Cuyahoga County E. coli outbreak - Ohio (2009)


On July 3, 2009, the Cuyahoga County Board of Health (CCBH) announced that it was investigating a cluster of hemolytic uremic syndrome (HUS) cases associated with exposure to E. coli O157:H7 bacteria. In its press release, CCBOH stated that three children had become ill with HUS secondary to E. coli infection; two from Olmstead Falls and one from Strongsville and that two additional HUS cases were still under investigation.

HUS occurs in two to seven percent of E. coli victims, primarily children, and is the most common cause of kidney failure in children. There is no cure or effective treatment for HUS, and health care providers can only provide supportive care for HUS patients.

HUS is believed to develop when the toxin from E. coli bacteria, known as Shiga-like toxin (SLT), enters the circulation through the inflamed bowel wall. SLT, and most likely other chemical mediators, attach to receptors on the inside surface of blood vessel cells (endothelial cells) and initiate a chemical cascade that results in the formation of tiny blood clots within these vessels.

Some organs seem more susceptible to injury during HUS—including the kidneys, pancreas, and brain—perhaps due to the presence of increased numbers of receptors. By definition, when fully expressed, HUS presents with the triad of hemolytic anemia (destruction of red blood cells), thrombocytopenia (low platelet count), and acute renal failure (loss of the filter function of the kidney).

As already noted, there is no known therapy to halt the progression of HUS. HUS is a frightening complication that, even in the best American centers, has a notable mortality rate. Among survivors, at least five percent will suffer end stage renal disease (ESRD) with the resultant need for dialysis or transplantation.

CCBH stated that its investigation had not indicated whether the E. coli and HUS cases were associated with ground beef recalls, including ameat recall by JBS Swift.