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Hemolytic Uremic Syndrome Cases Increase in Florida

Recombinomics Commentary
March 25, 2005

>>  State health investigators are trying to determine whether more than a dozen people with a life-threatening kidney infection might have taken part in a common activity at two state fairs.

As of Friday morning, the number of patients across five counties jumped to 15, with more cases expected, said Florida Health Secretary John Agwunobi.

Eleven of the ill are children younger than 10; the adults are older than 40.

The cases involve people living in Orange, Seminole, Collier, Volusia and Pasco counties who recently attended the Central Florida Fair in Orlando or the Florida Strawberry Festival in Plant City.

They all had diarrhea within the past two to three weeks and they all tested positive for a specific strain of E. coli, or showed signs of having hemolytic uremic syndrome, or HUS, a fairly infrequent complication arising from an initial infection of the E. coli bacterium, Agwunobi said.,,,,,,,

In addition, Pasco officials are awaiting a medical examiner's report to determine what took the life of a 12-year-old Wesley Chapel girl who collapsed and was found dead in her home Wednesday morning.

Kayla Nicole Sutter, a Weightman Middle School student, had been sick since Saturday with a 103-degree fever, according to the Pasco County Sheriff's Office.

Sutter visited the petting zoo at the Strawberry Festival, the family told a Pasco epidemiologist.

"We want to know if this is one of those cases," Yacht said. <<

The death of the Wesley Chapel girl may be a coincidence or an indication of a broader outbreak.  HUS is most commonly associated with younger children, so the linkage to older adults may be significant, since one or more did not attend the festival, but lived with one of the children with symptoms.

A temperature of 103 degrees is frequently associated with a viral disease.  The failure to find E. coli in most of the patients may signal something more than the most common explanation for HUS in young children.

Last month there was a flu outbreak among greyhounds in Daytona Beach, which may be a consideration.  There was an outbreak among greyhounds last season also, which was associated with H3N8, a virus that has been associated with flu in horses and birds.  Last season's jump to dogs was a first, so further spread to humans is possible.  Most human flu isolates are H3N2. The California/7 strain has been aggressive, and has spread throughout the United States and worldwide.  Its spread to the eastern portion of the US last month correlated with an outbreak of sudden deaths in students, most commonly associated with meningococcal-linked meningitis, including a cluster near Bonita Springs, FL.

Additional information on the Wesley Chapel girl would be useful to further evaluate the relationship between her illness and visit to the petting zoo at the Strawberry Festival.

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