Letters to the Editor

Cookouts and the Seasonal Peak of Escherichia coli Infection

Am Fam Physician. 1998 Apr 1;57(7):1494.

to the editor: Upon reading the article on Escherichia coli,1 I was a bit surprised when the authors stated, “For unknown reasons, the rate of infection follows a seasonal pattern, with a peak incidence from June through September.”

Out here in the Midwest, a lot of folks cook out from June through September. Not surprisingly, many of them cook hamburgers, a wonderful reservoir for E. coli. Since folks at cookouts tend to be impatient, many of them eat hamburger meat that is undercooked. This is, to my simplistic view, a logical explanation for the seasonal peak from June through September.

GORDON WALBROEHL, M.D

Department of Family Medicine

Wright State University School of Medicine

Dayton, OH 45435

REFERENCE

1. Koutkia P, Mylonakis E, Flanigan T. Entero-hemorrhagic Escherichia coli O157:H7—an emerging pathogen. Am Fam Physician. 1997;56:853–6.

in reply: We appreciate Dr. Walbroehl's comments on our article. The importance of undercooked hamburgers in the epidemiology for E. coli O157:H7 infection is well-described in the literature and has been referred to as “barbecue syndrome.”1 This association was actually noted two paragraphs after the phrase that Dr. Walbroehl mentioned; it was also noted in the patient information handout accompanying the article.2

We believe that the epidemiology of E. coli O157:H7 is very important. However, little is known about the actual risk factors. The observation regarding cookouts has been tested in a large and well-documented epidemiologic study,1 and there was no statistical significance noted with barbecued hamburgers. Although there are studies explaining the epidemiology of E. coli O157:H7-associated gastroenteritis, it is still not fully explained why this infection peaks during the summer.1,3–5 Also, it was recently noted that the “seasonal variation of E. coli O157:H7 infection may reflect the ecology of the organism, variation in the consumption of ground beef or some other factor.”6

More studies are needed to evaluate the seasonal pattern of this disease.

POLYXENI KOUTKIAK, M.D

ELEFTHERIOS MYLONAKIS, M.D., PH.D

TIMOTHY FLANIGAN, M.D

Department of Medicine

Miriam Hospital

164 Summit Ave

Providence, RI 02906

REFERENCES

1. Bryant HE, Athar MA, Pai CH. Risk factors for Escherichia coli O157:H7 infection in an urban community. J Infect Dis. 1989;160:858–64.

2. Koutkia P, Mylonakis E, Flanigan T. Escherichia coli O157:H7 infection [Patient information handout]. Am Fam Physician. 1997;56:859–61.

3. Pai CH, Ahmed N, Lior H, Johnson WM, Sims HV, Woods DE. Epidemiology of sporadic diarrhea due to verocytoxin-producing Escherichia coli: a two-year prospective study. J Infect Dis. 1988;157:1054–7.

4. Su C, Brandt LJ. Escherichia coli O157:H7 infection in humans. Ann Intern Med. 1995;123:698–714.

5. Griffin PM, Ostroff SM, Tauxe RV, Greene KD, Wells JG, Lewis JH, et al. Illnesses associated with Escherichia coli O157:H7 infections. A broad clinical spectrum. Ann Intern Med. 1988;109:705–12.

6. Boyce TG, Swerdlow DL, Griffin PM. Escherichia coli O157:H7 and the hemolytic-uremic syndrome. N Engl J Med. 1995;333:364–8.

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