Mar 25, 2005
By JAN HOLLINGSWORTH
PLANT CITY – State agriculture officials have dispatched a team of veterinarians and inspectors to test farm animals that may be linked to life- threatening cases of kidney failure among children and at least one adult who attended recent fairs in Orange and Hillsborough counties.
First stop was Ag-Venture, a Plant City-based farm show that operated petting zoos this month at the Florida Strawberry Festival and the Central Florida Fair.
All the patients with the potentially deadly syndrome had contact with livestock at the fairs.
“I think we were a good starting point because we had been mentioned in the news,” said Tom Umiker, who created Ag-Venture in 1996 to educate city kids about farm life.
The state Department of Health on Wednesday issued an alert along the Interstate 4 and Interstate 75 corridors, warning of the potential for children who had visited petting zoos at the fairs to develop hemolytic uremic syndrome.
The condition begins with diarrhea and can progress to kidney failure.
So far, Ag-Venture is the one common factor investigators have identified. Health officials say they have not ruled out other sources of the infection.
“They’re talking to the fairs, taking a look at what kind of vendors were there, where the animals were. They’re taking a look at food preparation as well,” said Joann Schulte, an epidemiologist with the state health department.
John Sinnott, director of the division of infectious disease at the University of South Florida, said the source may not be direct contact with animals.
“It’s tempting to think that there’s a petting zoo at fault, but all we remember are things that are out of the ordinary, whereas you may have forgotten that you drank milk or ate ice cream,” Sinnott said.
The syndrome is most often associated with a virulent form of the E. coli bacterium, commonly found in animals’ intestines. Yet none of the children has tested positive for E. coli, according to health officials.
The syndrome can occur with salmonella, which is associated with chicken; shigella, which is associated with sewage; and some viral agents, Sinnott said.
Contaminated food – not petting zoos – is a far more common source of infection, he said.
“It makes me wonder that there’s something else going on here,” Sinnott said. “This could be an unheard of or unidentified pathogen, and I hope they’re looking carefully at viruses.”
Whatever the source of infection, the illness follows a predictable course: diarrhea, especially bloody diarrhea, and possible fever followed by lethargy, anemia and decreased urine output.
The syndrome can develop up to eight days after the diarrhea has resolved itself, said Mehul Dixit, a pediatric kidney specialist who is tending to the stricken children at Florida Hospital in Orlando.
Although the diarrhea has stopped, the bacteria emit toxins that destroy red blood cells. Fragments of those cells can clog slender vessels in the kidneys, cutting off blood flow and impairing kidney function.
The number of children, ages 2 to 6, with the syndrome at Florida Hospital increased to six with the admission Thursday of another child.
Most are in critical condition. One has been on a ventilator and dialysis for days. A second child was put on dialysis late Wednesday.
The newest case involves a child whose sibling and a grandparent have bloody diarrhea and are being closely watched to see whether they develop the syndrome.
The siblings attended a petting zoo at the Central Florida Fair. Their grandparent, whose age and gender the hospital would not disclose, did not.
The message, Dixit said, is that household contact, especially for the elderly, can lead to infection even if they have not been in contact with livestock.
“Please watch out because they are potentially at risk of developing HUS,” he said.
Two additional cases at Arnold Palmer Hospital for Women and Children in Orlando involve a child and an adult who attended the Florida Strawberry Festival, which ended its 11-day run March 13.
The hospital would not disclose the conditions of those patients.
County health officials say no cases of hemolytic uremic syndrome have surfaced in Hillsborough County, although hospitals and doctors have been asked to be on the lookout for unexplained cases of bloody diarrhea.
Officials at several Tampa Bay area hospitals said Thursday that they have not seen any suspected cases of HUS.
Reporter Jan Hollingsworth can be reached at (813) 754-3765.