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Reporting diseases that rely on a clinical diagnosis: A look at Hemolytic Uremic Syndrome (HUS) Madhura Sundararajan, MPH The Effect of Misreporting August 4-5 Three cases from three nearby counties. All tested positive for both Campylobacter antigen and Shiga toxin. Two specimens sent to ISDH Lab both tested positive for Shiga toxin producing E. coli O157:H7 and negative for Campylobacter August 8 Investigations revealed that 2 cases from two separate counties attended same day care Control measures implemented at day care A August 10: ISDH learned from social media post that two cases were hospitalized for HUS Situation escalated and community members picketed the health department B Local hospital suspected HUS and transferred patient Hospital A Patient was treated at Hospital B, but died Background: Shiga-toxin producing E. coli (STEC) • Most E. coli are harmless, important for healthy human intestinal tract • Pathogenic E. coli diverse group of bacteria, cause illness • Shiga toxin-producing E. coli (STEC) – most commonly mentioned in the news associated with foodborne outbreaks – most common cause of postdiarrheal HUS in children Photo/Figure taken from CDC Image Library Shiga-toxin producing E. coli (STEC) O157 STEC STEC O157:H7 Non-O157 STEC Includes O26, O103, O111, O121, O45, O145 among others Shiga-toxin producing E. coli (STEC) Hemolytic Uremic Syndrome (HUS) • • • • Photo/Figure courtesy of Madhura Sundararajan Thrombotic microangiopathy: formation of a blood clot in capillaries and arterioles Hemolytic anemia: destruction of red blood cells Thrombocytopenia: deficiency of platelets causing bleeding, bruising, and slow blood clotting after injury Acute renal dysfunction: kidneys suddenly become unable to filter waste products from blood *Diarrhea may range from mild and non-bloody to stools that are virtually all blood Epidemiology Resource Center (ERC) • Conduct surveillance to monitor disease trends • Investigate communicable disease • Maintain Communicable Disease Reporting Rule (410 IAC 1-2.5) • List of diseases available at: http://www.in.gov/isdh/25366.htm Transmission and Contributing Factors Transmission • Fecal-oral • Foodborne (undercooked meats, raw produce) • Direct person-to-person can occur in families, child care centers, and custodial institutions • Waterborne from contaminated drinking water and recreational waters Contributing Factors • Consumption of undercooked meats, crosscontamination • Consumption of raw or unpasteurized products • Contact with animals • Contact with those infected When to Consider HUS • Evidence of anemia following a diarrheal illness • Evidence of renal injury following a diarrheal illness • Evidence of low platelet count following diarrheal illness • Nephrology consultation • High-risk age range (younger children) • Dehydration • Severe GI illness requiring hospitalization or transfer • Any of the above in conjunction with STEC O157 or non-O157 positive lab result Contacts for Infectious Diseases • ISDH Epidemiology Resource Center: 317-233-7125 • ISDH After Hours Line: 317-233-1325 • CDC/EOC Physician Line: 770-488-7100 [email protected] (317-234-6312)