The number of Escherichiosis cases caused by serotypes other than E. coli O157 was 37,000 in the United States, compared to 73,000 due to the serotype O157. In a study in Australia, it was reported that in half of the hemolytic uremic syndrome caused by serotypes other than O157, the serotype O111 was the etiologically significant factor.

According to a report published in the journal Archives of Internal Medicine, serotype E. coli O111 in some cases causes severe infection and can potentially be detected more often than is known thought so.

The epidemic in Oklahoma proved to be the case when it was possible to characterize for the first time the course of the infectious process caused by the serotypes E. coli, other than O157, and for to trace the development of hemolytic uremic syndrome (after E. coli O26, O157 is the serotype most often isolated in case of gastrointestinal infections in the USA). And, although the incidence of hemolytic uremic syndrome in cases of infection caused by serotype O111 (17%) was comparable to that in cases of infection caused by serotype O157, the age composition of the patients was significantly different.

The development of hemolytic uremic syndrome following an infection caused by E. coli, characteristic of young children. However, in 2008, during an epidemic of escherichiosis in Oklahoma, the highest percentage of hemolytic uremic syndrome was recorded in older children (age group 10-17 years), and almost one third of hospitalized patients and more than half of patients with advanced hemolytic uremic syndrome. the adults. The data obtained attracted the attention of specialists.

In this study, we analyzed all cases of hospitalizations associated with an epidemic of escherichiosis in Oklahoma, the incidence of hemolytic uremic syndrome, as well as factors associated with the subsequent development of hemolytic uremic syndrome in hospitalized patients. The medical documentation was analyzed based on the clinical course of the infection and data confirming the development of hemolytic uremic syndrome in hospitalized patients. A comparison was also made of clinical characteristics and laboratory analysis data of hospitalized patients based on the presence or absence of hemolytic uremic syndrome.

A team of researchers carefully analyzed the medical records of 156 people with escherichiosis (identified E. coli O111 serotype) after visiting a suburban buffet restaurant in Oklahoma. Of the 156 cases, 72 people were hospitalized, 26 (16.7%) developed hemolytic uremic syndrome, of which 65.4% of patients required hemodialysis, 1 patient died. The average age of patients with hemolytic uremic syndrome was 43.5 years (age range 1 year to 88 years) and the proportion of adult patients was 57.7%. The clinical and laboratory characteristics of patients on admission to hospital, associated with the subsequent development of hemolytic uremic syndrome, included the number of leukocytes in peripheral blood of at least 20,000 / ml (adjusted odds ratio 11, 3; 95% confidence interval 1.7-75.3), increased serum creatinine (9.7; 1.4-69.2), as well as vomiting before hospitalization (6.8; 1.5 -31.3). Prescribing antimicrobial drugs (risk ratio 1.0; 95% confidence interval 0.5-1.8) or antidiarrheals (1.4; 0.6-2.9) was not associated with development of subsequent hemolytic uremic syndrome.

Since there was previously no information on the properties of this serotype to cause a severe course of the disease with unfavorable results, most laboratories did not look for E. coli O111 and other serotypes other than O157 in patients with a preliminary diagnosis of infectious diarrhea. However, this case clearly demonstrates the need for tests to identify E. coli O111 and other serotypes other than O157, which should be used to circulate all potential E. coli , which can cause illness with diarrheal syndrome. In addition, according to the researchers, any laboratory is equipped with the equipment necessary for the analysis. If E. coli O111 and other serotypes other than O157 are isolated from the patient, physicians should closely monitor the appearance of early signs of the development of hemolytic uremic syndrome and conduct intensive therapy to prevent the development of serious complications. This provision echoes the recommendations of the Centers for Disease Control and Prevention that testing is mandatory to determine all possible producers of Shiga toxin, including serotypes other than E. coli 0157. The data obtained demonstrate the need to include in the differential diagnosis cases of infectious diarrhea caused by O111 and other serotypes other than O157 E. coli.

Thus, the incidence of hemolytic uremic syndrome in an outbreak of infection caused by E. coli O111, was comparable to that of E. coli O157 caused outbreaks of the disease, but in most cases, adult patients have been exposed to this serious complication. Upon admission to hospital, patients with diagnosed infection caused by serotypes other than E. coli O157, the factors associated with the development of hemolytic uremic syndrome should be identified. Careful observation and early initiation of intensive and effective therapy in this category of patients will help prevent the development of life-threatening complications and significantly improve clinical outcomes.