E. Coli Outbreak in Europe Growing

The Escherichia coli bacteria is found in the intestinal tracts of many animals, including humans. It is found in feces and spread through contact with feces. Improperly washed vegetables or mishandled meat are two common sources of infections. Proper food handling, from field to dinner plate, is the key to preventing any illness.

Most strains are benign and cause no illness. Some do, and the most serious illnesses are caused by strains that produce a toxin, Shiga toxin, which causes damage to the intestines and to other organs in the body. A typical E. coli infection causes symptoms of diarrhea, cramps and perhaps vomiting and fever and resolves in about 10 days. Enterohaemorrhagic E. coli (EHEC) infections can produce far more serious complications.

The two most common complications from an illness due to Shiga toxin E. coli are bloody diarrhea and a condition called haemolytic uraemic syndrome (HUS). HUS causes kidney failure through the production of tiny blood clots in the kidneys, reducing or cutting off their blood supply. 3-5% of patients with HUS may die. Up to 50% may have some residual kidney damage. Neurological problems such as seizures or stroke can occur in 25% of patients.

The current strain of enterohaemorrhagic Escherichia coli (EHEC) 0104:H4has been determined by public health authorities at the World Health Organization (WHO) as rare. It has never been seen before in a disease outbreak.

1,624 cases of illness due to E. coli infection have been reported through June 2. WHO reports that twelve countries have notified them of cases, 502 cases of HUS and 1,122 cases of EHEC. 1,621 cases are in people who live in or recently visited northern Germany. One case is in a person who had close contact with a German visitor and two patients appear to have no connection to Germany. The illness is blamed for 18 deaths.

HUS typically is seen in about 6% of E. coli illnesses. The current German outbreak has seen that rate jump to 31%.

Various strains of E. coli cause illnesses in the United States every year. The Centers for Disease Control (CDC) estimate that there were 203,000 cases of such infection on average in 2000-2008. Only 1.2% of the patients, 2,390, would have required hospitalization. They estimate that there were 21 deaths related to E. coli infection per year in that period.

The German outbreak is being closely watched by the CDC. They are working with state and local authorities to determine the source for two cases of HUS discovered in recent travelers to Hamburg, Germany.