BMJ  2008;336:1147-1148 (24 May), doi:10.1136/bmj.39583.767766.3A

Letters

Bloody diarrhoea

Test early for verotoxin producing Escherichia coli

The first 150 words of the full text of this article appear below.

Murphy’s article on the management of bloody diarrhoea in children in primary care (and indeed his interests, judging from his reference 1) seems to be orientated towards the early diagnosis and treatment of inflammatory bowel disease.¹ Some of his recommendations, however, particularly figure 1, should therefore be expanded so as not to be problematic for the management of infection, in general, and verotoxin producing Escherichia coli O157, in particular.

Surveillance based on a GP sentinel scheme in Wales showed an incidence of bloody diarrhoea of 30/100 000 in under 15 year olds, 80% of which was caused by either salmonella or campylobacter infection,² in line with Murphy’s estimates. Recognised infection with verotoxin producing E coli O157 is rare (1-2/100 000 per year in Wales), but early diagnosis—which, contrary to table 2, can usually be achieved by stool culture—is important:

• Spread occurs readily in household³ and similar settings (such as children’s . . . [Full text of this article]

¹ National Public Health Service for Wales, Temple of Peace and Health, Cardiff CF10 3NW, ² Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany

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