Download HUS

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)