out break of E Coli

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Outbreak of Shiga toxin-producing E. coli O104
(STEC O104H4)Edited by Dr Ihab Suliman
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What is Escherichia coli

• Escherichia coli (abbreviated as E. coli) are a
  large and diverse group of bacteria. Although
  most strains of E. coli are harmless, others can
  make you sick. Some kinds of E. coli can cause
  diarrhea, while others cause urinary tract
  infections, respiratory illness and pneumonia,
  and other illnesses.

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• A large outbreak of Shiga toxin-producing
  Escherichia coli O104H4 (STEC O104H4)
  infections ongoing in Germany.
• The responsible strain shares virulence
  characteristics with enteroaggregative E. coli
  (EAEC).

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• As of May 31, 2011, case counts confirmed by
  Germanys Robert Koch Institute include 470
  patients with hemolytic uremic syndrome (HUS) a
  type of kidney failure that is associated with E.
  coli or STEC infections and nine deaths.

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Disease background information

• Shiga toxin-producing E. coli (STEC) is a group
  of pathogenic Escherichia coli strains capable of
  producing Shiga toxins, with the potential to
  cause severe enteric and systemic disease in
  humans.
• The full serotype is usually defined by
  determining both O and H antigens.

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• There are around 200 different E. coli O
  serotypes producing Shiga toxin, of which over
  100 have been associated with human disease.

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• Two major Shiga toxin types (Stx1 and Stx2) have
  been associated with strains causing human
  disease. While the serotype O157H7 is considered
  as clinically the most important, it is estimated
  that up to 50 of STEC infections are caused by
  non-O157 serotypes.

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• Haemolytic uremic syndrome (HUS) is considered as
  the most common cause of acute renal failure in
  European children. Even if the clinical
  presentation of non-O157 STEC infections may
  vary, they can be as virulent as O157H7
  infections.

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Transmission of STEC infection mainly occurs
through contaminated food or water

• Transmission of STEC infection mainly occurs
  through contaminated food or water and contact
  with animals.
• Person-to-person transmission is also possible
  among close contacts (families, childcare
  centres, nursing homes, etc).

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• A wide variety of food has previously been
  implicated in outbreaks as suspected sources,
  including raw (unpasteurised) raw milk and
  cheese, undercooked beef, a variety of fresh
  produce (e.g. sprouts, spinach, lettuce),
  unpasteurised apple cider,

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The infective dose is very low.

• The infective dose is very low.

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The incubation period ranges from three to eight
days.

• The incubation period ranges from three to eight
  days.

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• Many of these illnesses are in persons who report
  recent travel to Germany, but reside elsewhere.
• In the United States, three suspected cases of
  STEC O104H4 infections have been identified in
  persons recently traveled to Hamburg, Germany.

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Investigation of the Outbreak

• At this time, a specific food has not been
  confirmed as the source of the infections.
  Travelers to Germany should be aware that the
  German public health authorities have recommended
  against eating raw lettuce, tomatoes, or
  cucumbers, particularly in the northern states of
  Germany (Hamburg, Bremen, Lower Saxony, and
  Schleswig Holstein).

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Clinical Features/Signs and Symptoms

• Symptoms of STEC infection include severe stomach
  cramps, diarrhea (which is often bloody), and
  vomiting. If there is fever, it usually is not
  very high.
• Most people get better within 57 days, but some
  patients go on to develop HUSusually about a
  week after the diarrhea starts. Symptoms of HUS
  include decreased frequency of urination, feeling
  very tired, and losing pink color to skin and
  membranes due to anemia.

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What is the best treatment for STEC infection

• Non-specific supportive therapy, including
  hydration, is important.
• Antibiotics should not be used to treat this
  infection.
• There is no evidence that treatment with
  antibiotics is helpful, and taking antibiotics
  may increase the risk of HUS. Antidiarrheal
  agents like Imodium may also increase that risk.

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How can STEC infections be prevented

• WASH YOUR HANDS thoroughly after using the
  bathroom or changing diapers and before preparing
  or eating food. WASH YOUR HANDS after contact
  with animals or their environments (at farms,
  petting zoos, fairs, even your own backyard).
• COOK meats thoroughly. Ground beef and meat that
  has been needle-tenderized should be cooked to a
  temperature of at least 160F/70C. Its best to
  use a thermometer, as color is not a very
  reliable indicator of doneness.
• AVOID raw milk, unpasteurized dairy products, and
  unpasteurized juices (like fresh apple cider).
• AVOID swallowing water when swimming or playing
  in lakes, ponds, streams, swimming pools, and
  backyard kiddie pools.
• PREVENT cross contamination in food preparation
  areas by thoroughly washing hands, counters,
  cutting boards, and utensils after they touch raw
  meat.
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