Hemolytic uremic syndrome surveillance to monitor trends in infection with Escherichia coli O157:H7 and other shiga toxin-producing E. coli.

ceftriaxone and convenience of outpatient parenteral therapy, this antibiotic was continued to complete a 10-day course. On extensive questioning, the patient denied contact with any cat, dog, or other animal. He had recently traveled to Nigeria but denied even transient animal contact. Since 1966, three cases of P. multocida epiglottitis have been reported (2-4). Although no direct culture of the epiglottis was performed in the present case, the clinical syndrome and the absence of any other focus accounting for P. multocida bacteremia strongly suggest that this organism caused the epiglottitis. Including the present case, three of the four reported cases have occurred since 1993, which suggests that either earlier cases were not recognized or the incidence of this condition may be increasing. In all three previous cases of P. multocida epiglottitis, the patients had cats as pets. As in the current case, the clinical features of P. multocida epiglottitis were indistinguishable from epiglottitis secondary to more common bacterial pathogens. However, the cases were all associated with positive blood cultures. In contrast, a 23% rate of bacteremia was reported in a series of epiglottitis cases in adults (including patients with blood cultures positive for Haemophilus influenzae type b or Group A streptococci)(5). The vehicle of infection for this patient remains unknown, as human-to-human transmission has not been documented. This case demonstrates that epiglottitis due to P. multocida, a rare condition that may be increasing in frequency, need not be accompanied by recognized exposure to animals.