Ecoli in Michigan, Source Still Pending

The Ottawa County Department of Public Health in Michigan is alerting the public to an increase in the number of cases of a shiga-toxin producing E. coli (STEC).  This Ecoli in Michigan comes after nine cases have been linked during the investigation so far.  Four have been serious enough to require hospitalization.

These cases of shiga-toxin producing E. coli infections are typically associated with foodborne outbreaks, though other factors such as higher levels of E. coli in lake water may be a cause.

About the Ecoli in Michigan

The local health department is working with State partners and the State agriculture departments to investigate possible links between the cases.

The current advisory from health leaders is to prevent infection by “using good handwashing, cooking meats thoroughly, washing fruits and vegetables under running water, and not swallowing water while swimming.”  All broad methods to reduce risk of infection.

What is STEC or Shiga-toxin Producing E. coli?

A shiga-toxin producing E. coli is a strain of bacteria that produces a harmful toxin as it reproduces and grows.  A common STEC is Escherichia coli O157:H7.  The letters and numbers following the name “Escherichia coli or E. coli” refer to the specific markers found on the surface of the bacteria that allow scientists to distinguish one strain from another.  This harmful bacteria is responsible for around 73,000 cases of infection and about 61 deaths in the United States each year.

Most strains of E. coli are harmless and live in the intestines of healthy humans and animals.  However, the type of E.coli currently concerned produces a powerful toxin that is responsible for the illness people feel after becoming infected.

At this time, the specific strain of E. coli has not been released.  With current information pointing towards an STEC, preventative measures and symptoms to look out for are fairly consistent.

Common Sources

Common sources of STEC are foodborne.  Undercooked, contaminated ground beef, raw sprouts, lettuce, raw milk, unpasteurized juice, or person-to-person contact with someone sick with the illness are the biggest culprits.  As is swimming in or drinking sewage contaminated water.

Cattle Farms Often the Source

Many cases of STEC originate from cattle farms.  Small amounts of the harmful bacteria can live in the intestines of healthy cattle.  During slaughter, meat can become contaminated and mixed into the product when it is ground.  Also, bacteria present on a cow’s udders or on equipment may get into raw milk.  Without the benefit of pasteurization, the harmful contaminant will not be destroyed.

Common Symptoms

Symptoms of STEC infection vary from person to person depending on age and severity of illness.  One of the more common symptoms includes bloody diarrhea and abdominal cramps.  However, this is not always the case.  Sometimes infection involves non-bloody diarrhea or occasionally and rare, no diarrhea at all.  Most cases have little or no fever and oftentimes illness resolves without medical intervention in 5 to 10 days.

Young children can spread the illness well after they feel better.  In fact, the organism can be shed in their feces for up to two weeks after they are no longer symptomatic.

Serious Complications – Hemolytic Uremic Syndrome

While most people infected will experience digestive symptoms, a rare but serious complication can cause severe and long-term effects.  About 2 to 7% of infections lead to a complication called hemolytic uremic syndrome (HUS) where red blood cells are destroyed and the kidneys fail.

This is more likely to occur in children under 5 years of age and the elderly as well as those with a compromised immune system.

In the United States, hemolytic uremic syndrome is the principal cause of kidney failure in children with most cases of HUS caused by E. coli O157:H7.

Diagnosis

Diagnosis is performed by analyzing a stool sample.  Most laboratories do not test for E. coli O157:H7 specifically, so your health care provider should request the specific test for this species given your symptoms.

A specific agar used to grow the culture for the stool specimen called sorbitol-MacConkey (SMAC) is used to screen for STEC.  If a positive result is found, the sample will be analyzed with Whole Genome Sequencing to determine if it is linked with other cases.

Treatment

While most people recover without antibiotics or other medical intervention in 5 to 10 days, some may prove more serious.  Many sources indicate that there is no evidence that antibiotics improve the course of the disease and may contribute to kidney complications.

Antidiarrheal agents such as loperamide (Imodium) should also be avoided so that the illness can run its course without trapping it inside the body for longer than necessary.  Medications such as loperamide slow down the digestive system – a process that delays your body from getting rid of the toxins in the system.

In the case of HUS, intensive care is necessary.  Blood transfusions and kidney dialysis are often needed to treat the illness.  Even with intensive care, mortality rate for HUS is around 3 to 5%.

Long-term Consequences

In general, those with digestive symptoms alone will recover completely with no long-term effects.

For those who develop HUS, about a third of individuals will continue to have abnormal kidney function for many years with some requiring long-term dialysis.  About 8% of those who develop HUS will have other long-term health issues such as high blood pressure, seizures, blindness, paralysis, and effects from having part of their bowel removed.

Preventative Measures

There are several measures you can take to prevent becoming infected with STEC.

• Cook Ground Beef and Hamburger Thoroughly: Color of meat during cooking is not a true indicator of appropriate internal temperature. To ensure disease-causing bacteria are killed, a food thermometer should be used.  Insert the thermometer into the thickest part of the food and be sure it reaches 160^o
• Keep Raw Meat Separate: Keep raw meat separate from ready-to-eat foods. Use hot, soapy water to wash hands, counters and utensils after contacting raw meat.  Never place cooked food on the same plate or tray that held raw meat.  Wash meat thermometers between testing food that require additional cook time.
• Consume only Pasteurized Milk, Juice, or Cider: Unpasteurized products have not been heat treated sufficiently to kill pathogens and should be avoided.
• Wash Fruits and Vegetables Thoroughly: Wash fruits and vegetables thoroughly, particularly those that will not be cooked. Those under 5 years old, the elderly, and those with a compromised immune system should avoid eating alfalfa sprouts.
• Drink Municipal Water: Drink water that has been treated with chlorine or other effective disinfectants.
• Avoid Swallowing Lake or Pool Water: Lake and pool water may be contaminated with sewage. Avoid swallowing lake or pool water while swimming.
• Wash Hands: Persons with diarrhea, especially children should wash their hands thoroughly after bowel movements to reduce the spread of infection. Hands should be thoroughly washed after changing soiled diapers or cleaning up after someone who is sick.
• Reduce Spread if You Are Sick: Anyone with diarrheal illness should reduce the spread of illness by refraining from certain activities. Avoid swimming in public pools or lakes, sharing baths with others, and preparing food for others.

What Should I Do If I Think I Am Linked to the Outbreak?

With STEC infections on the rise, it is possible that your diarrheal symptoms may be linked to the growing outbreak.  Even if you believe your symptoms can resolve without medical intervention, it is always a good idea to get tested to assist in traceback measures.

Reach out to your health care provider and indicate your concern for STEC infection.  After testing your stool sample, they will be able to determine if you have been infected with STEC and your sample will be sent for genetic testing to determine if it is the same strain involved in the outbreak.

Make a list of the foods and drinks you have consumed in the week prior to be coming sick.  This information can be used to help narrow down the source of the outbreak, helping to prompt a recall and prevent others from becoming sick if related to a food product.

Contact a Food Poisoning Lawyer, such as The Lange Law Firm, PLLC.  A free consultation can help answer questions you may have about navigating the outbreak process.  Call (833)330-3663 or fill out the form online at www.MakeFoodSafe.com.

By: Heather Van Tassell