Huerta M, Grotto I, Gdalevich M, Mimouni D, Gavrieli B, Yavzori M, Cohen D, Shpilberg O
Israel Defence Force, Army Health Branch, Military Post.
Infection. 2000 Sep;28(5):267-71. doi: 10.1007/s150100070017.
Over a period of 4 days between May 18-21, 1998, a multifocal outbreak of diarrhea, involving 175 Israel Defence Force soldiers and at least 54 civilians, occurred in the Golan Heights.
Stool samples from 40 affected soldiers were collected for microbiological testing. In addition, a rapid PCR technique was employed for the direct detection of the heat-labile (LT) and heat-stable toxin (ST) genes of enterotoxigenic Escherichia coli (ETEC) in stool samples.
All 40 stool specimens taken from patients with diarrhea was negative by culture. However, ETEC was detected in 16 stool specimens using the rapid PCR method. The epidemiological investigation found no association between the food items consumed prior to the onset of the outbreak and the attack rate of diarrhea. A review of the water distribution system revealed that all affected military posts and civilian communities were supplied by a common water pipeline. Water sampled from various points along the distribution system showed inadequate chlorination and high concentrations of E. coli.
This report suggests that the involvement of ETEC in the etiology of waterborne diarrheal outbreaks may be underestimated, probably due to the difficulties involved in the laboratory identification of this enteropathogen. Adoption of our rapid method for the identification of ETEC, which is applicable to routine diagnostic laboratories, facilitates pathogen detection within hours, and allows early intervention in cases of widespread diarrheal epidemics.
1998年5月18日至21日的4天时间里，戈兰高地发生了一起多灶性腹泻疫情，涉及175名以色列国防军士兵和至少54名平民。
采集了40名受影响士兵的粪便样本进行微生物检测。此外，采用快速聚合酶链反应（PCR）技术直接检测粪便样本中肠毒素性大肠杆菌（ETEC）的不耐热毒素（LT）基因和耐热毒素（ST）基因。
所有40份腹泻患者的粪便标本培养均为阴性。然而，采用快速PCR方法在16份粪便标本中检测到了ETEC。流行病学调查发现，疫情暴发前食用的食品与腹泻发病率之间没有关联。对供水系统的审查显示，所有受影响的军事驻地和平民社区都由一条共用的输水管道供水。从供水系统沿线各点采集的水样显示氯化不足且大肠杆菌浓度高。
本报告表明，ETEC在水源性腹泻暴发病因中的作用可能被低估，这可能是由于该肠道病原体的实验室鉴定存在困难。采用我们适用于常规诊断实验室的ETEC快速鉴定方法，可在数小时内促进病原体检测，并能在广泛腹泻流行的情况下进行早期干预。
