Spika J S, Parsons J E, Nordenberg D, Wells J G, Gunn R A, Blake P A
J Pediatr. 1986 Aug;109(2):287-91. doi: 10.1016/s0022-3476(86)80386-9.
Three cases of hemolytic uremic syndrome with bloody diarrhea occurred during an outbreak of diarrheal illness in children aged 4 months to 9 years who attended a day care center. Thirty-six (34%) of 107 had diarrhea (three or more loose or watery stools in 24 hours) lasting greater than or equal to 3 days. Thirty-one (48%) of 64 children younger than 4 years of age but only (12%) of 43 in the older classes became ill (relative risk 4.0, P less than 0.001). Eleven (31%) of the 36 children with diarrhea had blood in their stools. Sequential movement of illness from class to class was consistent with person-to-person spread. Ten (18%) of 56 family members of ill children but only one of 45 family members of well children younger than 4 years of age developed a diarrheal illness (P less than 0.05). Escherichia coli O157:H7 was detected in two of eight stool specimens from children who had bloody diarrhea (one with hemolytic uremic syndrome), two of seven with nonbloody diarrhea, and none of nine who remained well. All three stool specimens obtained at less than or equal to 6 days compared with one of nine obtained at greater than 6 days after onset yielded this organism (P less than 0.02). E. coli O157:H7 can cause hemolytic uremic syndrome and both nonbloody and bloody diarrhea, and can spread within families and through modes other than foodborne transmission.
在一家日托中心4个月至9岁儿童的腹泻病暴发期间，出现了3例伴有血性腹泻的溶血性尿毒症综合征病例。107名儿童中有36名（34%）出现腹泻（24小时内有三次或更多次稀便或水样便），持续时间大于或等于3天。4岁以下的64名儿童中有31名（48%）患病，但年龄较大班级的43名儿童中只有5名（12%）患病（相对危险度4.0，P<0.001）。36名腹泻儿童中有11名（31%）大便带血。疾病在班级间的依次传播符合人传人传播模式。患病儿童的56名家庭成员中有10名（18%）出现腹泻病，但4岁以下健康儿童的45名家庭成员中只有1名患病（P<0.05）。在8例血性腹泻儿童的粪便标本中有2例检测到大肠杆菌O157:H7（其中1例伴有溶血性尿毒症综合征），7例非血性腹泻儿童中有2例检测到该菌，9名未患病儿童的粪便标本均未检测到该菌。发病后小于或等于6天采集的所有3份粪便标本与发病后大于6天采集的9份标本中的1份相比，均检测到该菌（P<0.02）。大肠杆菌O157:H7可导致溶血性尿毒症综合征以及非血性和血性腹泻，可在家庭内传播，并可通过食源性传播以外的方式传播。
