Griffin P M, Ostroff S M, Tauxe R V, Greene K D, Wells J G, Lewis J H, Blake P A
Centers for Disease Control, Atlanta, Georgia.
Ann Intern Med. 1988 Nov 1;109(9):705-12. doi: 10.7326/0003-4819-109-9-705.
To describe the spectrum of illnesses associated with Escherichia coli O157:H7 infections.
Described an outbreak that showed the broad spectrum of these infections. Reviewed the clinical findings in the other eight major outbreaks reported between 1982 and 1986. Also reviewed reports of sporadic cases.
Outbreaks in communities, nursing homes, a day care center, and a kindergarten.
Persons identified in outbreaks of E. coli O157:H7 infections.
Escherichia coli O157:H7 infection causes bloody diarrhea (hemorrhagic colitis), nonbloody diarrhea, the hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura. Infection can be asymptomatic, can involve extraintestinal sites, and can be fatal. Bloody diarrhea is the commonest symptom. Most patients have severe abdominal cramps; fever is documented in less than half. Findings from fecal leukocyte examinations often suggest a noninfectious cause. Results of radiologic and colonoscopic examinations can be consistent with a diagnosis of inflammatory bowel disease or ischemic colitis. Patients at the extremes of age are at increased risk for E. coli O157:H7-associated diarrhea, the hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, and death. Antimicrobial agents have not been shown to modify the illness, but there are few data on individual agents.
Infection with E. coli O157:H7 should be considered in all patients with bloody diarrhea, the hemolytic uremic syndrome, or thrombotic thrombocytopenic purpura because the infection can masquerade as gastrointestinal bleeding of noninfectious cause, the antecedent diarrhea may be resolved and forgotten by the time the hemolytic uremic syndrome or thrombotic thrombocytopenic purpura is diagnosed, and the detection of E. coli O157:H7 requires specific stool culture techniques.
描述与大肠杆菌O157:H7感染相关的疾病谱。
描述了一次显示这些感染广泛范围的暴发。回顾了1982年至1986年间报告的其他八次主要暴发的临床发现。还回顾了散发病例的报告。
社区、养老院、日托中心和幼儿园的暴发。
在大肠杆菌O157:H7感染暴发中确定的人员。
大肠杆菌O157:H7感染可导致血性腹泻（出血性结肠炎）、非血性腹泻、溶血尿毒综合征和血栓性血小板减少性紫癜。感染可以无症状，可累及肠外部位，且可能致命。血性腹泻是最常见的症状。大多数患者有严重的腹部绞痛；不到一半的患者有发热记录。粪便白细胞检查结果常提示非感染性病因。放射学和结肠镜检查结果可能与炎症性肠病或缺血性结肠炎的诊断一致。年龄极端的患者发生与大肠杆菌O157:H7相关的腹泻、溶血尿毒综合征、血栓性血小板减少性紫癜和死亡的风险增加。尚未证明抗菌药物能改变病情，但关于个别药物的数据很少。
所有出现血性腹泻、溶血尿毒综合征或血栓性血小板减少性紫癜的患者均应考虑大肠杆菌O157:H7感染，因为该感染可能伪装成非感染性病因的胃肠道出血，在诊断溶血尿毒综合征或血栓性血小板减少性紫癜时，先前的腹泻可能已缓解并被遗忘，而且检测大肠杆菌O157:H7需要特定的粪便培养技术。
