Reida P, Wolff M, Pöhls H W, Kuhlmann W, Lehmacher A, Aleksić S, Karch H, Bockemühl J
Gesundheitsamt, Landkreis Hagenow, Universität Würzburg.
Zentralbl Bakteriol. 1994 Nov;281(4):534-43. doi: 10.1016/s0934-8840(11)80342-7.
An outbreak of gastrointestinal disease and haemolytic uraemic syndrome caused by Escherichia coli O157:H7 was investigated. The outbreak occurred in a day care centre located in northern Germany in August 1992 and involved 39 children and two adults. Furthermore, four asymptomatic infections were detected among the staff. Initial and secondary cases were reported over a 30-day interval, with cases occurring in three waves. Person-to-person contact and environmental contamination were assumed to be the main mode of transmission. The source of the outbreak has remained unknown but it is likely that primary or secondary contamination of the day care centre's kitchen, too, played a role in the spread of infections. The organisms were isolated from two open packs of deep-frozen stuffed cabbage rolls and turkey scallops in batter, and furthermore from swabs from two kitchen utensils. Of the 39 cases with diarrhoea, three developed a haemolytic uraemic syndrome; one of the latter patients died. In 8 of the cases as well as in four healthy adult employees, E. coli O157:H7 was isolated from stool samples, and in two stool culture-negative cases the presence of IgM antibody to O157 LPS indicated recent infection. The E. coli O157:H7 isolates from the cases and the kitchen were of identical phage type and yielded identical biochemical reactions. All E. coli O157:H7 isolates harboured stable slt-II genes. However, slt-I genes could only be demonstrated in the primary cultures and were lost during subcultivation. This is the largest outbreak caused by enterohaemorrhagic E. coli O157:H7 that has been documented in Germany so far. The high infectivity of the organism which was demonstrated by person-to-person transmission and propagation within certain groups of children stresses the need for strict hygienic measures and early case reporting when such infections occur in susceptible settings like day care centres, nursing homes, or hospitals.
对由大肠杆菌O157:H7引起的胃肠道疾病和溶血尿毒综合征的一次暴发进行了调查。此次暴发于1992年8月发生在德国北部的一家日托中心，涉及39名儿童和两名成人。此外，在工作人员中检测到4例无症状感染。在30天的时间间隔内报告了初始病例和二代病例，病例呈三波出现。人际接触和环境污染被认为是主要传播方式。此次暴发的源头仍然不明，但日托中心厨房的一次或二次污染很可能也在感染传播中起了作用。从两包开封的速冻填馅卷心菜卷和裹面糊的火鸡肉扇贝中分离出了该病菌，此外还从两件厨房用具的拭子中分离出了病菌。在39例腹泻病例中，有3例发展为溶血尿毒综合征；其中1例患者死亡。在8例病例以及4名健康成年员工的粪便样本中分离出了大肠杆菌O157:H7，在2例粪便培养阴性的病例中，对O157脂多糖的IgM抗体检测表明近期感染。从病例和厨房分离出的大肠杆菌O157:H7菌株具有相同的噬菌体类型，并且生化反应相同。所有大肠杆菌O157:H7菌株都携带稳定的slt-II基因。然而，slt-I基因仅在初代培养物中得到证实，传代培养时丢失。这是德国迄今记录的由肠出血性大肠杆菌O157:H7引起的最大规模暴发。该病菌通过人际传播以及在特定儿童群体中的传播所显示出的高传染性，强调了在日托中心、养老院或医院等易感环境中发生此类感染时采取严格卫生措施和早期病例报告的必要性。
