国立感染症研究所

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Reporting criteria of Enterohemorrhagic Escherichia coli Infection

(1) Definition: Systemic infection of vero-/Shigatoxin-producing (enterohemorrhagic) E. coli (VTEC/STEC/EHEC) that cause clinical symptoms as described under (2).
(2) Clinical Symptoms: Typical symptoms are abdominal pain and watery and bloody diarrhea, which is occasionally associated with vomiting, high fever as high as 38°C.  Hemolytic anemia and acute renal failure, i.e., Hemolytic Uremic Syndrome (HUS), may occur due to the action of verotoxin.  Infants or elderlies may develop convulsion, coma and encephalopathy, which may lead to the fatal consequence.
(3) Criteria of Notification: 
a) “Patient”: When a physician examines a person who has symptoms listed in (2), suspects EHEC infection and makes diagnosis of EHEC infection based on laboratory testing as described in the left column of Table below, the physician must notify the case immediately according to the Law, Article 12, paragraph 1.  The specimens to be used for the test should be suitable for the test, which are indicated in the right column of the Table.
b) “Asymptomatic carrier”: When a physician finds an individual who has no symptom listed in (2) but the laboratory test in the Table indicates the EHEC infection, the physician must notify immediately the person as an “asymptomatic carrier” according to the Law, Article 12, paragraph 1.  The specimens to be used for the test should be suitable for the test, which are indicated in the right column of the Table.
c) “Dead body of the infected”: When a physician inspects a body of a person with clinical characteristics listed in (2), suspects EHEC infection based on clinical pictures and symptoms, and diagnoses EHEC infection based on the laboratory tests as described in the left column of Table below, the physician must notify the case. The specimens to be used for the test should be suitable for the test, which are indicated in the right column of the Table.
d) “Dead body of the infection-suspected person”: When a physician investigates a dead body with characteristics listed in (2) and suspects death due to EHEC infection, the physician must notify the case according to the Law, Article 12, paragraph 1.
 

Laboratory tests

Specimens

  Detection of the pathogen through isolation and identification of the pathogen

  and confirmation of verotoxin using:

  1) Confirmation of toxin production;

  2) Detection of the toxin coding gene by means of PCR or other methods;

Stool

  Detection of verotoxin (only for clinical HUS cases)

  Detection of O antigen agglutinating antibody or anti-verotoxin antibody
 (only for clinical HUS cases)

Serum

Copyright 1998 National Institute of Infectious Diseases, Japan

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