河南省睢县一起腹泻后并发急性肾功能衰竭爆发的调查

目的 调查大肠埃希菌O157：H7感染性腹泻的分布特征，临床特点及家畜、家禽的带菌状况和外环境污染程度，方法 用现患调查方法，描述大肠埃希菌O157：H7感染性腹泻的发病情况，分析引起流行的原因，用O157特异性筛查方法进行病原体分离培养，应用分子生物学，微生物学，细胞学技术进行病人，家畜、家禽的病原学分离，培养，毒素因子测定。结果 睢县是河南省首先发现的疫区，从3月17日至7月6日共发生病人35例，合并急性肾功能衰竭32例，死亡28例，病死率87.50%，60岁以上发病占91%；从家畜，家禽分离出107株O157：H7菌株，从腹泻病人中分离出48株；微生物学，分子生物学及细胞学技术鉴定67株具有毒素基因；显示有5个毒素因子组合型。结论 大肠埃希菌O157：H7感染性腹泻并发急性肾功能衰竭是病人死亡的主要原因，家畜、家禽的高速 菌率可通过污染水，食物传染给人，亦可通过蝇和日常生活接触感染，睢县疫情是一起大肠埃希菌O157：H7感染引起的溶血性尿毒综合征的爆发。

A study on acute renal failure after an outbreak of diarrhea in Suixian county, Henan province

OBJECTIVE: To study the distributional feature and clinical characteristics of infectious diarrhea caused by enterohemorrhagic Escherichia coli O157:H7, and to understand its pollution to the environment and the carrier status among livestock and poultry. METHODS: To describing the incidence of diarrhea, to isolate and culture the pathogenic bacteria from samples of the patients with diarrhea and livestock or poultry with methods of microbiology, molecular biology and cytology, and then to determine the toxic factors. RESULTS: In the first epidemic area in Suixian county, Henan province, 35 cases had been found during 17 March and 6 July with 91% of them above age of 60. Of them, 32 were complicated with acute renal failure, including 28 death (death rate: 87.50%). One hundred and seven strains of O157:H7 were isolated from the samples of livestock or poultry and 48 strains were isolated from patients. It was found that 67 strains having toxic gene through microbiological, molecular biological and cytological technologies. Five types of toxic factors were found. CONCLUSION: The main factor causing death was the complicated acute renal failure from diarrhea infected by E. coli O157:H7. The pathogen from livestock or poultry with high carrying rate might infect people through polluted water, food flies and close contacts. The outbreak of acute hemolytic uremic syndrome in Suixian county was caused by Enterohemorrhagic Escherichia coli O157:H7 infection.