Haemolytic uraemic syndrome

EnterohemorrhagicEscherichia coliO157: epidemiology and ecology in bovine production environments

EnterohemorrhagicEscherichia coli, particularly the O157(:H7) serogroup, has become a worldwide public health concern. Since cattle feces are often implicated as the source ofE. coliO157 in human infections, considerable resources have been devoted to defining the epidemiology and ecology ofE. coliO157 in cattle environments so that control might begin at the farm level. Diagnostic limitations and the complexity of often interrelated microbial, animal, herd, environmental and production factors have hindered the determination of the epidemiology, ecology and subsequent farm-level control ofE. coliO157. The widespread distribution ofE. coliO157, the transitory nature of fecal shedding, multiple potential environmental sources, lack of species specificity, and age-, feed- and time-related differences in cattle prevalence are documented. However, the significance and/or role of these factors in the epidemiology and ecology ofE. coliO157 is still unclear. Cattle are a major source ofE. coliO157, but it may be simplistic to believe that most herds are relatively closed systems with small percentages of cattle serving as true reservoirs. Practical on-farm control may require explicit definitions of the seemingly complex system(s) and the microbial, animal, herd, environmental and production factors involved in the multiplication, maintenance and transmission ofE. coliO157.

Acute gastroenteritis in children : what role for antibacterials?

The aim of this article is to define the currently accepted role of antibacterials in the treatment of acute gastroenteritis in children. Most cases of acute gastroenteritis in children are viral, self-limited, and need only supportive treatment. Appropriate fluid and electrolyte therapy, with close attention to nutrition, remain central to therapy.Antibacterial therapy serves as an adjunct, to shorten the clinical course, eradicate causative organisms, reduce transmission, and prevent invasive complications. Selection of antibacterials to use in acute bacterial gastroenteritis is based on clinical diagnosis of the likely pathogen prior to definitive laboratory results. Antibacterial therapy should be restricted to specific bacterial pathogens and disease presentations. In general, infections with Shigella spp. and Vibrio cholera should usually be treated with antibacterials, while antibacterials are only used in severe unresponsive infections with Salmonella, Yersinia, Aeromonas, Campylobacter, Plesiomonas spp., and Clostridium difficile. Antibacterials should be avoided in enterohemorrhagic Escherichia coli infection. However, empiric therapy may be appropriate in the presence of a severe illness with bloody diarrhea and stool leucocytes, particularly in infancy and the immunocompromised. The benefits and risks of adverse drug reactions should be weighed before prescribing antibacterials. Moreover, a major concern is the emergence of antibacterial-resistant strains due to the widespread use of antibacterial agents.

Detection of Shiga toxin-producing Escherichia coli in food

Shiga toxin-producing Escherichia coli are emerging as a significant source of food-borne infectious disease all over the world. Illness caused by Shiga toxin-producing E. coli can range from self limited, watery diarrhea to life-threatening manifestations such as hemorrhagic colitis, hemolytic uremic syndrome or thrombotic thrombocytopenic purpura and death. Shiga toxin-producing E. coli can potentially enter the human food chain from a number of animal sources, most commonly by contamination of meat with feces or intestinal contents after slaughter or cross-contamination of unpasteurized milk products. Because of the low infectious dose of the O157:H7 Shiga toxin-producing E. coli strain, laboratory diagnosis of Shiga toxin-producing E. coli in food samples has developed a great importance. This review will focus on the microorganism, giving priority to illness prevention and Shiga toxin-producing E. coli detection in food.