HAEMOLYTIC URAEMIC SYNDROME ASSOCIATED WITH A FAMILY CLUSTER OF ENTEROHAEMORRHAGIC ESCHERICHIA COLI

still had significantly impaired renal function. 2 In Australia HUS is usually caused by a subgroup of Shiga toxin-producing Escherichia coli known as enterohaemorrhagic E. coli (EHEC). The Shiga toxins cause cell damage and trigger an inflammatory process which initiates intravascular coagulation resulting in microthrombi forming in small blood vessels in the gut and kidney. 3 The natural reservoir of EHEC is the gut of animals, particularly cattle and sheep. Hence HUS can be caused by contact with animal faeces, either directly or via contaminated, inadequately cooked food, particularly meat and dairy products. Most of the cases in the 1995 outbreak of HUS in South Australia had consumed (in the week before the onset of illness) an uncooked fermented sausage manufactured in Adelaide. 1 Subsequent molecular studies revealed an identical EHEC in both faeces of the cases and samples of the sausage. 4 Because EHEC infection, and therefore HUS, can be foodborne, it is of considerable public health concern. Following the South Australian outbreak, HUS became a notifiable disease in Queensland in mid-1996, and EHEC in mid-2001. However, a recent case of HUS in north Queensland has identified several shortcomings in the management and investigation of HUS and EHEC infections; some of these shortcomings were also identified in a previous cluster of HUS cases that occurred in north