DOCTOR'S VIEWS ARCHIVE
Potato Salad in Illinois
In Orland Park, Illinois near Chicago, more than 4,000 people took sick after eating potato salad prepared by Iwan's Deli and Catering for more than 530 parties over the weekend of June 6, a busy weekend for graduations. This is the largest known outbreak in the U.S. of the enterotoxigenic strain of E. coli (ETEC).
ETEC has been generally viewed as a disease of developing countries. It is a common cause of diarrhea among children in the developing countries and among travelers to these countries. ETEC remains the most common cause of traveler's diarrhea or "Montezuma's revenge". However, the Illinois outbreak is an obvious reminder that ETEC is not foreign to the U.S.
ETEC infection is acquired mainly through eating food and drinking water that are contaminated with the bacteria. Toxins produced by the bacteria in the small intestine cause profuse diarrhea. Most people recover in 3-5 days, although severe dehydration can occur in the very young and the elderly.
Preventing and correcting dehydration is most important in treating traveler's diarrhea. In persons with mild to moderate symptoms, anti-diarrhea agents such as Imodium, Lomotil, and Pepto-Bismol can be used to decrease cramps and diarrhea. In more severe cases, early treatment with short courses of antibiotics such as doxycycline (Vibramycin), trimethoprim-sulfamethoxazole (Septra, Bactrim), and ciprofloxacin (Cipro) can help decrease the duration of illness.
Because of the sometimes severe side effects of antibiotics, the routine use of antibiotics to prevent infection among travelers to developing countries is not encouraged.
For travelers to developing countries, to avoid ETEC:
- Be careful about what fluids you drink
- Do not drink untreated tap water
- Drink mineral and other processed water
- Drink bottled beverages
- Carbonated drinks and bottled beer or wine are safe
- Be careful about what foods you eat
- Do not eat cold salads
- Do not eat food from street vendors
- Bread is safe
- Fruits and vegetables that have been peeled are safe
- Eat well-cooked foods that are served steaming hot
ETEC is one of the reasons that restaurants often have a sign reminding employees to wash their hands before leaving the rest room. Everyone should.
Wading Pool in Georgia
A more dangerous strain of E. coli called O157:H7 struck at least 19 children in Northwest Atlanta. Four of were critically ill with the hemolytic-uremic syndrome, a grave complication of this form of E. coli. One of the critically ill children was Brody, the 3-year-old son of Walt Weiss, shortstop on the Atlanta Braves baseball team.
E. coli 0157:H7 causes about 20,000 cases of hemorrhagic (bloody) colitis (inflammation of the bowel) each year in the U.S. In a widely publicized outbreak in 1993 in Washington State, hundreds became ill and 3 died from E. coli 0157:H7 that was tracked to undercooked hamburgers from Jack in the Box restaurants. Undercooked ground beef is a prime food source for this infection. For this reason, hemorrhagic colitis due to E. coli 0157:H7 is commonly referred to as "hamburger disease."
Toxins (poisons) produced by E. coli 0157:H7 are responsible for the bloody diarrhea (hemorrhagic colitis) and the dire complications of thrombotic thrombocytopenic purpura (TTP) and the hemolytic-uremic syndrome (HUS).
Hemorrhagic diarrhea (hemorrhagic colitis) due to E. coli 0157:H7 involves diarrhea with painful abdominal cramps. The diarrhea is severe, usually with gross blood in the stool, little or no fever, and lasts for 6 to 8 days.
Thrombotic thrombocytopenic purpura (TTP) involves anemia due to fragmentation of red blood cells, shortage of platelets (thrombocytopenia) with easy bruising, neurologic abnormalities, impaired kidney function, and fever. TTP is still a serious consequence from E. coli 0157:H7, one to which the elderly are particularly prone.
Children are particularly prone to develop the hemolytic- uremic syndrome (HUS). "Hemolytic" refers to the breakup of red blood cells. This leads to anemia. There is a shortage of platelets (thrombocytopenia) which causes abnormal bleeding. "Uremic" refers to the acute kidney failure. Central nervous system problems with seizures and coma can also occur.
Brody Weiss and the other children in Atlanta with E. coli 0157:H7 are thought to have contracted it in a wading pool at White Water Recreation Park. Tests there revealed chlorine levels below the level needed to kill E. coli 0157:H7.
Georgia health officials have sketched out this scenario. A child with E. coli 0157:H7 defecated in the wading pool at the park. Other children swallowed the contaminated water. The original E. coli kid returned the next day and repeated the scenario. And, finally, yet another fecal accident (possibly by a child who had become infected at the pool) occurred some days later, infecting still more children.
Three of the children including Brody Weiss are reported to be in critical condition with kidney failure at the Scottish Rite Children's Medical Center (The location of the fourth child is not known). All of the children are aged 2 to 4.
The hemolytic-uremic syndrome from which they suffer is now the most common cause of acute renal failure in infants and young children.