Key words: verotoxin-producing Escherichia coli, bloody diarrhea, intussusception, sorbitol-macconkey medium, PCR

Transcription

1 Key words: verotoxin-producing Escherichia coli, bloody diarrhea, intussusception, sorbitol-macconkey medium, PCR

2 Fig. 1 Monthly distribution of enterocolitis with bloody stools seen at three hospitals in the Fukuoka area between October 1990 and September 1994 Table 1 Comparison of clinical details due to diarrheagenic bacteria among enterocolitis patients

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4 0157: H7. Ann. Intern. Med., 101: , ) Karmali M. A., Petric, M., Winkler, M., Bielaszewska, M., Brunton, J., van de Kar, N., Morooka, 1) Karmali, M. A.: Infection by verocytotoxinproducing T., Nair, G.B., Richardson, S.E. & Arbus, G. Escherichia coli. Clin. Micobiol. Rev., S.: Enzyme-linked immunosorbent assay for 2: 15-38, detection of immunoglobulin G antibodies to 2) Lopez, E. L., Devoto, S., Woloj, M., Pickering, L. K. & Cleary, T. G.: Intussusception associated with Escherichia coli 0157: H7. Pediatr. Infect. Dis., 8: , prevalence of serum antibodies to Verotoxins 1 and 2 among healthy adults in Japan. J. Infect., 27: , ) Cimolai, N., Anderson, J. D., Bhanji, N. M. F., Chen, L. & Blair, G.K.: Escherichia coli 0157: H7 infections associated with perforated 14) Riley, L. W., Remis, R. S., Helgerson, S. D., appendicitis and chronic diarrhoea. Eur. J. McGee, H.B., Wells, J.G., Davis, B.R., Hebert, Pediatr., 149: , R. J., Olcott, E. S., Johnson, L. M., Hargrett, N. 5) Hamano, S., Nakanishi, Y., Nara, T., Seki, T., T., Blake, P.A. & Cohen, M.L.: Hemorrhagic Ohtani, T., Oishi, T., Joh, K., Oikawa, T., colitis associated with a rare Escherichia coli Muramatsu, Y., Ogawa, Y. & Akashi, S.: Neurological manifestations of hemorrhagic colitis in the outbreak of Escherichia coli 0157: H7 infection in Japan. Acta Paediatr., 82: 454 8) Pai, C. H., Ahmed, N., Lior, H., Johnson, W. M., Sims, H.V. & Woods, D. E.: Epidemiology of sporadic diarrhea due to verocytotoxinproducing Escherichia coli: A two-year prospective study. J. Infect. Dis., 157: , ) Remis, R. S., McDonald, K. L., Reiley, L. W., Puhr, N.D., Wells, J. G., Davis, B. R., Blake, P. A. & Cohen, M.L.: Sporadic cases of hemorrhagic colitis associated with Escherichia coli Escherichia coli Vero cytotoxin 1. J. Clin. Microbiol., 32: , ) Takeda, T., Nakao, H., Yamanaka, T., Igarashi, T., Takeda, Y. & Kobayashi, N.: High serotype. N. Engl. J. Med., 308: , ) Gunzer, F., Bohm, H., Russmann, H., Bitzan, M., Aleksic, S. & Karch, H.: Molecular detection of sorbitol-fermenting Escherichia coli 0157 in patients with hemolytic-uremic syndrome. J. Clin. Microbiol., 30 : , ) Bell, T. M. & Steyn, J. H.: Viruses in lymph nodes of children with mesenteric adenitis and intussusception. Br. Med. J., 2: , ) Gardner, P.S., Knox, E.G., Court, S.D.M. & Green, C.A.: Virus infection and intussuscep- in childhood. Br. Med. J., 2: , tion 19) Gianantonio, C. A., Vitacco, M., Mendilaharzu, F., Gallo, G. E. & Sojo, E. T.: The hemolyticuremic syndrome. Nephron., 11: , ) van Wieringen, P.M., Monnens, L.A. & Schretlen, E. D.: Haemolytic-uraemic syndrome epidemioligical and clinical study. Arch. Dis. Child., 49: , 1974.

5 Isolation of Verotoxin-producing Escherichia coli from Pediatric Patients Suffering from Enteritis with Bloody Stool and Intussusception Department of Pediatrics, Fukuoka University Chikushi Hospital Department of Pediatrics, Fukuoka Tokushukai Hospital Department of Pediatrics, School of Medicine, Fukuoka University Department of Clinical Laboratories, Fukuoka University Hospital Shionogi Biomedical Laboratories, Shionogi Pharmaceutical Co., Ltd. We tried to isolate verotoxin-producing Escherichia coli (VTEC) on sorbitol-macconkey (SMAC) agar and in part by the polymerase chain reaction (PCR) method from sporadic enteritis patients with bloody stools and intusussception patients who came to three pediatric clinics in the Fukuoka area from October 1990 to September VTEC O157:H7 strains were isolated from 6 (10.5%) of 57 patients with bloody stools, Campylobacter spp. 15 (26.3%), Salmonella spp. 14 (24.6%), and Yersinia enterocolitica 2. We were not able to detect VT genes by PCR from 11 of 20 patients from whose stools no causative bacteria were isolated. Massive fresh bloody stools following frequent watery diarrhea were typical of the VTEC enteritis patients. Only 1 patient had fever and 2 had leukocytosis, but the C-reactive protein level in all of them was below 1+. The VTEC strains were isolated during the summer season, 1 in June, 2 in July, and 3 in September. Since in the area O157:H7 appeared to be the most prevalent VTEC serotype, SMAC is very useful for screening VTEC in bloody stools. VTEC seems to be a rare pathogen of intusussception because the organisms were detected from none of the 30 patients.