Minnesota Department of Health (MDH) Bug Bytes
June 4, 2001
Vol. 2: No. 11
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.
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