Betsy Todd's article "Outbreak: E. coli O157:H7" (Emerging Infections, February) reminds me of a patient I saw last summer, just before the outbreak, who had bloody diarrhea and severe abdominal pain. I suspected Escherichia coli infection immediately because my brother almost died from hemolytic uremic syndrome (possibly from E. coli infection); otherwise, I probably wouldn't have considered it. The process for identifying whether a case is part of an outbreak takes two to three weeks. But E. coli infection can be spread from person to person, so knowing its prominent symptoms-abdominal cramps and bloody diarrhea-helps nurses initiate contact precautions to prevent its being transmitted to others before positive identification has been made.

Rachel M. Groves, RN

Hanson, KY