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Food Poison Journal Food Poisoning Outbreaks and Litigation: Surveillance and Analysis

E. coli Cases in Central Missouri Announced

The Missouri Department of Health and Senior Services (DHSS) is investigating an increase in cases of Shiga toxin-producing Escherichia coli (STEC) in Central Missouri during late March and early April 2012. Five cases of E. coli O157:H7 have been identified during this time period. Two of the cases, a two-year old child and a seventeen-month old child, reportedly have developed hemolytic uremic syndrome (HUS), a severe, life-threatening condition that may result in permanent kidney damage in some of those who survive.

The investigation is ongoing and the source of the infections has not been identified.

DHSS recommends that any person who has signs or symptoms of STEC infection should seek medical care. Health care providers should determine if testing for STEC infection is warranted.

Symptoms of STEC infection include severe stomach cramps, diarrhea (which is often bloody), and vomiting. If there is fever, it usually is not very high. Most patients’ symptoms improve within 5–7 days, but some patients go on to develop HUS, usually about a week after the diarrhea starts. The classic triad of findings in HUS is acute renal damage, microangiopathic hemolytic anemia, and thrombocytopenia.

Use of antibiotics in patients with suspected STEC infections is not recommended until complete diagnostic testing can be performed and STEC infection is ruled out. Some studies have shown that administering antibiotics in patients with STEC infections might increase their risk of developing HUS. However, clinical decision-making must be tailored to each individual patient. There may be indications for antibiotics in patients with severe intestinal inflammation if perforation is of concern.