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E.coli the Science Behind the Headlines

E.coli the Science Behind the Headlines.

Ecoli is a bacteria that lives in the intestines of all humans, and in many animals, including cows.  Normally, us and them live in harmony, with them helping to digest our food, and us giving them a nice warm moist environment to thrive.

Over the last 20,000 years, however, multiple strains of Ecoli have evolved. Some of these strains have picked up genetic "extra" material called plasmids, which often carry genes that give a bacteria extra survival advantage over it's neighbors.  

E. coli O157:H57 is one such strain; it produces a toxin known as Shiga toxin, one of the most potent toxins in nature. It is similar in action to ricin, a poison that has gained fame in the world of espionage as a weapon of assassination. Other strains of Ecoli have also developed toxin-producing abilities, often with even more dangerous potential than Shiga toxin.  Depending on the strain, there may be mild illness, severe bloody diarrhea, a high fatality rate, or even renal failure from something called HUS (hemolytic uremic syndrome).

Cow products are the main source of EColi disease; it is not known why cows are colonized with this bacteria, nor why they don't themselves get sick.  However, multiple outbreaks of toxin-producing EColi have been linked to other foods as well; the list is frighteningly long:  alfalfa, clover and radish sprouts, lettuce, and spinach, unpasteurized juices, yogurt, dried salami, mayonnaise, raw milk, game meats, hazelnuts, and raw cookie dough. Outbreaks usually occur related to a single strain, can have unique features, and be non- O157:H57. For instance, a German outbreak related to contaminated seeds of fenugreek from Egypt, sold as sprouts by an organic farm in Germany, sickened 4000 people, caused 50 deaths, and multiple cases of HUS, with a predilection for women.

O157:H7 is estimated to cause 100,000 cases of food poisoning a year in the US, 2000 hospitalizations, and 20 deaths per year.  Even slight undercooking of red meat can allow the bacteria to survive, and as few as 20 living bacteria, if ingested, can cause disease in a human. The other bad news is that O157:H7, unlike the usual EColi in your gut, lives through freeze/thaw cycles, drying, high heat (111 F !) and can be transmitted person to person.

Both O157:H7 and non- O157:H7 EColi can start as mild diarrhea.  In many cases, it may resolve on it's own due to unknown factors.  However, a certain percentage go on to severe disease, usually 1-4 days after every exposure. Diarrhea becomes severe, and may bear grossly bloody with severe cramping.  The volume is so great that patients become rapidly dehydrated.  The toxin spreads, after invading the intestinal walls, to distant organs like the kidneys, which shut down from HUS.  Children may appear lethargic out of proportion to the amounts of dehydration.

Treatment is supportive; antibiotics have no place in the care of these patients, which is true for MOST infectious diarrhea (giardiasis and c-diff are exceptions).  The main thing to know about EColi disease is that prevention is vital. Test all red meat WITH A THERMOMETER. 165F is absolutely required to kill this bug. If you want to swear off red meat completely, you will probably live longer anyway.  Don't allow surfaces or other foods to be contaminated with raw meat, and handle all diarrhea (as when changing a diaper of a sick child or adult) with gloves and careful hand washing afterwards. 

In the centers, remember that these pathogenic EColi can be identified on culture; it worth sending one off for patients who do not appear to have a routine viral enteritis, which is of course the most common cause of infectious diarrhea.

Steak tartare, anyone?

 

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