ILLNESSES ASSOCIATED WITH ESCHERICHIA-COLI O157-H7 INFECTIONS - A BROAD CLINICAL SPECTRUM
ILLNESSES ASSOCIATED WITH ESCHERICHIA-COLI O157-H7 INFECTIONS - A BROAD CLINICAL SPECTRUM
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DOI：
10.7326/0003-4819-109-9-705
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发表时间：
1988-11-01
影响因子：
39.2
通讯作者：
BLAKE, PA
中科院分区：
文献类型：
--
作者：
GRIFFIN, PM;OSTROFF, SM;BLAKE, PA
研究目的：描述与大肠杆菌015：H7感染相关的疾病谱。设计：描述了一次爆发，显示了这些感染的广谱性。回顾了1982年至1986年期间报告的其他8起重大疫情的临床结果。还审查了散发病例的报告。地点：社区、疗养院、日托中心和幼儿园的暴发。病例：在E.大肠杆菌0157：H7感染。结果如下：大肠杆菌0157：H7感染引起出血性腹泻（出血性结肠炎）、非出血性腹泻、溶血性尿毒综合征和血栓性血小板减少性紫癜。感染可以是无症状的，可以涉及肠外部位，并且可以是致命的。带血腹泻是最常见的症状。大多数患者有严重的腹部绞痛，发烧记录在不到一半。粪便白细胞检查结果通常提示非感染性原因。放射学和结肠镜检查的结果可能与炎症性肠病或缺血性结肠炎的诊断一致。年龄极端的患者患大肠杆菌的风险增加。大肠杆菌0157：H7相关性腹泻、溶血性尿毒综合征、血栓性血小板减少性紫癜和死亡。抗菌药物尚未被证明可以改变疾病，但关于单个药物的数据很少。结论：E.大肠杆菌0157：H7应考虑在所有患者的出血性腹泻，溶血性尿毒综合征，或血栓性血小板减少性紫癜，因为感染可以伪装成非感染性原因的胃肠道出血，前期腹泻可能会解决和遗忘的时候，溶血性尿毒综合征或血栓性血小板减少性紫癜被诊断，和E.大肠杆菌0157：H7需要特殊的粪便培养技术。
Study Objective: To describe the spectrum of illnesses associated with Escherichia coli 015:H7 infections. Design: Described an outbreak that showed the broad spectrum of these infections. Reviewed the clinical findings in the other eight major outbreaks reported between 1982 and 1986. Also reviewed reports of sporadic cases. Setting: Outbreaks in communities, nursing homes, a day care center, and a kindergarten. Cases: Persons identified in outbreaks of E. coli 0157:H7 infections. Results: Escherichia coli 0157:H7 infection causes bloody diarrhea (hemorrhagic colitis), nonbloody diarrhea, the hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura. Infection can be asymptomatic, can involve extraintestinal sites, and can be fatal. Bloody diarrhea is the commonest symptom. Most patients have severe abdominal cramps, fever is documented in less than half. Findings from fecal leukocyte examinations often suggest a noninfectious cause. Results of radiologic and colonoscopic examinations can be consistent with a diagnosis of inflammatory bowel disease or ischemic colitis. Patients at the extremes of age are at increased risk for E. coli 0157:H7-associated diarrhea, the hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, and death. Antimicrobial agents have not been shown to modify the illness, but there are few data on individual agents. Conclusion: Infection with E. coli 0157:H7 should be considered in all patients with bloody diarrhea, the hemolytic uremic syndrome, or thrombotic thrombocytopenic purpura because the infection can masquerade as gastrointestinal bleeding of noninfectious cause, the antecedent diarrhea may be resolved and forgotten by the time the hemolytic uremic syndrome or thrombotic thrombocytopenic purpura is diagnosed, and the detection of E. coli 0157:H7 requires specific stool culture techniques.