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6/7/2011 1:18 PM
Shiga toxin-producing Escherichia coli (STEC) Alert
"Considerations for Ohio EMS Providers"
By: The Centers for Disease Control and Prevention (CDC) The Centers for Disease Control and Prevention (CDC) is monitoring a large outbreak of Shiga toxin-producing Escherichia coli (STEC) infections that are currently ongoing in Germany. This is a highly aggressive and virulent strain of Escherichia coli (E. coli), the bacteria that is a common cause of gastrointestinal illness and diarrhea in the United States. This rare strain of E. coli has been associated with patients with hemolytic uremic syndrome (HUS), nine of whom, as of May 31, 2011, have died. HUS is a constellation of acute renal failure, an infrequently seen form of hemolytic anemia, and thrombocytopenia (low platelet count). Although the CDC is not aware of any cases of STEC infections in the United States, there have been three cases of HUS in the United States as of May 31, 2011 in persons who have recently traveled to Hamburg, Germany. The CDC has recommended that any person who has recently traveled to Germany and has signs or symptoms of STEC infection, or HUS, should seek medical care immediately and let the medical provider know about the outbreak of STEC infections in Germany and the importance of being tested for STEC infection. EMS professionals can facilitate the identification of patients who may be at risk for STEC infections by obtaining the travel history, particularly to Germany, in patients exhibiting signs and symptoms of STEC infection or HUS. The symptoms of a STEC infection include severe stomach cramps, vomiting, diarrhea (which may be bloody), and possibly a low-grade fever. The majority of patients with STEC will make a full recovery within 5-7 days; however, a percentage of these patients will subsequently develop HUS. The signs and symptoms of HUS that can be noted in the prehospital setting by EMS professionals include profuse watery bloody diarrhea, pallor (secondary to the anemia and blood loss), purpura (subcutaneous bleeding secondary to low platelets), and weakness or lethargy (secondary to the uremia of renal failure). The treatment of the patient with symptoms of STEC infection or HUS should be completed according to the prehospital protocols provided by the EMS medical director, and the patient should be transported to the appropriate facility. As in all patient encounters, regardless of the chief complaint, signs, or symptoms, the assessment of vital signs and the donning of the appropriate level of personal protective equipment (PPE) are essential. NOTE: The Division of EMS does not endorse products or services. The contents of this e-mail are provided as a service to the EMS community. |
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