Skip to main content

A community outbreak of haemolytic-uraemic syndrome in children occurring in a large area of Northern Italy over a period of several months

  • A. E. Tozzi (a1), A. Niccolini (a1), A. Caprioli (a2), I. Luzzi (a3), G. Montini (a4), G. Zacchello (a4), A. Gianviti (a5), F. Principato (a5) and G. Rizzoni (a5)...

From March to October 1993. 15 cases of haemolytic-uraemic syndrome (HUS) in children were detected in a large area of northern Italy, where only 8 cases had occurred in the previous 5 years. Analysis of stool and serum specimens obtained from 14 cases showed evidence of Verotoxin-producing Escherichia coli (VTEC) infection in 13. Serum antibodies to the E. coli O157 lipopolysaccharide (LPS) were found in 8 patients and to the O111 LPS in 2. An O86 VTEC was isolated from another patient. Fourteen children needed dialysis, and 1 died. No obvious epidemiologic link was observed among cases, most of whom lived in small townships. A case-control study did not show an association between HUS and food or exposure to cattle, but suggested an association with contact with chicken coops (OR = 6·5. 95% C.I. 1·2–34·9). However, VTEC were not isolated from stool samples obtained from the chicken coops involved. The risk factors for VTEC infection related to living in rural settlements, including the exposure to live poultry, should be considered in outbreak investigations.

Corresponding author
* Correspondence and reprint requests to: Dr A. E. Tozzi, Istituto Superiore di Sanita. Laboratorio di Epidemiologia e Biostatistica. Viale Regina Elena. 299. 00161 ROMA. Italy.
Hide All
1.Griffin PM, Tauxe RVThe epidemiology of infections caused by Escherichia coli O157:H7. other enterohemorrhagic E. coli. and the associated hemolytic uremic syndrome. Epidemiol Rev 1991; 13: 6098.
2.Ostroff SM, Griffin PM, Tauxe RV et al. . A statewide outbreak of Escherichia coli O157:H7 infections in Washington state. Am J Epidemiol 1990; 132: 239–47.
3.Pavia AT, Nichols CR, Green DP et al. . Hemolytic-uremic syndrome during an outbreak of Escherichia coli O157:H7 infections in institutions for mentally retarded persons: clinical and epidemiologic observations. J Pediatr 1990; 116: 544–51.
4.Belongia EA, MacDonald KL, Parham GL et al. . An outbreak of Escherichia coli O157:H7 colitis associated with consumption of precooked meat patties. J Infect Dis 1991; 194: 338–43.
5.Swerdlow DL, Woodruff BA, Brady RC et al. . A waterborne outbreak in Missouri of Escherichia coli O157:H7 associated with bloody diarrhea and death. Ann Int Med 1992; 117: 812–9.
6.Morgan GM, Newman C, Palmer SR et al. , First recognized community outbreak of haemorrhagic colitis due to verotoxin-producing Escherichia coli O157:H7 in the UK. Epidemiol Infect 1988; 101: 8391.
7.Thomas A, Chart H, Cheasty T, Smith HR, Frost JA, Rowe BVero cytotoxin-producing Escherichia coli. particularly serogroup O157. associated with human infections in the United Kingdom: 1989–91. Epidemiol Infect 1993; 110: 591600.
8.Centres for Disease Control. Multistate outbreak of Escherichia coli O157:H7 infections from hamburgers – Western United States. 1992–1993. MMWR 1993; 42: 258–63.
9.Caprioli A, Luzzi I, Rosmini F et al. . Hemolytic-uremic syndrome and veroevtotoxin-producing Escherichia coli infection in Italy. J Infect Dis 1992; 166: 154–8.
10.Morgan D, Newman CP, Hutchinson DN, Walker AM, Rowe B, Majid FVerotoxin producing Escherichia coli O157 infections associated with the consumption of yoghurt. Epidemiol Infect; 111: 181–7.
11.Besser RE, Lett SM, Weber JT, Doyle MP, Barrett TJ, Wells JG, Griffin PMAn outbreak of diarrhea and hemolytic uremic syndrome from Escherichia coli O157:H7 in fresh-pressed apple cider. JAMA 1993; 269: 2217–20.
12.Caprioli A, Luzzi I, Rosmini F et al. . Communitywide outbreak of heinolvtic-uremic syndrome associated with non-O157 verocytotoxin-producing Escherichia coli. J Infect Dis 1994; 169: 208–11.
13.Caprioli A, Nigrelli A, Gatti R et al. , Characterisation of verocytotoxin-producing Escherichia coli isolated from pigs and cattle in northern Italy. Vet Rec 1993; 133: 323–4.
14.Conedera G, Caprioli A, Zuin A, De Biasi G, Cancellotti FMEscherichia coli produttori di verocitotossine: indagine su prodotti earnei. Archivio Veterinario Italiano 1992; 43: 245–52.
15.Walter SDMatched case-control studies with a variable number of controls per case. Biometrika 1979; 66: 181–3.
16.Chart E, Smith HR, Scotland SM, Rowe B, Milford DV, Taylor CMSerological identification of Escherichia coli O157:H7 infection in haetnolytie-uraemie syndrome. Lancet 1991; 337: 138–40.
17.Karmali MA, Arbus GS, Ish-Shalom N et al. . A family outbreak of hemolytic-uremic syndrome associated with verotoxin-producing Escherichia coli serotype O157:H7. Pediatr Nephrol 1988; 2: 409–14.
18.Beautin L, Geier D, Steinruck H, Zimmermann S, Scheutz FPrevalence and some properties of verotoxin (Shiga-like toxin)-producing Escherichia coli in seven different species of healthy domestic animals. J Clin Microbiol 1993; 31: 2483–8.
19.Doyle MP, Schoeni JLIsolation of Escherichia coli O157:H7 from retail fresh meats and poultry. Appl Environ Microbiol 1987; 53: 2394–6.
20.Berry JT, Doyle MP, Schoeni JLColonization of chicken caecae by Escherichia coli associated with hemorragic colitis. Appl Environ Microbiol 1985; 49: 310–5.
21.Dev VJ, Main M, Gould IWaterborne outbreak of Escherichia coli O157. Lancet 1991; 337: 1412.
22.Bitzan M, Ludwig K, Klemt M, Konig H, Buren J, Muller-Wiefel DEThe role of Escherichia coli O157 infections in the classical (entheropatic) haemolytic uraemic syndrome: results of a central European multicentre study. Epidemiol Infect 1993; 110: 183–96.
23.Cieslak PR, Barrett TJ, Griffin PM et al. . Escherichia coli O157:H7 infection from a manured garden. Lancet 1993; 342: 367.
24.Rowe PC, Orrbine E, Lior H, Wells GA, McLaine PN, and the CPKDRC co-investigators. Diarrhoea in close contacts as a risk factor for childhood haemolytic uraemic syndrome. Epidemiol Infect 1993; 110: 916.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 0
Total number of PDF views: 2 *
Loading metrics...

Abstract views

Total abstract views: 41 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 24th November 2017. This data will be updated every 24 hours.