Hemorrhagic Colitis Associated with a Rare<i>Escherichia coli</i>Serotype

TLDR

Hemorrhagic colitis presented with severe crampy abdominal pain, watery then bloody diarrhea, and minimal fever, and had only been previously isolated from a single 1975 case. The study investigated two outbreaks of a rare gastrointestinal illness affecting at least 47 people in Oregon and Michigan during 1982. The authors conducted epidemiologic investigations of the two outbreaks, including case analysis and stool culture testing. The outbreaks were linked to a fast‑food chain and specific sandwiches, and stool and beef patty cultures isolated a rare non‑invasive, non‑toxic E.

Abstract

We investigated two outbreaks of an unusual gastrointestinal illness that affected at least 47 people in Oregon and Michigan in February through March and May through June 1982. The illness was characterized by severe crampy abdominal pain, initially watery diarrhea followed by grossly bloody diarrhea, and little or no fever. It was associated with eating at restaurants belonging to the same fast-food restaurant chain in Oregon (P less than 0.005) and Michigan (P = 0.0005) and with eating any of three sandwiches containing three ingredients in common (beef patty, rehydrated onions, and pickles). Stool cultures did not yield previously recognized pathogens. However, a rare Escherichia coli serotype, O157:H7, that was not invasive or toxigenic by standard tests was isolated from 9 of 12 stools collected within four days of onset of illness in both outbreaks combined, and from a beef patty from a suspected lot of meat in Michigan. The only known previous isolation of this serotype was from a sporadic case of hemorrhagic colitis in 1975. This report describes a clinically distinctive gastrointestinal illness associated with E. coli O157:H7, apparently transmitted by undercooked meat.