1301. Utilization of Target Enriched Multiplex PCR to Rapidly Detect Community Outbreak of Enteric Illness Caused by Escherichia coli O157
Session: Poster Abstract Session: Below the Diaphragm
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 1301_IDWposter.pdf (983.6 kB)
  • Background

    Shiga toxin producing Escherichia coli (STEC), in particular O157, are a frequent cause of food and water-borne diarrheal disease with significant associated morbidity and mortality including hemorrhagic colitis and hemolytic uremic syndrome.   Rapid and definitive diagnosis of STEC causing community outbreaks results in actionable decisions with respect to clinical management of the patient and containment of disease.

    Method

    The index patient presenting to the Emergency Department (ED) with bloody diarrhea was tested for enteric pathogens utilizing Diatherix target enriched multiplex (Tem-PCR) proprietary enteric pathogen panel.  This assay is a nested PCR assay, with tagged, target specific primers providing initial target gene identification, and common flanking Super Primers providing bulk amplification.  Rapid detection of STEC 0157 within 6 hours prompted the case definition of bloody diarrhea, abdominal pain, fever, and attendance at a community picnic.  The Ohio Department of Health was notified.  Local physicians were asked to submit stools for Tem-PCR and treat patients with volume expansion, withhold antibiotics, and observe for progressive severe disease.

    Results:

    Stool samples were obtained from 15 patients meeting the case definition.  13 samples were positive for STEC O157 by Tem-PCR.   All were confirmed by culture. Only 4 were positive for Shiga Toxin using conventional screening technology.  Salmonella was detected in two patients, and one patient was co-infected with Giardia. PCR results were available with 24hours, whereas culture took at least 2 days.

    Conclusion:

    Rapid diagnosis of the etiology of community outbreak of STEC O157 resulted in early notification of the public health department, reduction in inappropriate use of antibiotics, and correct diagnosis of two patients fitting the case definition but infected with Salmonella, demonstrating the overlapping  clinical presentation of diarrheal illness.   In addition, diagnosis of co-infection with Giardia in another patient resulted in appropriate therapy.  In spite of the rapid identification of STEC O157, two patients developed hemolytic uremic syndrome, and one expired following surgery for toxic megacolon.  Figure 1 is the gross finding following colectomy.  

    Figure 1. 

    photo (6)

    Carol Quinter, PhD, Microbiology, Kettering Medical Center, Kettering, OH, Catherine D. Bacheller, MD, Medicine, Kettering Medical Center/Wright State University, Kettering, OH and Bobbye Owens, MLS (ASCP), Pathology, Kettering Health Network, Kettering, OH

    Disclosures:

    C. Quinter, Diatherix Laboratory: Consultant and Speaker's Bureau, Consulting fee

    C. D. Bacheller, Diatherix Laboratories: Consultant and Speaker's Bureau, Consulting fee

    B. Owens, Diatherix Laboratories: Employee, Salary

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