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E. COLI O157, RESTAURANT - USA (OREGON) *************************************** A ProMED-mail post ProMED-mail is a program of the International Society for Infectious Diseases ______________________________________________________________ Sponsored in part by Elsevier, publisher of Antiviral Research ***************************************************************** Date: Mon, 24 Oct 2005 From: ProMED-mail Source: Bend.com [edited] _____________________________________________________________ Deschutes County Public Health, Deschutes County Environmental Health, and the Oregon Department of Human Services are investigating an outbreak of _E. coli_ O157:H7 infection with common exposure at McGrath's Fish House in Bend. ______________________________________________________________ To date, 18 cases of diarrhea have been reported; 2 have confirmed _E. coli_ O157 infection. The restaurant is fully cooperative and working with the agencies to help identify the source and address any issues. At this point in time no specific food item stands out as a likely source. -------------------------------------- "We ask that persons who ate at McGraths in Bend between 12-18 Oct 2005 and afterwards who developed diarrhea to call the Deschutes County Health Department at 322-7451," said Dan Peddycord, Deschutes County Health Administrator. "Persons with severe diarrhea, bloody diarrhea, or inability to keep fluids down should seek medical attention," he added. ______________________________________________________________ Peddycord also cautioned persons with suspected O157 infection to avoid over-the-counter anti-diarrheal agents, such as loperamide (Imodium), and avoid antibiotics, because these medicines may increase the risk of complications. "_E. coli_ O157 can be spread easily to other family members if infected persons don't wash their hands after using the toilet," said Peddycord. _____________________________________________________________ _E. coli_ O157:H7 produces a powerful toxin and can cause severe illness. _E. coli_ O157:H7 infections may be spread from a variety of food products, most commonly undercooked ground beef, unpasteurized milk and apple cider, other foods cross-contaminated with raw beef, and untreated water. _E. coli_ O157:H7 can also be spread person-to-person, primarily within households. _______________________________________________________________ -- ProMED-mail ------------------------------------------- [The vehicle for acquisition of O157 in this outbreak is not yet known. Once a standard food survey is given to both those affected and unaffected who ate at the target facility, the information is likely to point to a source. Since the apparent source is a fish restaurant, the salad bar may be a prime suspect. ----------------------------------------- It is often stated that both antimicrobial and antimotility agents should be avoided in cases suspected to be due to _E. coli_ O157 infections to avoid complications, particularly hemolytic uremic syndrome (HUS). Although a number of studies, including an oft-cited one from the New England Journal of Medicine (1) suggest that antimicrobial therapy increases the risk of HUS, a more recent meta-analysis (2) revealed a pooled odds ratio of only 1.15 with 95 percent confidence interval (CI) of 0.79-1.68, suggesting no higher risk. A thoughtful and analytic editorial in the same issue of JAMA by Molbak and colleagues (3) agreed that the bottom line in this issue is not yet known and may relate to the particular strain of O157, the antimicrobial used, and the timing of antimicrobial treatment. ---------------------------------- Regarding the use of antimotility agents, a retrospective analysis of 278 children who developed O157 enteritis during a 1993 outbreak in Washington State USA had an odds ratio of 2.9 with CI 1.2-7.5 (4). In those who did not develop HUS, there was no difference in the median duration of diarrhea among children who received antimotility agents, but the median duration of bloody diarrhea was longer (4 vs. 3 days, p less than 0.05). In another study of 118 _E. coli_ O157 enteritis cases (5), a relative risk of 44.11 was found for those receiving prolonged antimotility agents with CI 8.48-229.4. The proceedings of a recent seminar on this illness, published in March 2005 in The Lancet (6), categorically states that antimicrobial agents, antimotility agents, narcotics (also antimotility), and non-steroidal anti-inflammatory agents (can diminish renal blood flow) should be avoided. _____________________________________________________________ 1. Wong CS, Jelacic S, Habeeb RL, et al: The risk of the hemolytic-remic syndrome after antibiotic treatment of _Escherichia coli_ O157:H7 infections. N Engl J Med 2000; 342:1930-36. _____________________________________________________________ 2. Safdar N, Said A, Gangnon RE, Maki DG: Risk of hemolytic uremic syndrome after antibiotic treatment of _Escherichia coli_ O157:H7 enteritis. A meta-analysis. JAMA 2002; 288:996-1001. _______________________________________________________________ 3. Molbak K, Mead PS, Griffin PM: Antimicrobial therapy in patients with _Escherichia coli_ O157:H7 infection. JAMA 2002; 288:1014-16. _______________________________________________________________ 4. Bell BP, Griffin PM, Lozano P, et al: Predictors of hemolytic uremic syndrome in children during a large outbreak of _Escherichia coli_ O157:H7 infections. Pediatrics 1997; 100:e12. _____________________________________________________________ 5. Cimolai N, Basalyga S, Mah DG, et al: A continuing assessment of risk factors for the development of _Escherichia coli_ O157:H7-associated hemolytic uremic syndrome. Clin Nephrol 1994; 42:85-89. ________________________________________________________________ 6. Tarr PI, Gordon CA, Chandler WL: Shiga-toxin-producing _Escherichia coli_ and haemolytic uraemic syndrome. Lancet 2005; 365:1073-86. - Mod.LL] ________________________________________________________________ [see also: E. coli O157 - USA (HI): alert 20050830.2564 E. coli O157, lake swimming - USA (MN) 20050712.1983 E. coli O157, ground beef - USA (multistate): recall 20050610.1612 E. coli O157, religious camp - USA (OR)(02) 20050602.1540 E. coli O157, religious camp - USA (OR) 20050531.1504 2004