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State probes what caused kidney failure in 5 children

The urgent investigation focuses on links to petting zoos at fairs.

By Robyn Shelton

Sentinel Medical Writer

March 23, 2005

Five children are in critical condition at Orlando hospitals with kidney failure that may have been caused by infections they picked up at area petting zoos, health officials said Tuesday.

A sixth child has been treated and released after suffering from the same kidney ailment.

The rare condition can be fatal, and doctors said early symptoms include bloody diarrhea, vomiting, stomach cramps and decreased urination. While urging parents not to panic, doctors also said they should be aware of the unusual spate of infections.

Children have a good chance for a complete recovery if they get help early.

"It is important for parents to at least draw their health-care provider's attention to [the possibility] that their child's diarrhea is not just diarrhea -- especially parents who have taken their kids to county fairs," said Dr. Mehul Dixit, a pediatric nephrologist who is overseeing the care of four children being treated at Florida Hospital Orlando.

The infections are the subject of a large-scale investigation by a team of state and county health officials who are working urgently to determine how the youngsters became infected, said Bill Toth with the Orange County Health Department.

One theory is that they were exposed to trouble-causing bacteria through the feces of the petting-zoo animals. As recently as December, a petting zoo in North Carolina was linked to an outbreak of the kidney condition that sickened more than 100 children, according to the North Carolina Department of Health.

But Toth warned that it's early in the local investigation, and health officials are not ready to draw conclusions. They are, however, "leaning" toward the petting zoos as a possible source of the illnesses, he said.

The four children at Florida Hospital Orlando visited zoos at the Central Florida Fair, which ended a 10-day run in Orlando on March 13. A fifth child at Arnold Palmer Hospital for Children & Women visited a petting zoo at the Florida Strawberry Festival in Plant City, which also ran March 3-13.

Officials still are checking whether a sixth child, who was treated and released from Arnold Palmer about four weeks ago, had any exposure to petting-zoo animals. The child's case did not draw attention at the time, but officials are now interviewing the family to get more details, said Dr. Jorge Ramirez, a pediatric nephrologist with Arnold Palmer.

Toth said his department hopes to determine the cause in the next day or so, especially because there would be an ongoing danger if the illnesses are connected to the petting zoos, which move from county to county.

A representative from the Strawberry Festival declined to comment. But Central Florida Fair manager Charles Price said late Tuesday that no one had told him that his fair might be connected to the children's infections.

Both fairs had one exhibit in common -- the Ag-Venture Farm Tour, which is described on a Web site as an "interactive farm-animal exhibit" that offers "hands-on experience milking cows, bottle-feeding calves, gathering eggs [and] caring for the goats."

No one is singling out Ag-Venture as the source of the problems, however. Attempts to reach Ag-Venture officials were unsuccessful Tuesday.

But Price said he would be shocked if the petting-zoo exhibits were a source of the infections.

"All are inspected by health officials and vets -- we demand that," Price said. "We have hand-washing stations everywhere. . . . A fair today is not like it was 15 years ago," he said. "We are under extreme scrutiny."

The potentially dangerous kidney condition -- called hemolytic uremic syndrome or HUS -- is a rare complication arising from an initial infection most commonly associated with Escherichia coli, a bacterium found in undercooked beef or contaminated food.

Health officials also have documented E. coli exposures through the feces of animals, especially young calves, according to the Web site for the Centers for Disease Control and Prevention.

The local cases are confusing, however, because not all of the children are showing signs of E. coli exposure.

The two children at Arnold Palmer tested positive for the bacterium. But the four at Florida Hospital have tested negative so far, Dixit, the pediatric nephrologist, said.

Toth said the state is running fresh samples through additional testing to check for E. coli again. Officials are puzzled because three of the children at Florida Hospital have tested positive for a different bacterium -- Staphylococcus aureus.

This bacterium can lead to the kidney problem, but it's highly unusual.

"That's where the puzzle in this comes in," Toth said. "We really have a lot of question marks yet that we need to deal with."

Dixit said the first sick child came into Florida Hospital on Friday, and doctors became concerned when a second child was admitted with the kidney problem on Sunday. By Tuesday, the hospital had two more cases in children ranging from 2 to 6 years of age.

One child's kidney function has deteriorated to the point of requiring dialysis, and Dixit said the youngster is also on a ventilator.

Ramirez, the pediatric nephrologist, said the child who remains at Arnold Palmer also is undergoing dialysis.

In most cases of hemolytic uremic syndrome, Dixit said, the kidney failure is temporary and the child survives without complications.

Toth said county health departments and hospitals statewide have been alerted about the possibility of the rare kidney infections, and doctors are being asked to notify officials if they come upon any other cases.

Sandra Mathers and Tania deLuzuriaga of the Sentinel staff contributed to this report.

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