hemolytic uremic syndrome

All milk sold or distributed in British Columbia must be pasteurized.  No less an authority that the Provincial Health Officer, Dr. Perry Kendall, recently discussed why, "in response to a number of letters published in the Times Colonist extolling the alleged benefits and alleged safety of "raw" (unpasteurized) milk."

With respect to the alleged antimicrobial properties

Kyle Wolden, a nine year old boy from Mount Vernon, Washington and the son of a baseball coach at Stanwood High School, got to run the bases at Safeco Field before the Seattle Mariners’ game yesterday.  45,876 fans of Seattle Mariners baseball became even bigger fans of Kyle’s, and now probably have a better understanding of

West Missouri Beef, LLC has voluntarily recalled 14,000 pounds of boneless beef products due to potential contamination by E. coli O157:H7.  USDA’s Food Safety and Inspection Service (FSIS) announced the Class I recall in a press release last night.  It is the third Class I recall this year, and the fifth since November, adding up to 1,636,000 pounds of beef products that have been recalled due to potential E. coli O157:H7 contamination in the last 3+ months.

What is a Class I recall?

A Class I recall, according to FDA definitions, should occur when "there is a reasonable probability that the use of or exposure to a violative product will cause serious adverse health consequences or death."  Class II and III recalls are appropriate only when there is a significantly lesser, or remote, risk of adverse health consequences, or when the health consequences are minor.  Due to its lethal capacity, E. coli O157:H7 is a bacteria that always requires a Class I recall.

What is E. coli O157:H7?

Escherichia coli (E. coli) are members of a large group of bacterial germs that inhabit the intestinal tract of humans and other warm blooded animals (mammals, birds). Newborns have a sterile alimentary tract which within two days becomes colonized with E. coli.

More than 700 serotypes of E. coli have been identified. The different E. coli serotypes are distinguished by their “O” and “H” antigens on their bodies and flagella, respectively. The E. coli serotypes that are responsible for the numerous reports of contaminated foods and beverages are those that produce Shiga toxin (Stx), so called because the toxin is virtually identical to that produced by another bacteria known as Shigella dysenteria type 1 (that also causes bloody diarrhea and hemolytic uremic syndrome [HUS] in emerging countries like Bangladesh) (Griffin & Tauxe, 1991, p. 60, 73). The best known and most notorious Stx-producing E. coli is E. coli O157:H7. It is important to remember that most kinds of E. coli bacteria do not cause disease in humans, indeed, some are beneficial, and some cause infections other than gastrointestinal infections, such urinary tract infections. This section deals specifically with Stx-producing E. coli, including specifically E. coli O157:H7.

Shiga toxin is one of the most potent toxins known to man, so much so that the Centers for Disease Control and Prevention (CDC) lists it as a potential bioterrorist agent (CDC, n.d.). It seems likely that DNA from Shiga toxin-producing Shigella bacteria was transferred by a bacteriophage (a virus that infects bacteria) to otherwise harmless E. coli bacteria, thereby providing them with the genetic material to produce Shiga toxin.

Although E. coli O157:H7 is responsible for the majority of human illnesses attributed to E. coli, there are additional Stx-producing E. coli (e.g., E. coli O121:H19) that can also cause hemorrhagic colitis and post-diarrheal hemolytic uremic syndrome (D+HUS). HUS is a syndrome that is defined by the trilogy of hemolytic anemia (destruction of red blood cells), thrombocytopenia (low platelet count), and acute kidney failure.

Stx-producing E. coli organisms have several characteristics that make them so dangerous. They are hardy organisms that can survive several weeks on surfaces such as counter tops, and up to a year in some materials like compost. They have a very low infectious dose meaning that only a relatively small number of bacteria, less than 50, are needed “to set-up housekeeping” in a victim’s intestinal tract and cause infection.

The Centers for Disease Control and Prevention (CDC) estimates that every year at least 2000 Americans are hospitalized, and about 60 die as a direct result of E. coli infections and its complications. A recent study estimated the annual cost of E. coli O157:H7 illnesses to be $405 million (in 2003 dollars) which included $370 million for premature deaths, $30 million for medical care, and $5 million for lost productivity (Frenzen, Drake, and Angulo, 2005).
 


Continue Reading

Counting Friday’s sausage recall by Daniele International, Inc., food companies have recalled at least 2,880,000 pounds of meat products since November 2009 due to contamination by E. coli or Salmonella. 

Friday’s recall:  (from FSIS press release)

Daniele International Inc., an establishment with operations in Pascoag and Mapleville, R.I., is recalling approximately 1,240,000 pounds of ready-to-eat (RTE)

Every time an E. coli O157:H7 outbreak occurs, we get yet another reminder how devastating the bacteria can be, particularly when it causes hemolytic uremic syndrome (HUS).  See www.about-hus.com..  And every time we represent a young child with HUS, I am reminded of the story of Regan Erickson, who was sickened in the spinach E. coli outbreak in September 2006 (We represented over 100 victims, including nearly 30 who suffered kidney failure and hemolytic uremic syndrome). 

Tiffany and Russ Erickson were just like most Americans until September 2006. Their four-year-old son Regan (pronounced "Ree-gun") was one of many young kids whose future was unalterably and forever changed by spinach. What appears below is Regan’s story. It is a little long, but that must be forgiven. Regan’s illness very nearly cost him his life.

ONSET OF ILLNESS:

Regan’s mother, Tiffany, and his sister, Emma, were both sickened during the Spinach outbreak as well. Tiffany actually fell ill first, on August 28. It felt like cruel timing, given that it was only three days before Emma’s birthday and little more than a week since discovering that she was pregnant with her third child, Maggie, but Tiffany took everything in stride. She had no reason to suspect that she was dealing with anything more than a run-of-the-mill flu, and her primary concern was with the health of her unborn child.

After twenty-four hours or so, however, thoughts began to change about the nature of Tiffany’s illness. Her bouts of diarrhea had grown more frequent and severe, and her abdomen was beset by cramps more severe than labor pains. Then, the evening of August 29, after a particularly painful bout of diarrhea, Tiffany noticed that the toilet bowl was streaked with blood. Up until this point, Tiffany had endured everything with resolute confidence, but this symptom suggested something that she had never before reckoned with.

Tiffany soon underwent a diagnostic procedure called an endoscopy to shed light on what was wrong. Of his wife’s illness, before his thoughts turned to Regan alone, Russ recalls:

We left the urgent care facility and gave the drugs some time to work, but the pain continued to be unbearable. As my concern shifted from the baby to Tiffany I couldn’t stand seeing her in that much pain, tired from lack of sleep, and not able to get comfortable.

Meanwhile, Regan had begun to develop symptoms, and Emma soon would. “We didn’t realize that the illnesses could be related,” Russ recalls, “since Regan couldn’t express his pain as well as Tiffany. He just knew his ‘tummy’ hurt and he began having diarrhea.” Emma’s symptoms began the very next day, September 1.

Russ recalls:

Everyone in the family was sick, tired, and the children being so young, not knowing how to tell or deal with the symptoms like diarrhea, I was continually cleaning, comforting, and helping where I could, all without Tiffany’s help who is usually the stalwart caregiver. We knew that we had some kind of ‘bug’ but not how severe yet. It presented a lot like flu symptoms, but we began to know it was more serious as the kids, just as Tiffany, began to have blood in their stool, and then blood instead of stool. That is a scary, unnerving experience to see blood when your 3 and 4 year olds are using the bathroom.

Compared to four year-old Regan, the illnesses that Tiffany and Emma Erickson suffered were nothing more than a small current in a raging sea. Nevertheless, to hear Russ describe what his wife and daughter endured is to fully comprehend the aggressive nature of this virulent pathogen. Emma endured many days of an illness more acutely painful than anything her parents had ever seen. But as sick as she was, her older brother was fast-becoming critically ill, and her parents thoughts and attention soon went solely and exclusively to Regan.


Continue Reading

 Tuesday morning, we will be filing lawsuits on behalf of the families of two children sickened in the ongoing, likely developing, outbreaks of E. coli O157:H7 linked to ground beef.  The lawsuits will be filed in Plymouth County Superior Court for the Commonwealth of Massachussetts against Brockton, Mass.-based Crocetti-Oakdale Packing, Inc., doing business as South Shore

We have already heard from several families whose children have developed hemolytic uremic syndrome (HUS) after contracting E. coli O157:H7 from Nestle cookie dough.  Most often, though we certainly see cases where the pathalogic process described below affects other organs, HUS affects the kidneys.  Here is a short explanation of what HUS is, and why it is so

Bill Marler and the other attorneys at Marler Clark have been litigating E. coli O157:H7 cases for sixteen years.  I have done it now for six.  Collectively, we have seen E. coli illnesses ranging from a few days of diarrhea to some of the most agonizing deaths imaginable . . . and everything in between.  It doesn’t matter how it happens–at least not to the parents of the kids getting sick.  Whether its lettuce, hamburgers, stagnant pond water, or contaminated venison, the results can be tragic.

Many of the saddest cases we have been involved came from California produce.  Ruby Trautz is a perfect example.  She was a beloved mother and grandmother who lived in Bellevue, Nebraska.  Ruby died a death more befitting of a capital murderer . . . and only because she ate contaminated spinach.  Read more about Ruby’s E. coli O157:H7 illness here.

Kelly Cobb is yet another example.  Kelly was also infected by California produce, though her illness arose from a different outbreak than Ruby Trautz.  Kelly was more fortunate than Ruby, but only because her younger body was more capable of fighting the severe infection than Ruby’s was. 

Nonetheless, Kelly’s E. coli O157:H7 infection also resulted in hemolytic uremic syndrome.  See www.about-hus.com.  Here is the story of Kelly’s illness:

In the early morning hours of May 16, 2008, Kelly was roused from sleep, at first by a strange bloated feeling and then a bad bout of diarrhea. It seemed as if there was a rock under her rib cage causing an overwhelming feeling of nausea, yet she did not vomit. This was followed by crampy pain in the upper part of her stomach, with sharper spasms of pain coursing through her torso every ten minutes or so. With the pain came diarrhea, which by 5:00 AM had turned to blood.

Kelly was seen in the emergency room of Good Samaritan Hospital in Tacoma, Washington from 6:00 AM until 11:00 AM. She described to the doctors the surprisingly severe, sudden onset of the nausea, abdominal cramping and bloody diarrhea. The history taken by the triage nurse revealed nothing out of the ordinary: Kelly had been in good health, she was not pregnant, her children had not been sick.

But blood tests showed an elevated number of white blood cells, the sign of a bacterial infection. The presence of gallstones was picked up by an abdominal ultrasound, yet there was no evidence that Kelly had cholecystitis, an active gallbladder attack. A watery stool was guaiac positive—in other words, there was blood in it. This was sent to be cultured and also for Clostridium difficile toxin-testing. Kelly was initially given intravenous fluids and pain medication, then sent home with prescriptions for the antibiotic Ciproflaxin, as well as oral pain and anti-nausea medications. She was told to see her primary care physician in a day or two, or return to the emergency room if other problems arose.

Other problems did crop up, almost immediately. Kelly could not drink or eat anything, including her prescribed medications, without vomiting. The diarrhea was unrelenting, and the watery rectal discharge was mostly bright red with blood. She was also suffering from intense pain. Kelly returned to the Good Samaritan Hospital emergency room on May 17, and this time she was admitted to the hospital for treatment. She was severely dehydrated, with depressed levels of serum electrolytes, blood urea nitrogen and creatinine. She was started on IV fluids and given something for the pain.

A colonoscopy performed on May 18 showed pancolitis, a form of severe, ulcerative colitis that is manifested by an irritation throughout the length of the colon and that typically is the result of an infection. The pathologist suspected that the source was likely E. coli O157:H7, but could not rule out the possibility of ulcerative colitis. Bowel tissue biopsies showed inflammatory pseudomembranes. These findings were nonspecific, so still did not explain the cause of the problem.

On May 19, the doctor noted that Kelly’s abdominal pain was relatively better, and that she no longer felt nauseated and was not vomiting. Her pancolitis was improving and there was no blood in her stool. The plan was to take her off intravenous medications, switch her to oral treatments and then let her go home.

On the morning of May 20, the mystery of Kelly’s symptoms was solved. A stool sample collected on May 16 had grown out E. coli O157:H7 bacteria. The Ciproflaxin was discontinued. Kelly still rated her abdominal pain as a seven on a scale of one to ten, and she was nauseated again. But doctors were encouraged that she could finally keep down food and water and that there had been no bouts of bloody diarrhea overnight, so they discharged her to go home around midday.

The following day, May 21, Kelly’s symptoms returned worse than ever. She had awakened overnight feeling quite ill and began to vomit again repeatedly. She was absolutely unable to keep any fluids down. Her family took her back to the hospital on May 22 after she had been up the whole night with awful nausea and vomiting.

Laboratory tests now indicated that she was anemic. Since her discharge May 20, her hematocrit and platelet counts had decreased significantly, while her BUN and creatinine levels had increased since her recent discharge. These were ominous signs that Kelly’s kidneys were beginning to lose filter function and that she appeared to be developing hemolytic uremic syndrome (HUS), the dire complication of an E. coli O157:H7 infection. Kelly was told her kidney function was at 50 percent of normal.

Kelly was once again admitted to the hospital, where a catheter was inserted so she could receive intravenous fluids and for blood draws. She was tired and miserable. Whenever she opened her eyes she felt dizzy and sick to her stomach.

By May 23, the doctors agreed that plasmapheresis, or plasma exchange, would be necessary as soon as possible to remove waste products from the blood that were accumulating as Kelly’s kidney function diminished. Plasmapheresis involves withdrawing whole blood from the patient, removing the plasma from the blood cells through a cell separator, and then returning the blood cells to the patient while replacing the plasma with donor plasma.


Continue Reading