When occasional, temporally related cases occur in siblings or playmates, common ingestion of infected food is usually surmised, although person-to-person contact is always a possibility. The current report is significant because if the authors’ speculation that person-to-person spread of HUS was responsible for the 10 cases, then it becomes very important to identify index cases and their etiology promptly and take measures such as careful hand-washing to prevent the possible spread in households or day care settings.
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