E. Coli at Newton Wellesley Hospital and What to Look For
An importnat note from Michael A. Lew, MD, Chief of Infectious Diseases, on behalf of the Newton-Wellesley Hospital Infectious Diseases Service:
- Three cases of E. Coli that have been diagnosed so far have occurred in middle-aged females, two of whom reside in Wellesley, and one in Waltham.
- Be on the lookout for new cases of bloody diarrhea.
Three cases diagnosed so far have occurred in middle-aged females, two of whom reside in Wellesley, and one in Waltham. All patients presented with bloody diarrhea that was followed in several days by rising serum creatinine, anemia, and thrombocytopenia. All three patients currently are in our hospital.HUS is triggered by intestinal infection by Shiga-like toxin-producing bacteria, otherwise known as enterohemorrhagic E. coli (EHEC). Most cases in the United States have been associated with E. coli serotype O157:H7, but other serotypes have been implicated in other outbreaks, as in the highly publicized outbreak that occurred in Germany last year. Only a small minority of patients infected by EHEC develop HUS. The illness seems to occur with greater frequency in children, but all ages can be affected, and in any given outbreak the age group most affected can be influenced by the type of food that served as the vehicle for infection. Host genetics may play a role in determining which individuals develop HUS after infection by EHEC. HUS may produce long-term impairment of renal function and other sequelae.
We have checked with the State Epidemiologists, and, until we reported our cases to them, they were not aware of any recent outbreaks of E. coli, O157:H 7 infection or HUS in the state.
We urge you to be on the lookout for new cases of bloody diarrhea and to follow CBCs and renal function in such patients. The literature is mixed, but antibiotics do not seem to alter the course of the colitis, and they may foster the development of HUS by inducing abrupt release of Shiga-like toxin.
Please report any new cases to us, so that we can keep our medical community and the Department of Public Health informed.
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