Pai C H, Gordon R, Sims H V, Bryan L E
Ann Intern Med. 1984 Dec;101(6):738-42. doi: 10.7326/0003-4819-101-6-738.
During a 6-month period in 1983, Escherichia coli O157:H7 was isolated from 19 (15%) of 125 patients with grossly bloody diarrhea and 1 sibling with non-bloody diarrhea in the Calgary area. There was no clustering of the cases geographically or in time. All but 1 had clinical manifestations typical of hemorrhagic colitis associated with E. coli O157:H7. The illness appeared to be associated with consumption of hamburgers by 15 patients. The diarrheal illness was usually self-limited, but 3 children developed the hemolytic-uremic syndrome shortly after onset of illness. The organism was excreted in the stools very briefly in adults, although bacterial shedding continued for a longer period in children. All isolates produced verotoxin, and cytotoxic activities were present in stool filtrates. The results suggest that the incidence of sporadic cases of hemorrhagic colitis due to E. coli O157:H7 may be higher than has been suspected, and that patients with grossly bloody diarrhea should be studied promptly for E. coli O157:H7 infection. Specific techniques for identifying this serotype must be applied to the stool cultures. Detection of free cytotoxin in stool filtrates may be an effective diagnostic procedure.
1983年的6个月期间，在卡尔加里地区，从125例严重血性腹泻患者中的19例（15%）以及1例非血性腹泻的同胞中分离出了大肠杆菌O157:H7。病例在地理上或时间上均无聚集性。除1例患者外，所有患者均有与大肠杆菌O157:H7相关的出血性结肠炎的典型临床表现。15例患者的疾病似乎与食用汉堡包有关。腹泻病通常为自限性，但3名儿童在发病后不久发展为溶血尿毒综合征。该病菌在成人粪便中的排泄时间很短，不过在儿童中细菌排出持续时间更长。所有分离株均产生志贺毒素，粪便滤液中存在细胞毒性活性。结果表明，由大肠杆菌O157:H7引起的散发性出血性结肠炎的发病率可能高于此前的推测，对于严重血性腹泻患者应及时进行大肠杆菌O157:H7感染的研究。必须将鉴定该血清型的特定技术应用于粪便培养。检测粪便滤液中的游离细胞毒素可能是一种有效的诊断方法。
