The neurological manifestations of hemorrhagic colitis in seven kindergarten children with Escherichia coli 0157:H7 infection are reported from the Saitama Children’s Medical Center, Saitama, Japan. Generalized convulsions, occurring in 5 comatose patients, were intractable in 3 and required toxic doses of anticonvulsants for their control. Two patients died after 5 and 7 days of illness. Transient symptoms, delayed in onset for 2 to 6 weeks and after consciousness improved, included phrenic nerve paralysis in 1 patient, neurogenic urinary incontinence in 3, gaze nystagmus in 3, action tremor and oral dyskinesia in 1, and vertigo in 1 patient. Pyrexia and hemolytic uremic syndrome were seen only in patients with neurologic complications. Diarrhea, bloody diarrhea, and abdominal pain were more frequent and severe in this group compared to 7 patients with no neurologic symptoms who were admitted to hospital. Contaminated well water was the source of infection, and verotoxin-I (Shiga-like toxin I) was the likely cause of neurological symptoms. [1]

COMMENT. Fever, high white blood cell count, young or old age, and prolonged antimotility drug use are risk factors for complications of this strain of E. coli infection. The neurologic and other complications of foodborne and waterborne infections, pollutants, and additives, are covered in Environmental Poisons in Our Food, Chicago, PNB Publishers.