E. coli spinach scare

Q: The spinach scare last fall was unsettling. How can I protect my children from an E. coli infection?

It didn’t take long for Madelyn Wright, of Gilbert, to know that her daughters were dealing with more than just the typical tummy rumblings kids can get from too much apple juice. Colleen and Cassidy, then 5 and 7, had developed painful upset stomachs in August of 2005. Within a few days, Wright recalls, the girls complained of abdominal cramping and non-stop diarrhea. “Something wasn’t right. When they were in the bathroom they would just want me there. They were just moaning.”

After a few days, Cassidy felt much better. But Colleen continued to be in pain. There seemed to be no end to the frequent trips to the bathroom. When the diarrhea turned a clear color and became bloody, Wright became alarmed. A trip to the emergency room ensued and Colleen was found to be dehydrated. Doctors admitted Colleen and began treatment with intravenous fluids. But within just a few days, Colleen’s body began to appear puffy and she began coughing, signaling kidney dysfunction. After some blood tests, a pediatric nephrologist (kidney specialist) diagnosed Colleen with hemolytic uremic syndrome — kidney failure — resulting from an E. coli 0157:H7 infection.

Most strains of the bacterium Escherichia coli are harmless and often are found living in the digestive tracks of healthy people and animals. But the strain that infected Colleen, the same type that affected some 200 people across the United States in the fall of 2006 from spinach leaves, can cause severe illness and, in some cases, death.

According to the Centers for Disease Control, E. coli 0157:H7 was first recognized as a cause of illness in 1982, during an outbreak of severe, bloody diarrhea. Eventually, health officials traced the outbreak to contaminated hamburgers. Parents with older children may recall a 1993 scare when hundreds of people became ill and four children died after eating underdone burgers at Jack-in-the-Box restaurants. That’s when our family started buying those bleach wipes to sterilize countertops that came in contact with raw meat. We also bought two cutting boards — one for meats, another for produce — and put both in the dishwasher every night.

State epidemiologist Ken Komatsu, MPH, says that, as a result, most fast food restaurants are very careful about cooking their hamburgers these days. The CDC reports that changes in testing ground beef products is probably partly responsible for a subsequent decrease in this illness. But the bacteria can also show up in the lettuce that tops your burger. Cattle manure can contaminate the environment when streams flowing through produce fields are used for irrigation, pesticide application or washing crops. Investigators now speculate that wild pig or deer feces could have been contributed to last fall’s outbreak from fresh spinach.

What parents can do, says Komatsu, is be aware of how to reduce the risk of infection. Children under 5 years of age (and the elderly) are particularly at risk. Komatsu recommends taking hand sanitizer if you plan an encounter with farm animals or a petting zoo. Talk to children about keeping hands and fingers away from their faces until after they’ve de-sanitized. And follow these other safety precautions as recommended by the CDC:

  • Cook all ground beef and hamburger thoroughly. Keep raw meat separate from ready-to-eat foods.
  • Wash hands, counter tops and utensils with hot, soapy water after contact with raw meat.
  • Drink only pasteurized milk, juice or cider. Wash raw fruits and vegetables thoroughly.
  • Avoid swallowing lake or pool water while swimming.
  • Make sure that everyone washes hands carefully after bowel movements or changing diapers. Ingestion of con-taminated food or water is the main route of exposure but direct person-to-person contact can also spread infection.
  • Anyone with diarrhea should avoid swimming in public pools or lakes, sharing baths with others or preparing food for others.

Most people recover from an infection in five to 10 days, according to the Arizona Department of Health Services, which says that approximately 30 to 40 cases of E. coli O157:H7 are reported in Arizona each year. By comparison to other diseases, such as pertussis (363 confirmed from January through September 2006) or HIV infections (543 for the same period), the chances for infection seem fairly low.

But those numbers mean very little if your child is the one of the 15 percent who develops HUS from an infection. “It is very rare,” says Wright, but also “very scary when you just don’t know what is going to happen with your child.” After being admitted to the hospital, Colleen endured kidney dialysis for two weeks. On top of that, says Wright, “she had three surgeries to make the dialysis happen. There were tons of things she had to deal with — lots of pokes and prods and x-rays. And we didn’t know during the acute stages whether she was going to make it or not. It was terrifying.”

Colleen remains on medication because tests continue to indicate damage to her kidneys. How the bacteria found her daughter and created such havoc remains a mystery. Despite efforts to re-create the menus and behaviors leading up to the days before Colleen got sick, the Wrights will probably never know where the bacteria originated. But news reports of outbreaks of illness due to E. coli O157:H7 in faraway places surely take on a different meaning for families like the Wrights.

“It’s more personal when it is your own child,” she says. “That’s your whole world.”