Minnesota Department of Health (MDH) Bug Bytes
June 4, 2001
Vol. 2: No. 11
1. HUS Death
2. Pseudomonas
3. Cryptosporidiosis and Swimming
4. The Owl and Salmonella
5. Twentieth Anniversary
1. HUS Death
On May 6, we were notified of a case of hemolytic uremic syndrome (HUS)
in a 3 year-old resident of Isanti County. The child had onset of bloody
diarrhea on May 1, and was hospitalized on May 2. E. coli O157:H7
was isolated from stool on May 4. The child died due to complications
of HUS on May 11. This is the second death due to HUS in a Minnesota child
since September 2000; before then we had seen no deaths in children since
1995. The child had attended family daycare. One additional case of HUS
was discovered in a co-attendee with onset of symptoms 9 days after the
initial case. A sibling of the second HUS case, who also attended the
day care, had a positive stool culture for E. coli O157:H7. Two
stool samples were collected from the other 8 children in the day care
and all were negative for E. coli O157:H7. As a reminder to clinicians,
recent practice guidelines for the management of diarrhea (http://www.journals.uchicago.edu/CID/journal/
issues/v32n3/001387/001387.html Attention: Non-MDH
link) urge careful consideration before initiating treatment of
an E. coli O157:H7 infection with antimicrobials. Antimicrobial
treatment has not been shown to ameliorate illness and may lead to an
increased risk of developing HUS.
2. Pseudomonas Folliculitis Outbreak
On May 8, we received a report of follicular lesions among individuals
who had stayed at a resort in Cook County. Eleven of 12 persons
who had stayed at the resort were interviewed; six developed follicular
lesions. Their rash was raised, red, and painful, and occurred on
the arms, legs, and torso. Five also reported having a sore throat.
Two persons saw a physician who collected cultures from the rash;
Pseudomonas sp. was isolated from one of these individuals,
the other was negative. Illness was associated with use of a hot
tub at the resort. Water was collected from the resort hot tub associated
with illness and a second hot tub; Pseudomonas aeruginosa
was isolated from both samples. Dermatitis and otitis externa outbreaks
due to Pseudomonas aeruginosa associated with hot tubs and
swimming pools are well described. To prevent these occurrences,
pool operators need to adhere to a strict disinfection, maintenance,
and monitoring program.
3. Cryptosporidiosis and Swimming
Last week's MMWR (http://www.cdc.gov/mmwr/preview/
mmwrhtml/mm5020a3.htm Attention: Non-MDH link)
highlighted outbreaks of cryptosporidiosis associated with swimming pools.
Gastrointestinal illness outbreaks associated with treated recreational
water have increased in recent years with most being caused by Cryptosporidium.
Cryptosporidium oocysts are small and may not be removed by filtration,
and they are resistant to chlorine. Due to the low infectious dose and
high titer of oocysts in the stool of an infected person, a single fecal
accident can contaminate an entire pool and accidental ingestion of a
small amount of water can result in infection. In Minnesota, we have seen
outbreaks of cryptosporidiosis associated with swimming pools, a water
sprinkler fountain, and swimming areas in natural lakes. In addition,
we have documented that a primary risk factor for sporadic cases is swimming
in public pools. Persons with diarrhea should not swim and swimmers should
avoid swallowing water. Additional information is at http://www.cdc.gov/healthyswimming.
Attention: Non-MDH link
4. The Owl and Salmonella
Last week, the Washington County Department of Public Health and
Environment investigated an outbreak of gastrointestinal illness
and fever among children attending two elementary schools (kudos
to them!). Approximately 40 were ill in one school and four in a
second school. Seven students (to date) have had positive stool
cultures for Salmonella Typhimurium. Illness was associated
with being in the science club or attending an after-school program
that met at the same time and place as the science club. Members
of the science club dissected owl pellets (the regurgitated remains
of the owl's meal - this owl was being fed chicks and mice) one
to four days before onset of illness. The dissecting took place
on a cafeteria table that was not sanitized before re-use, possibly
accounting for additional cases. We provided assistance and cultured
owl pellets and fresh droppings from the owl; Salmonella Typhimurium
was isolated from both pellets and droppings. Additional testing
including testing the meal source of chicks and mice, and molecular
subtyping, is ongoing. Children should enjoy science activities
such as these as long as they wash their hands when they are done
with soap and water, and their work area should be sanitized.
5. Twentieth Anniversary
Twenty years ago on June 5 was the first published report of the
syndrome that later would become known as AIDS. Many of you might
remember where you were when you first read it. Appearing in the
MMWR, the report described "5 young men, all active homosexuals,
… treated for biopsy-confirmed Pneumocystis carinii pneumonia
at 3 different hospitals in Los Angeles, California." A month later
was a second report of Kaposi's sarcoma and Pneumocystis
pneumonia among homosexual men in New York City and California.
The relentless spread of HIV across the globe since then has been
remarkable.
Bug Bytes is a combined effort of the Infectious Disease Epidemiology, Prevention and Control Division and the Public Health Laboratory Division of MDH. We provide Bug Bytes as a way to say THANK YOU to the infection control professionals, laboratorians, local public health professionals, and health care providers who assist us.
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