Related Experiment Videos
Haemolytic-uraemic syndrome outbreak caused by Escherichia coli O111:H-: clinical outcomes
P H Henning1, E B Tham, A A Martin
1Department of Nephrology, Women's and Children's Hospital, Adelaide, SA. henningp@wch.gov.sa.au
Insights
A 1995 outbreak of haemolytic-uraemic syndrome (HUS) in South Australia, caused by Escherichia coli O111:H-, affected 20 children. This outbreak, linked to contaminated mettwurst, resulted in severe complications and highlighted the risks of foodborne pathogens.
Area of Science:
- Pediatric Nephrology
- Infectious Disease Epidemiology
- Food Safety
Background:
- Escherichia coli O111:H- is a known cause of sporadic hemolytic-uremic syndrome (HUS).
- Foodborne outbreaks of HUS are a significant public health concern, particularly in vulnerable populations like children.
- The consumption of contaminated meat products has been implicated in previous E. coli outbreaks.
Purpose of the Study:
- To report on the clinical features and outcomes of children affected by a large outbreak of HUS.
- To identify the source of the outbreak and implement control measures.
- To assess the long-term renal function in children following HUS.
Main Methods:
- Retrospective case series analysis of 20 children diagnosed with HUS.
- Epidemiological investigation to identify the food vehicle of transmission.
- Clinical data collection on patient demographics, symptoms, complications, and treatment.
Main Results:
- Twenty children developed HUS associated with E. coli O111:H- infection in South Australia in 1995.
- The outbreak was traced to contaminated locally produced semi-dry fermented sausage (mettwurst).
- Complications included renal impairment (18/20 required dialysis, 5/18 with significant impairment at 12 months), colonic necrosis (3), cerebral complications (3), and seizures (4). One child died.
Conclusions:
- This was the first reported large outbreak of E. coli O111:H- associated HUS in Australia.
- Contaminated fermented sausages pose a significant risk for HUS outbreaks.
- Prompt recognition and management are crucial, but long-term sequelae, particularly renal impairment, are common.
Abstract:
In South Australia in 1995, we treated 20 children with haemolytic-uraemic syndrome associated with Escherichia coli O111:H-. The source of the outbreak was contaminated locally produced semi-dry fermented sausage (mettwurst). One child died of multiple haemorrhagic cerebral infarcts. Eighteen children required renal dialysis (for a median of 14 days); 12 months after discharge five still had significant impairment of renal function. Other major complications included colonic necrosis (3), cerebral haemorrhage/infarction (3), convulsions (4), and glucose intolerance (2). Although E. coli O111:H- has been associated with sporadic cases of haemolytic-uraemic syndrome, this was the first large outbreak reported in Australia.