gi grand rounds: a brief discussion of e coli 0157:h7

Just

Ed McDonald

Another

case of

3 days of…

Diarrhea

Pain

Emesis

Other HPI

Questions

?

PCOS

Long QT

Migraine

Past Medical

History

Temp

98

HR

107

BP

105/57 Vital Signs

WBC

8.3

Hgb

13.5

Plt

187

NL

CMP

CRP

56 ESR 6 Labs

CT

Extensive

colonic

thickening

Severe colitis w/ rectal sparing

Ischemic

Hyalinization

Acute

Colitis

Inflammatory

Exudates

Salmonella 0.9%

Shigella 0.6%

Campylobacter 1.4%

E. Coli O157 0.3%

1996: 233,212 stools tested

Overall

1.5%-2.9%

Clin Infect Dis. (2001) 32 (3): 331-351

Diffusely Adhering (DAEC)

Enteroaggregative

(EAEC)

Enteroinvasive (EIEC)

Pathogenic Strains of Ecoli

Enterohemorrhagic (EHEC)

Enteropathogenic (EPEC)

Enterotoxigenic (ETEC)

Cows are a natural habitat a role for vaccination and probiotics

Hamburger meat is the leading

vehicle of infection

CDC: 2012 Incidence Rate per

100,000 people

16.42 14.30

E. coli

1.12

Vibrio

0.41

Salmonella Campylobacter

Isolation rate of STEC O157 by age

United States 2009 (n=1,947)

National Enteric Disease Surveillance: Shiga toxin-

producing Escherichia coli (STEC) Annual Summary, 2009

result in colitis that resembles

ischemic colitis

Would you treat this

patient?

Isolation Hand

Hygeine

Well-Cooked

Food

159 cases of E. coli O157: H7 in children

who attended a fair in Canada in 1999

BMC Public Health. 2013; 13: 799

Cipro- increases Shiga production in mice models

Hemolytic Uremic Syndrome

No effect on duration of symptoms

Is concern about giving antibiotics legitimate?

Proulx F, Turgeon JP, Delage G, et

al: Randomized, controlled trial of

antibiotic therapy for Escherichia coli

O157:H7 enteritis.

Non-immune

Hemolytic

Anemia

Thrombocytopenia

Renal Impairment

NHS-0583-3DC-3N

HUS

Hemolytic Uremic Syndrome (HUS) *Most common cause of renal failure in children

Micrographs of Samples from Patients with Hemolytic–Uremic Syndrome.

Noris M, Remuzzi G. N Engl J Med 2009;361:1676-1687.

1997 – 2009: 981 Cases of HUS

National Enteric Disease Surveillance: Shiga toxin-

producing Escherichia coli (STEC) Annual Summary, 2009

Median

4.5 yrs

Deaths

52 (5%)

Summer

569

(58%)

E. Coli

O157:H7

95%

Antibiotics and HUS Systemic Reviews

Safdar

2002

• 9 Studies

• Neither protection nor increased risk

• Pooled OR 1.15 (95% CI 0.79-1.68)

Panos

2006

• 19 Studies

• Inconclusive

Safdar N. JAMA 2002; 288:996-1001

Other Treatment and HUS

Synsorb • an agent that binds to ST to prevent

its absorption from the gut.

Antibodies • Monoclonal Ab against Shiga 1 and 2

•Antibiotics were stopped by ID •Hgb 11.7 9.1

•Schistocytes on Smear

•Normal Renal Function