The country became conscious of E. coli in 1993 after an E. coli O157:H7 outbreak struck West Coast Jack in the Box restaurants. 700 people were sickened; many people developed hemolytic uremic syndrome; and at least 4 kids died. In direct response to the outbreak, the USDA deemed E. coli O157:H7 an adulterant per se on all non-intact cuts of meat, which includes ground beef and ground beef components. (Notably, however, the USDA does not currently consider E. coli O145, or any strain of E. coli other than O157:H7, to be an adulterant on meat.  It is well past time for the USDA to deem all shiga-toxin producing strains of E. coli "adulterants" on meat.)

I.    The law on contaminated food

In all states, companies that manufacture and sell food that is contaminated with Salmonella, E. coli,hepatitis A, campylobacter, or anything else that can cause illness or injury, is liable to anybody who becomes ill or injured as a result of the contamination. In some states, even companies that do nothing other than sell a contaminated food item that another company made—e.g. Peanut Corporation of America Salmonella Typhimurium outbreak—are liable to all people who become ill as a result of the contamination. This is called strict liability.

In application in the E. coli O145 outbreak being investigated in New York, Ohio, and Michigan, the law of strict liability will hold the companies that manufactured and sold the contaminated food item liable to all outbreak victims. The law does not discriminate on the basis of severity of injury and, as a result, a person who suffered a relatively mild illness has the same legal rights as a person who was hospitalized. This is not to say, however, that the jury verdict will be the same, because that is driven exclusively by the severity of injury.

II.     E. coli O145 characteristics and pathogenicity

E. coli O145 is another strain of enterohemorrhagic Escherichia coli (EHEC) or shiga-toxin producing Escherichia coli (STEC). The letters and numbers O145 refer to the specific markers found on the bacterium’s surface; these letters and numbers distinguish E. coli O145 from the 50+ other strains of EHEC/STEC.

E. coli O145 has emerged as one of the primary non-O157 serotypes—i.e. strains—of Escherichia coli in Europe, and has begun to appear more frequently in the United States as well. E. coli O145 was one of several strains found in bags of Dole baby spinach in September 2006, along with its more famous counterpart E. coli O157. And of course, in the month of April 2010, at least 50 people were sickened by E. coli O145 in an outbreak in Ohio, Michigan, and New York, for which no specific food vehicle has yet been announced.

E. coli O145 generally functions like other strains of EHEC/STEC, in that the bacteria typically enters the human body by consumption of contaminated food. Infecting the gastrointestinal tract, the bacteria causes symptoms between 1 and 5 days after ingestion, and symptoms typically include abdominal cramps, often-bloody diarrhea, and other gastrointestinal symptoms.

But, like any other strain of EHEC/STEC, the true virulence of E. coli O145 results from its ability to produce Shiga-like toxins. It has been theorized that generic E. coli picked up this deadly ability through horizontal transfer of virulence genes from the Shigella bacteria. Whatever the case, the toxins released by E. coli O145 enter the circulating blood stream through the inflamed bowel wall. There, the toxins attach to receptors on the inside surface of blood vessel cells (endothelial cells) and initiate a chemical cascade that results in the formation of tiny thrombi (blood clots or Thrombotic Microangiopathy – TMA) within these vessels.

Some organs seem more susceptible—perhaps due to the presence of increased numbers of receptors—including the kidneys, pancreas, and brain. By definition, when fully expressed, hemolytic uremic syndrome (HUS) presents with the triad of hemolytic anemia (destruction of red blood cells), thrombocytopenia (low platelet count), and acute renal failure (loss of the filter function of the kidney).