CLINICAL-FEATURES OF INFECTIONS DUE TO ESCHERICHIA-COLI PRODUCING HEAT-STABLE TOXIN DURING AN OUTBREAK IN WISCONSIN - A RARELY SUSPECTED CAUSE OF DIARRHEA IN THE UNITED-STATES

In September 1994, a foodborne outbreak of enterotoxigenic Escherichia coli (ETEC) infection occurred in attendees of a banquet in Milwaukee , E. coli was isolated from stool specimens from 13 patients that were comprehensively tested; isolates from five patients were positive for E. coli producing heat-stable toxin, were biochemically identified an d serotyped as E. coli 0153:H45, and were all resistant to tetracyclin e, ampicillin, sulfisoxazole, and streptomycin, Diarrhea (100%) and ab dominal cramps (83%) were the most prevalent symptoms in 205 cases; vo miting (13%) and fever (19%) were less common. The median duration of diarrhea and abdominal cramps was 6 days and 5 days, respectively. In the United States, health care providers rarely consider ETEC as a pos sible cause of diarrhea in their patients, and few laboratories offer testing to identify ETEC, Hence, outbreaks of ETEC infection may be un derdiagnosed and underreported, As in this outbreak, the relatively hi gh prevalence of diarrhea and cramps lasting greater than or equal to 4 days and the low prevalence of vomiting and fever can help distingui sh ETEC infection from Norwalk-like virus infection and gastroenteriti s due to other causes with incubation times of greater than or equal t o 15 hours and can provide direction for confirmatory laboratory testi ng.