Sporadic Cases of Hemorrhagic Colitis Associated with Escherichia coli 0157:H7

Abstract

After two outbreaks of hemorrhagic colitis associated with a previously unrecognized pathogen, Escherichia coli 0157:H7, a surveillance system was established to identify and study sporadic cases of this distinct clinical illness in the United States. Between August 1982 and April 1984, we identified 28 persons from 11 states who met our case definition and whose stool specimens yielded E. coli 0157:H7. Patients ranged in age from 1 to 80 years. Seventeen patients required hospitalization. All patients recovered, although one developed hemolyticuremic syndrome 7 days after the onset of bloody diarrhea. Detection of E. coli 0157:H7 in stools from persons with hemorrhagic colitis was highly associated with collection of stool specimens within the first 6 days after onset of illness. All E. coli 0157:H7 isolates produced a Vero cytotoxin. Hemorrhagic colitis caused by E. coli 0157:H7 is widely distributed in the United States as a sporadic illness; clinicians should be aware of its distinctive clinical presentation, and should collect specimens promptly when the diagnosis is suspected.