A Cluster ofCasesofEscherichia coli 0157Infection ina Day-Care Center ina CommunalSettlement (Kibbutz) inIsrael

Thisisthefirst report inIsrael ofacluster ofcasesofdiarrhea associated withtheisolation ofEscherichia coli 0157instool samples. E.coli 0157:NM(nonmotile), producing verotoxins 1and2was isolated fromthe stool samples ofthree infants less than1yearofage withdiarrhea andfroma fourth asymptomatic infant staying inthesame day-care class ina communalsettlement (kibbutz). Theclinical presentation included nonbloody diarrhea without other symptoms. Surveillance efforts should beenacted inordertodefine the relative importance ofE.coli 0157infections inIsrael. Escherichia coli serotype 0157was first recognized as a humanpathogen during theinvestigation oftwo separate outbreaks ofdiarrhea intheUnited States in1982(5). The clinical syndrome described was distinguished bycopious bloody diarrhea unaccompanied bytheclassical signs of dysentery suchas fever andpus cells inthestools (2,6). Infections withE.coli 0157havealso beenassociated with hemolytic uremicsyndrome andthrombotic thrombocytopenic purpura(3,8). Several reports ofoutbreaks ofdiarrhea duetoE.coli 0157innursing homes,day-care centers, schools, andthe community haveestablished thepublic health importance of this organism. (1,3,4,9).Until now, only a fewsporadic infections withE.coli 0157inIsrael havebeenreported. We describe herethefirst cluster ofcasesofenteric infection duetoverotoxin-positive E.coli0157:NMoccurring in