Cransberg K, van den Kerkhof J H, Bänffer J R, Stijnen C, Wernars K, van de Kar N C, Nauta J, Wolff E D
Dept. of Ped. Nephrology, Sophia Children's Hospital, Rotterdam, The Netherlands.
Clin Nephrol. 1996 Jul;46(1):45-9.
In June '93, 4 children, aged 1.5-3.5 years, all living in one town, were admitted to our hospital with the diagnosis hemolytic uremic syndrome (HUS) within one week. In cooperation with the local health authorities a common source was searched for. Questionnaires indicated that the single condition shared by all patients was swimming water. The patients were not acquainted, visited different daycares, and had no food resources in common. All 4 patients bathed in the same, shallow, recreational lake within a period of 5 days. During this time the air temperature was high according to Dutch standards (around 27 degrees C), and many people visited the lake, estimated several hundreds a day. The water level was lower than normal. Diarrhea followed 3-11 days after swimming and the first clinical symptoms of HUS developed 6-7 days after the onset of diarrhea. The lake was closed for swimming when the fourth HUS patient was diagnosed and the possibility of transmission by way of the lake was mentioned. E. coli O157: H7 was demonstrated in the fecal samples of 2 index patients. The samples were taken 9-20 days after the start of diarrhea. Antibodies to O157 and verotoxin 2 were strongly positive in all patients. A local outbreak of diarrheal illness was not registered. Of 16 family members who also swam in the same lake, 7 developed symptoms of enteritis, 3 had positive cultures of their fecal samples and 5 had positive serology. Pulsed-field gel electrophoresis of the E. coli isolates of the patients and family members showed an identical pattern. No O157: H7-DNA could be detected in filter concentrated lake water samples using polymerase chain reaction (PCR) enhancement. These samples were, however, taken 16 days after the latest possible date of contamination of our patients, 15 days after decrease of the air temperature to 15-17 degrees C, and 14 days after the inlet from water from the environment. It could thus very well be that the microorganism was no longer present. This third report of swimming water associated HUS should direct environmental surveys in similar cases of local HUS outbreaks.
1993年6月，4名年龄在1.5至3.5岁之间、均居住在同一个城镇的儿童在一周内被收治于我院，诊断为溶血尿毒综合征（HUS）。我们与当地卫生当局合作，寻找共同的感染源。问卷调查显示，所有患者共有的唯一情况是接触过游泳用水。这些患者互不相识，去不同的日托机构，且没有共同的食物来源。所有4名患者在5天内都在同一个浅的休闲湖中游泳。在此期间，按照荷兰的标准气温较高（约27摄氏度），每天有很多人去这个湖，估计有数百人。水位低于正常水平。游泳后3至11天出现腹泻，腹泻开始后6至7天出现HUS的首批临床症状。当第四名HUS患者被诊断出来时，该湖禁止游泳，并提及了通过湖水传播的可能性。在2名指示患者的粪便样本中检测到大肠杆菌O157:H7。样本在腹泻开始后9至20天采集。所有患者中针对O157和志贺毒素2的抗体均呈强阳性。未记录到当地腹泻病的暴发。在同样在该湖游泳的16名家庭成员中，7人出现肠炎症状，3人的粪便样本培养呈阳性，5人的血清学检测呈阳性。对患者和家庭成员的大肠杆菌分离株进行脉冲场凝胶电泳显示出相同的图谱。使用聚合酶链反应（PCR）增强技术，在过滤浓缩的湖水样本中未检测到O157:H7-DNA。然而，这些样本是在我们的患者最晚可能被污染日期后的16天、气温降至15至17摄氏度后的15天以及环境水流入后的14天采集的。因此很有可能该微生物已不再存在。这份关于游泳用水相关HUS的第三份报告应指导对类似的当地HUS暴发病例进行环境调查。
