Diagnosis of thrombotic microangiopathy (TMA) is challenging due to its close association with other forms of microangiopathic hemolytic anemia, such as malignant hypertension and disseminated intravascular coagulation, and because other manifestations including cytopenia and acute kidney injury are manifestations of other medical comorbidities. Further challenges for accurate diagnosis include distinguishing between primary and secondary TMA, as well as between hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP). TTP is typically differentiated from HUS by the presence of more severe thrombocytopenia, along with a higher frequency of altered mental status with relatively preserved renal function. However, the clinical course can vary among patients, requiring polymerase chain reaction testing of patient stools for enterohemorrhagic Escherichia coli and a disintegrin and metalloproteinase with thrombospondin type 1 motif 13 (ADAMTS13) assay. To reduce the mortality rate, prompt initiation of plasmapheresis is important in cases where TPP cannot be excluded. Future advances enabling more rapid testing for ADAMTS13 levels will reduce the need for unnecessary plasmapheresis, so that treatment strategy can be more optimized.
Acute Kidney Injury ; Anemia, Hemolytic ; Comorbidity ; Diagnosis ; Diagnosis, Differential ; Disseminated Intravascular Coagulation ; Enterohemorrhagic Escherichia coli ; Hemolytic-Uremic Syndrome ; Humans ; Hypertension, Malignant ; Mortality ; Plasma Exchange ; Plasmapheresis ; Polymerase Chain Reaction ; Purpura, Thrombotic Thrombocytopenic ; Thrombocytopenia ; Thrombospondins ; Thrombotic Microangiopathies

BACKGROUND/AIMS: To compare the epidemiological aspects of enterohemorrhagic Escherichia coli (EHEC) between Korea and Japan by analyzing the current state of EHEC infection outbreaks and related risk factors. METHODS: We investigated the epidemiological aspects of EHEC infection cases between Korea and Japan from 2006 to 2010. The following factors were analyzed: national prevalence rate (PR), regional prevalence rate, epidemic aspects (i.e., Cases related to gender), male to female morbidity ratio, age, and seasonal distribution. RESULTS: In total, there were 254 cases of EHEC with an average PR of 0.11 per 100,000 populations in Korea from 2006 to 2010. During the same period in Japan, there were 20,883 cases of EHEC with an average PR of 3.26 per 100,000 populations. The PR in Japan was significantly higher than that in Korea (p < 0.01). In both countries, more females than males had EHEC infections, with the highest incidence of infections (> 50%) observed for individuals younger than 9 years. EHEC is an emerging zoonosis and may be caused by consumption of raw or undercooked meat products from ruminants. CONCLUSIONS: This study provides a quantitative analysis of the epidemiological aspects and risk factors of EHEC infections in Korea and Japan and will provide insight on effective future strategies to reduce these infections.
Disease Outbreaks ; Enterohemorrhagic Escherichia coli* ; Epidemiologic Studies ; Female ; Humans ; Incidence ; Japan* ; Korea* ; Male ; Meat Products ; Prevalence ; Risk Factors ; Ruminants ; Seasons

PURPOSE: This study was performed to evaluate the compliance with, and adequacy of, the Korean national guidelines which had been recommended until 2011 for isolation of patients with group 1 nationally notifiable infectious diseases (NNIDs), namely cholera, typhoid fever, paratyphoid fever, shigellosis, and enterohemorrhagic Escherichia coli (EHEC) infection. MATERIALS AND METHODS: We evaluated the clinical and microbiological characteristics of confirmed cases of group 1 NNIDs and compliance with the guidelines in 20 Korean hospitals nationwide in 2000-2010. We also compared the Korean guidelines with international guidelines. RESULTS: Among 528 confirmed cases (8 cases of cholera, 232 of typhoid fever, 81 of paratyphoid fever, 175 of shigellosis, and 32 EHEC infections), strict compliance with the Korean guideline was achieved in only 2.6% to 50.0%, depending on the disease. While the Korean guidelines recommend isolation of all patients with group 1 NNIDs, international guidelines recommend selective patient isolation and screening for fecal shedding, depending on the type of disease and patient status. CONCLUSION: Compliance with the previous national guidelines for group 1 NNIDs in Korea was generally very low. Further studies are needed to evaluate whether compliance was improved after implementation of the new guideline in 2012.
Cholera ; Communicable Disease Control ; Communicable Diseases* ; Compliance* ; Dysentery, Bacillary ; Enterohemorrhagic Escherichia coli ; Guideline Adherence ; Humans ; Korea* ; Mass Screening ; Methods ; Paratyphoid Fever ; Patient Isolation ; Typhoid Fever

Hemolytic uremic syndrome (HUS) is one of the most common causes of acute renal failure in childhood and is primarily diagnosed in up to 4.5% of children who undergo chronic renal replacement therapy. Escherichia coli serotype O157:H7 is the predominant bacterial strain identified in patients with HUS; more than 100 types of Shiga toxin-producing enterohemorrhagic E. coli (EHEC) subtypes have also been isolated. The typical HUS manifestations are microangiopathic hemolytic anemia, thrombocytopenia, and renal insufficiency. In typical HUS cases, more serious EHEC manifestations include severe hemorrhagic colitis, bowel necrosis and perforation, rectal prolapse, peritonitis, and intussusceptions. Colonic perforation, which has an incidence of 1%-2%, can be a fatal complication. In this study, we report a typical Shiga toxin-associated HUS case complicated by small intestinal perforation with refractory peritonitis that was possibly because of ischemic enteritis. Although the degree of renal damage is the main concern in HUS, extrarenal complications should also be considered in severe cases, as presented in our case.
Acute Kidney Injury ; Anemia, Hemolytic ; Child* ; Colitis ; Colon ; Enteritis ; Enterohemorrhagic Escherichia coli ; Escherichia coli ; Hemolytic-Uremic Syndrome* ; Humans ; Incidence ; Intestinal Perforation* ; Intussusception ; Necrosis ; Peritonitis ; Rectal Prolapse ; Renal Insufficiency ; Renal Replacement Therapy ; Shiga Toxin ; Thrombocytopenia

BACKGROUND: We investigated the prevalence of various pathogens (13 enteric bacteria and 5 viruses) which cause diarrhea using multiplex PCR of stool specimens and compared two multiplex PCR methods for detecting diarrheagenic Escherichia coli. METHODS: A total of 405 stool specimens submitted between November 2010 to February 2011 for routine culture of enteric pathogens were included and screened for five viruses (astrovirus, Group A rotavirus, enteric adenovirus, norovirus G1/G2) and eight bacteria (Salmonella spp., Shigella spp., Campylobacter spp., Vibrio spp., C. difficile Toxin B, C. perfringens, Y. enterolytica, Aeromonas spp.) using the Seeplex(R) Diarrhea ACE detection kit (Seegene). In addition, virulence-associated genes of enteropathogenic E. coli, (EPEC), enterohemorrhagic E. coli (EHEC), enteroinvasive E. coli, (EIEC), enterotoxigenic E. coli (ETEC), and enteroaggressive E. coli (EAEC) were detected using 16-plex PCR and a commercial diarrheagenic E. coli detection (DEC) PCR kit (SSI Diagnostica). RESULTS: Overall, 138 (34.1%) of 405 samples was positive for pathogen. The positive rate for virus was 18.5%. norovirus G2, Group A rotavirus, enteric adenovirus, astrovirus and norovirus G1 were detected in 40, 23, 8, 3 and 1 samples, respectively. The positive rate for bacteria was 24.4% (99/405). C. difficile toxin B was the most frequently detected, followed by C. perfringens, EPEC, and EAEC. The agreements of the two multiplex PCR methods for detecting EPEC and EHEC were 99.3% and 100%, respectively. CONCLUSION: The detection rate was high (34.1%) including various diarrheagenic E. coli (6.2%) and C. perfringens (5.2%). Multiplex PCR is thus useful for detecting various pathogens.
Adenoviridae ; Aeromonas ; Bacteria ; Campylobacter ; Diarrhea ; Enterobacteriaceae ; Enterohemorrhagic Escherichia coli ; Enteropathogenic Escherichia coli ; Enterotoxigenic Escherichia coli ; Escherichia ; Escherichia coli ; Multiplex Polymerase Chain Reaction ; Norovirus ; Polymerase Chain Reaction ; Prevalence ; Rotavirus ; Shigella ; Vibrio ; Viruses

Enterohemorrhagic Escherichia coli ; Escherichia coli Infections ; epidemiology ; Germany ; epidemiology ; Humans

Escherichia (E.) coli serotype O157:H7 is a globally distributed human enteropathogen and is comprised of microorganisms with closely related genotypes. The main reservoir for this group is bovine bowels, and infection mainly occurs after ingestion of contaminated water and food. Virulence genetic markers of 28 O157:H7 strains were investigated and multilocus enzyme electrophoresis (MLEE) was used to evaluate the clonal structure. O157:H7 strains from several countries were isolated from food, human and bovine feces. According to MLEE, O157:H7 strains clustered into two main clonal groups designated A and B. Subcluster A1 included 82% of the O157:H7 strains exhibiting identical MLEE pattern. Most enterohemorrhagic E. coli (EHEC) O157:H7 strains from Brazil and Argentina were in the same MLEE subgroup. Bovine and food strains carried virulence genes associated with EHEC pathogenicity in humans.
Animals ; Argentina/epidemiology ; Brazil/epidemiology ; Cattle ; Cattle Diseases/epidemiology/*microbiology ; Enterohemorrhagic Escherichia coli/genetics/*isolation & purification/pathogenicity ; Escherichia coli O157/*genetics/*isolation & purification/pathogenicity ; Food Microbiology ; Gene Expression Regulation, Bacterial/physiology ; Genetic Markers ; Humans ; Polymerase Chain Reaction/veterinary ; Shiga Toxin 1/genetics/metabolism ; Shiga Toxin 2/genetics/metabolism ; Virulence

The purpose of the study was to collect the opinions of doctors who are specialists in infectious disease with regard to the current method used for isolation of patients with group 1 nationally notifiable infectious diseases in Korea. A web-based survey was conducted from June 27 to July 7, 2011. Relevant questions included: 1) adequacy of the current policy of forced hospital isolation; evaluation of current guidelines for release from hospital isolation; and 3) priority for policy switching from forced hospital isolation to home isolation. The rate of response to the survey was 28.4% (40 out of 140). First, the majority of infectious disease specialists in Korea believed that the current method of forced hospital isolation for patients with group 1 infectious diseases should be changed to the home isolation method. Second, if the Korean government changes its policy to home isolation, the top priority of the policy switch would be typhoid fever, followed by paratyphoid fever, shigellosis, cholera, and EHEC (enterohemorigic Escherichia coli). Regarding current guidelines for release from hospital isolation, in cases of shigellosis, EHEC, and hepatitis A, the majority of respondents supported the current guidelines, while they were not able to make collective opinions in cases of cholera and typhoid/paratyphoid fever. We were able to confirm that the majority of specialists want to change the current isolation method. Therefore, the Korean government should consider switching their policy from forced hospital isolation to home isolation.
Cholera ; Communicable Diseases ; Dysentery, Bacillary ; Enterohemorrhagic Escherichia coli ; Escherichia ; Fever ; Hepatitis A ; Humans ; Infectious Disease Medicine ; Korea ; Paratyphoid Fever ; Specialization ; Surveys and Questionnaires ; Typhoid Fever

Many infectious diseases have emerged or re-emerged during the past 50 years in the Republic of Korea. Some of these are new infectious diseases delivered by new or newly recognized micro-organisms. Others are already known infectious diseases which have increased in frequency or have developed an expanded region of occurrence. Still others are infectious diseases that are caused by the same micro-organisms which are resistant to antibiotics, and therefore difficult to treat. Newly recognized Emerging Infectious Diseases (EIDs) include legionellosis, leptospirosis, tsutsugamushi diseases, Vibrio vulnificus sepsis, and brucellosis. New EIDs include acquired immunodeficiency syndrome, enterohemorrhagic E. coli infection, Creutzfeldt-Jacob disease. Of the EIDs occurred in the Republic of Korea during the past 50 years, healthcare-related infections, especially by antibiotic-resistant organisms, are the most important EIDs in terms of morbidity and mortality.
Acquired Immunodeficiency Syndrome ; Anti-Bacterial Agents ; Brucellosis ; Communicable Diseases ; Communicable Diseases, Emerging ; Enterohemorrhagic Escherichia coli ; Legionellosis ; Leptospirosis ; Republic of Korea ; Scrub Typhus ; Sepsis ; Vibrio vulnificus

Enterohemorrhagic Escherichia coli (EHEC) is an important cause of bloody diarrhea in children, but is considered to be rare in infants. Herein, a case of infant hemorrhagic colitis of verotoxin-producing E. coli O157:H7 diagnosed by multiplex PCR is reported. A nine-month-old boy was admitted to our hospital with bloody diarrhea for the previous two days. Multiplex PCR using Seeplex(R) Diarrhea ACE Detection Kit (Seegene, Seoul, Korea) was directly applied to the stool specimens. Amplified bands specific for verotoxin, O157, and H7 indicated the presence of O157:H7 EHEC. The stool specimens were inoculated on sorbitol-MacConkey agar (SMA) and tryptic soy broth containing mitomycin C (TSB-M). Colorless colonies on sorbitol-MacConkey agar were O157-positive. TSB-M enrichment cultures of the stool specimen and the isolates were positive for verotoxin according to an enzyme immunoassay (EIA). The prepared ingredients of baby foods for the patient including ground meat, chopped carrot, chopped cabbage, and white rice porridge showed no EHEC on TSB-M and SMA. The patient's parents and three-year-old sister did not recently have any gastrointestinal symptoms. Cefdinir was administered for one day and was ceased after diagnosis of EHEC colitis. The stool culture and verotoxin assay were negative on the second day of hospitalization. Application of multiplex PCR and verotoxin EIA directly to diarrheal stool warrants the rapid diagnosis and appropriate treatment of EHEC colitis.
Agar ; Brassica ; Caseins ; Cephalosporins ; Child ; Colitis ; Daucus carota ; Diarrhea ; Enterohemorrhagic Escherichia coli ; European Continental Ancestry Group ; Hospitalization ; Humans ; Immunoenzyme Techniques ; Infant ; Meat ; Mitomycin ; Multiplex Polymerase Chain Reaction ; Parents ; Protein Hydrolysates ; Shiga Toxins ; Shiga-Toxigenic Escherichia coli ; Siblings