Southwest District Health (SWDH) has identified a significant increase in Shiga toxin-producing E. coli (STEC) infections among residents of the public health district, especially among children less than 5 years of age, some of whom attend daycare facilities.

Children <5 years of age and the elderly are at increased risk of severe illness resulting from STEC infections. Stool testing should be performed for enteric diseases, including STEC in people with diarrhea accompanied by fever, bloody or mucoid stools, severe abdominal cramping or tenderness, or signs of sepsis.

Antibiotics are not recommended for patients with suspected STEC infections until complete diagnostic testing can be performed and STEC infection is ruled out. Administering antibiotics to patients with STEC infections might increase their risk of developing hemolytic uremic syndrome (HUS), and a benefit of treatment has not been clearly demonstrated. Features of HUS include low platelet count, anemia, and renal failure.

To improve STEC diagnosis and reporting:

• All stools submitted from patients with acute community-acquired diarrhea should be tested for STEC, and if positive, serotyped. Serotyping can be done at the Idaho Bureau of Laboratories (IBL).

• Testing for STEC should include a PCR test for Shiga toxins or the genes encoding these toxins.

• Clinical laboratories should forward STEC isolates or Shiga toxin-positive stools to the IBL as soon as possible for additional characterization.

• Often, by the time a patient presents with HUS, the causative STEC can no longer be easily isolated from a stool specimen. For any patient with HUS without a culture-confirmed STEC infection, please contact IBL to discuss sampling and testing.

All STEC cases (including suspect STEC) are reportable within 1 working day. Report the detection of STEC or diagnosis of HUS to Southwest District Health Communicable Disease / Epidemiology Program

Southwest District Health confidential reporting phone line: (208) 455-5442

Southwest District Health confidential reporting fax line: (208) 455-5350

Daycare attendees, daycare workers, food handlers and healthcare workers with suspected STEC should be excluded from work until they can no longer transmit STEC. Contact SWDH for more details about exclusions and restrictions.

Additional Resources:

2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea 

CDC E. coli Resources for Clinicians and Laboratories