Epidemic diarrhea due to enterotoxigenic Escherichia coli
Epidemic diarrhea due to enterotoxigenic Escherichia coli
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DOI：
10.1086/499246
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发表时间：
2006-02-01
影响因子：
11.8
通讯作者：
Mintz, ED
中科院分区：
文献类型：
--
作者：
Beatty, ME;Adcock, PM;Mintz, ED
背景。1998年6月，我们调查了美国报道的最大的食源性肠毒素大肠杆菌肠胃炎暴发之一。我们对11项餐饮活动进行了队列研究，以确定患病的风险因素。我们使用粪便培养、聚合酶链反应和血清学测试来确定病原体，并进行环境检查以确定相关机构的易感条件和做法。在6月5日至7日期间，涉及的熟食店为539场活动提供了服务，参加人数达11.6万人。我们对11个事件的流行病学研究共包括612名参与者。通过将患病参与者事件的中位数患病率（20%）应用于患病参与者事件的总数，我们估计在本次暴发期间至少有3300人可能患了肠胃炎。多种食物（土豆沙拉、通心粉沙拉、鸡蛋沙拉和西瓜）与疾病有关，所有这些都需要在准备过程中大量处理。从11例患者的粪便标本中分离出产肠毒素大肠杆菌血清型O6:H16，产生热不稳定和热稳定的毒素。8例粪便培养结果阳性的患者，19例其他症状参与者中的11例（58%）和17例对照受试者中的0例（0%）血清中大肠杆菌O6脂多糖抗体滴度升高。熟食店洗手用品不足，防止饮用水系统中废水反虹吸的保护措施不足，厨房水槽排水不良，食品储存和运输方法不当。在美国，产肠毒素大肠杆菌是食源性疾病的新病因，当没有发现常见的细菌或病毒性肠道病原体时，应怀疑肠胃炎爆发。
Background. In June 1998, we investigated one of the largest foodborne outbreaks of enterotoxigenic Escherichia coli gastroenteritis reported in the United States.Methods. We conducted cohort studies of 11 catered events to determine risk factors for illness. We used stool cultures, polymerase chain reaction, and serologic tests to determine the etiologic agent, and we conducted an environmental inspection to identify predisposing conditions and practices at the implicated establishment.Results. During 5-7 June, the implicated delicatessen catered 539 events attended by 116,000 people. Our epidemiological study of 11 events included a total of 612 attendees. By applying the median prevalence of illness (20%) among events with ill attendees to the total number of events with any ill attendees, we estimate that at least 3300 persons may have developed gastroenteritis during this outbreak. Multiple food items (potato salad, macaroni salad, egg salad, and watermelon) were associated with illness, all of which required extensive handling during preparation. Enterotoxigenic Escherichia coli serotype O6:H16 producing heat-labile and heat-stable toxins was isolated from the stool specimens from 11 patients. Eight patients with positive stool culture results, 11 (58%) of 19 other symptomatic attendees, and 0 (0%) of 17 control subjects had elevated serum antibody titers to E. coli O6 lipopolysaccharide. The delicatessen had inadequate hand-washing supplies, inadequate protection against back siphonage of wastewater in the potable water system, a poorly draining kitchen sink, and improper food storage and transportation practices.Conclusions. In the United States, where enterotoxigenic Escherichia coli is an emerging cause of foodborne disease, enterotoxigenic Escherichia coli should be suspected in outbreaks of gastroenteritis when common bacterial or viral enteric pathogens are not identified.