engleski

Epidemics in the hospital for mentally retarded persons

In the beginning of March 2004, an epidemics of the bowel infection occured in the Centre for accomodation and rehabilitation of mentally retarded persons, with the clinical picture of acute gastric enterocolitis. There are 690 persons in Centre, 401 of which are patients and 289 staff. A total of 160 patients developed the illness, three of which died. 80 patients developed a severe clinical picture, and 15 of them were transferred to the Clinic for Infectious Diseases "Dr F. Mihaljević" ; seven were kept under treatment. The affected persons displayed dominant gastric symptoms over 1-2 days with abundant profuse watry diarrhea, mostly without fever are vomiting. The transfer path was alimentary and all of the affected persons consumed a day befor the illness occured fried pork liver. From the samples of the food no pathogenic microbes were isolated. From 50 stool samples of the affected persons the following was not isolated: standard intestinal bacteria, vibriones, adeno or rota viruses, protozoa, B. Cereus, C. Perfringens, S. Aureus, negative ELISA on Norwalk-like. The only positive finding with an affected person was verotoxine. This finding was established also with the three deceased persons on which a postmortem was performed ; as the necrotic hemorraging inflamation of small intestine and colon is the consequence of verotowine, created in the by the enterohaemorhagic E. Coli. Verotoxine with the person on which post-mortem was performed was not found, as the post-mortem was performed more then 12 hours after death. With four affectes persons, verotoxine was established through reverse aglutination, and was confirmed by PCR. In Croatia, such analysis can be done in the Public Health Institute of City of zagreb. Lethality with the persons with impaired immune system affected with this infection can reach up to 11%. In this particular epidemics, it was 2%. The causes of the epidemics: specific population group, inadequate kitchen capacities, obsolete and poorly maintained kitchen, inability of mantaining the hygienic standards, utilisation of cheap and substandard food and inadequatly qualified personnel and poor organization of work. Epidemics lasted for a short time. By applying the proper measures of hygiene and epidemiological measures, and through co-operation of Sanitary inspection led by the epidemiologists, the epidemics was succesfully stopped.

epidemics; gastroenterocolitis; E. coli

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