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E. coli gastroenteritis - USA: (MS) restaurant, EPEC, EAEC

An outbreak of infections with EPEC and EAEC involving more than 50 cases of diarrhea is ongoing in the USA. The episode has been associated with eating at a restaurant and highlights the importance of not letting down the guard on the infections caused by pathogenic E. coli other than STEC.


PRO/EDR> E. coli gastroenteritis - USA: (MS) restaurant, EPEC, EAEC
Date: 16 january 2017 00:55:01 CET
A: promed-post@promedmail.org, promed-edr-post@promedmail.org
Rispondi a: <promedNOREPLY@promedmail.org>

E. COLI GASTROENTERITIS - USA: (MISSISSIPPI) RESTAURANT, EPEC, EAEC

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A ProMED-mail post <http://www.promedmail.org> ProMED-mail is a program of the International Society for Infectious Diseases <http://www.isid.org>

[1]

Date: Fri 13 Jan 2017
Source: Food Safety News [edited] <http://www.foodsafetynews.com/2017/01/gulfport-restaurant-remains-closed-more-than-50-infected/#.WHj6P010yUk>

A Gulfport, MS restaurant remains closed as state officials investigate an outbreak of _E. coli_ infections among people who ate there during the last 2 weeks of 2016. Captain Al's Steak and Seafood Restaurant was closed by public health officials on 4 Jan 2017 after more than 50 people reported becoming ill, according to a health advisory from the Mississippi State Department of Health (MSDH) [see below].

"Molecular testing at the Mississippi Public Health Laboratory has indicated that the causative organisms are types of _E. coli_ referred to as enteropathogenic _E. coli_ (EPEC) and enteroaggregative _E. coli_ (EAEC)," according to the state health department's advisory.

"These types of _E. coli_ are not Shiga toxin-producing _E. coli_ (STEC), but are known to cause significant diarrheal illness. Routine stool cultures are unable to identify EPEC and EAEC, but they can be identified through PCR testing available through reference laboratories."

In the health advisory, state epidemiologist Dr. Paul Byers reported that symptoms began for the victims between 2 hours and 6 days after eating at Captain Al's. The reported dates of exposure were from 16-30 Dec 2016.

As of Wed 11 Jan 2017, the state had identified more than 50 people who developed acute gastroenteritis after eating at the restaurant.

The primary symptoms reported and the percentage of victims reporting each symptom are:
- diarrhea 83 percent;
- stomach cramps 76 percent;
- chills 57 percent;
- headache 51 percent;
- nausea 39 percent;
- fever 34; and
- bloody stools 13 percent.

The symptoms lasted for 5 to 21 days, with a median illness length of 10 days, according to the state. Of the more than 50 sick people, 21 sought medical attention, and one person had to be admitted to a hospital.

Officials from the state health department are working with the restaurant owner and operator to make sure there are no problems that could endanger public health before Captain Al's will be allowed to reopen.

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Communicated by: ProMED-mail <promed@promedmail.org>

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[2]

Date: Wed 11 Jan 2017
Source: Mississippi State Department of Health [edited] <http://msdh.ms.gov/msdhsite/_static/resources/7035.pdf?rss=>

The Mississippi State Department of Health (MSDH) is investigating an outbreak of gastrointestinal illnesses associated with Captain Al's Steak and Seafood Restaurant in Gulfport, Mississippi. The reported dates of exposure were from 16 to 30 Dec 2016. The restaurant was temporarily closed on 4 Jan 2017, and MSDH is working with the restaurant to implement procedures to safely re-open.

As of 11 Jan 2017, MSDH has identified more than 50 individuals with an acute gastroenteritis after eating at the restaurant. The primary symptoms reported are diarrhea (83%), stomach cramps (76%), chills (57%), headache (51%), nausea (39%), and fever (34%). Bloody stools were reported by 13% of cases. The incubation period ranges from 2 to 146.5 hours, with a median of 24 hours; the duration of illness is between 5 to 21 days, with a median of 10 days. 21 people reported seeing a healthcare provider at some point during their illness, and one individual has required hospitalization.

Molecular testing at the Mississippi Public Health Laboratory has indicated that the causative organisms are types of _E. coli_ referred to as enteropathogenic _E. coli_ (EPEC) and enteroaggregative _E. coli_ (EAEC). These types of _E. coli_ are not Shiga toxin-producing _E. coli_ (STEC), but are known to cause significant diarrheal illness. Routine stool cultures are unable to identify EPEC and EAEC, but they can be identified through PCR testing available through reference laboratories.

Patients reporting gastrointestinal illness related to this outbreak should be treated primarily with supportive care and rehydration. In severe cases, antimicrobials may be necessary for treatment.

--

Communicated by: ProMED-mail <promed@promedmail.org>

[A number of _E coli_ strains have acquired virulence factors to become pathogens which could be called enteropaths, diarrheagenic E. coli_. These strains differ relating their virulence factors, and clinical manifestations are referred to as:
Enterotoxigenic _E. coli_ (ETEC)
Enteropathogenic _E. coli_ (EPEC)
Enterohemorrhagic _E. coli_ (EHEC)
Enteroaggregative _E. coli_ (EAEC)
Enteroinvasive _E. coli_ (EIEC)
Diffusely Adherent _E. coli_ (DAEC).

Most clinical laboratories have not been able to specifically identify any of these except for EHEC. Newer technologies using multiplex PCR have become available and are moving from reference to more standard clinical laboratories to test for a cluster of organisms, including
Enteric Adenovirus
Astrovirus
Norovirus
Rotavirus A
Sapovirus
Cryptosporidium
_Cyclospora cayetanensis_
_Entamoeba histolytica_
_Giardia lamblia_
_Campylobacter (jejuni, coli and upsaliensis_)
_Clostridium difficile_ (toxin A/B)
_Plesiomonas shigelloides_
Salmonella
Shigella
_Yersinia enterocolitica_
_Vibrio (parahaemolyticus, vulnificus and cholerae_)
Diarrheagenic E. coli/Shigella
Enteroaggregative _E. coli_ (EAEC)
Enteropathogenic _E. coli_ (EPEC)
Enterotoxigenic _E. coli_ (ETEC)
Enterohemorrhagic _E. coli_ (EHEC)
Enteroinvasive _E. coli_ (EIEC).

This is done by probing for specific virulence factors for each type of organism.

Of note, I have just consulted on a patient who presented with several weeks of diarrhea who had a totally negative GI PCR screen, but the stool actually grew _Aeromonas hydrophilia_, which can cause diarrhea. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: <http://healthmap.org/promed/p/226>.

[See Also:

2013
----
E. coli EAEC - UK: pathogenicity analysis
E. coli ETEC - South Korea: O169, fermented vegetables

2011
----
E. coli O104 - EU (15): case update, EaggEC VTEC O104:H4 genetics

2010
----
Foodborne illness, lettuce, norovirus, E. coli - Denmark

1998
----
Enteroaggregative E. coli, emerging pathogen worldwide

Published 16-01-2017 in Focus on , last update 16-01-2017

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