E. Coli outbreak in Germany (was "Cholera")

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E. Coli outbreak in Germany (was "Cholera")

Postby tubeswell » Fri Jun 03, 2011 11:14 am

So Arneb, what's with this e. coli thing? Pray tell us what you have heard?

http://www.pamil-visions.net/german-eco ... es/228669/
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Postby Arneb » Sat Jun 04, 2011 10:06 pm

What gives you the idea that Cholera, of all things, is at work here?

Cholera, caused by a special strain of the bacterium Vibrio cholerae, is characterized by vomiting and watery diarrhea. The last cholera epidemic in Gemany was in Hamburg, in 1892. The history of Cholera in Germany ends with the 19th century. It did not even come back under the catastrophic circumstances of post-WWII. Cholera is usually transmitted by drinking water contaminated with Cholera patients' excrement, which contains V. cholerae in excessive numbers. The number of bacteria needed to cause Cholera is high (10^6), and direct human-to-human transfer or contaminated food is rare.

Enterohaemorrhagic Escherichia coli (EHEC) is the bug you are asking me about. It is an infection by a ubiquitous denizen of the human gut (E. coli), which has acquired several so-called virulence factors. It causes a disease characterized by bloody diarrhea, abdominal pain, sepsis (severe general reaction to an infection: fever, shortness of breath, low blood pressure, rapid pulse, weakness), haemolysis (the destruction of red blood cells in the blood stream) and uncontrolled clotting of blood platelets. The latter, by obstructing blood flow in the small vessels of the kidney, causes acute kidney failare. The full-blown disease is therefore called haemolytic-uraemic syndrome (HUS). The bacterium also carries the so-called ESBL plasmid, which makes it highly resistant to comonly-used antibiotics (which is not the point in this disease, as HUS is not usually treated antibiotically; however , it is a hint that the causative organism is from an environment in which antibiotics are used).

The dose for infections is extremely low (less than 10^2). The main source is contaminated food. The first patients (typically young, previously healthy women taking good care of their diet and usually eating little or no meat, plus their families) hinted at raw vegetables as the source of the infection, hence the ruckus about Spanish organic cucumbers being fertilized with manure.

This epidemic is extremely interesting: With the low infection dose, the source of the contamination can be extremely subtle. In the early days, there was speculation that the epidemic was caused by a single palette of cucumbers falling over in the Hamburg central food market, and hitting contaminated ground. Living in a country where serious infectious disease or serious food hygiene incidents are rare, we do not, of course, have a "Peel it, boil it, cook it or forget it" attitude towards food - except when we travel. Thus, what is considered the healthiest food of all, a salad, could have become the source of an epidemic that has, to date, killed 11 people (1213 reported cases of EHEC infection; 502 HUS cases).

I have not personally treated any patients with the disease, but our canteen has since removed fresh vegetable from the menu, according to the new customer protection guidelines (which are basically, and sensibly, "peel it, boil it..." and "wash your hands"). I've had a lot of pickled kraut salad during those last days, I can tell you.

This is the most severe EHEC epidemic EVER in the world. The causative organism was known beforehand, it occurred worldwide, but was very rare. Something extraordinary must have happened to make this thing the cause of an epidemic in a usually hygiene-obsessed rich country.
I'll keep you informed, if there is interest.

And, tubeswell, don't call it cholera. Please.
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Postby KLA2 » Sun Jun 05, 2011 2:23 am

OK, I see. The thread title was "Cholera", but the post was e coli.

Great answer, Arneb.

Maybe the mods could change the thread title.

Tubes, if I may be so bold, please take a little care. :wink:
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Postby tubeswell » Sun Jun 05, 2011 12:45 pm

Thanks for the explanation Arneb. That was interesting. (Forgive my misconception - I am a total ignoramus when it comes to medicine, and indeed when it comes to most things on this forum.)

@KLA2 - Luckily I'm not perfect, otherwise I'd never forgive myself ;-)
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Postby Lance » Sun Jun 05, 2011 1:19 pm

Title edited.

Arneb, wow, what a wonderful explanation. Yes, please keep us updated if it is convenient for you to do so.
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Postby Arneb » Sun Jun 05, 2011 6:15 pm

:(

1526 infections
627 HUS
21 dead as of today.

The epidemic is small in absolute terms - 21 deaths in two weeks is substantially less than the death rate from road traffic accidents - but of course the sheer number of patients, concentrated in the North of the country, put a strain on blood banks and dialysis capacity.

There are hints that mung bean sprouts from a particular producer might be the culprit.

Getting to the source of something like this is extremely taxing detective work. Chances to find the culprit tend to diminish as the epidemic progresses: The source has sold out, has travelled between multiple traders and vendors, people have travelled, too. The principal method of elucidating the source is the case-control study, which relies on patients (severely ill people, after all - or their family members) telling an interviewer what they ate during the past week - you know people aren't generally good witnesses, and the longer the timespan...It is possible that the source is never identified and that the wave just peters out a while after the last of the contaminated produce has been eaten.
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Postby Heid the Ba » Sun Jun 05, 2011 9:19 pm

I have been in Spain for the last two weeks and cucumbers have disappeared from salads there in that time.

I hope you get this under control and there are no more deaths.
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Postby Arneb » Sun Jun 05, 2011 10:31 pm

There will certainly be more deaths. A lot of the HUS patients are in ICUs and in critical condition.

The warning of - not only Spanish - salad and cucumbers, gien out by the German authorities is unlikely to have helped a lot.
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Postby Arneb » Mon Jun 06, 2011 7:21 pm

The sprouts thing is telling of modern media/science /politics: The Robert Koch Institute (sort of the German CDC) identifies a possible trade/proliferation chain - the source being at an organic vegetable farm and trade firm in Lower Saxony where, notably, one employee had come down with EHEC.

The RKI has the firm shut down and sets out to investigate samples.

Meanwhile, Lower Saxony's Halth Secretary trumpets the news in a press conference; the hapless little firmis surrounded by TV crews and less-than-scrupulous journalists. All newspapers open with "Sproutgate"

One day later, today, the results from the tests are published by the RKI: No EHEC in any of the investigated samples, with more samples waiting for analysis.

Congrats, asshole.
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Postby tubeswell » Mon Jun 06, 2011 8:04 pm

LoL Quick everybody! grab your pitchforks and head down to the sprout farm for a good ol'e hippie bashin' witchhunt...
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Postby Arneb » Mon Jun 06, 2011 8:18 pm

Oh, and did I mention it: The salad bar today featured pickled kraut, pickled carrot cuts, cooked and pickled celery, and pickled red cabbage. Main course was Leberkäs, mashed potatoes and mushroom sauce.

You know, IN A HOSPITAL 8)
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Postby Enzo » Mon Jun 06, 2011 9:10 pm

SO sprouts are bad, but kraut is OK?


Then why don't we make...sprout kraut?

Let us all to the "what is sprout kraut about shout."

We would flout our sprout kraut.
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Postby Мастер » Mon Jun 06, 2011 9:50 pm

Enzo wrote:SO sprouts are bad, but kraut is OK?


Then why don't we make...sprout kraut?

Let us all to the "what is sprout kraut about shout."

We would flout our sprout kraut.


Now for the first time, I really truly feel like we've got our Enzo back 8)
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Postby Arneb » Tue Jun 07, 2011 5:43 am

Cheers to that!

Also, it reminds us that pickling is just another conservation method...

I read that the derogatives for the British and Germans, "limey" and "kraut", come from the scurvy prevention measures that were taken by the respective navies in the 19th century. Oh, and captain Cook's method was also kraut. Hah!
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Postby Enzo » Wed Jun 08, 2011 12:41 am

Wasn't Captain COok killed by angry islanders?

We bring you fruits and vegetables and our young women and you offer us fucking KRAUT??? KILL HIM.....
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Postby KLA2 » Wed Jun 08, 2011 2:24 am

Arneb wrote:Cheers to that!

Also, it reminds us that pickling is just another conservation method...

I read that the derogatives for the British and Germans, "limey" and "kraut", come from the scurvy prevention measures that were taken by the respective navies in the 19th century. Oh, and captain Cook's method was also kraut. Hah!


I think you meant "preservation." Would pickling kill e coli bacteria in the food?
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Postby Arneb » Wed Jun 08, 2011 12:45 pm

Yes, preservation. A very German mistake - a food can is a "Konserve", while a condom is a "Präservativ" :D . In my opinion, German is truer to the Latin original here, but that point is moot.

Pickling of fresh fruit does two things: 1, Prevent microorganisms from growing by providing a hostile environment (very salty, highly acidic, and anoxic); and 2, shielding the food from further contamination (barrel, jar, can). That's the original point of pickling: Preventing food from "going bad".

In the case of EHEC, things are not that clear: As I told you, the infectious dose is extremeley low, so food can carry the disease without having "gone bad"; it is sufficient that some EHEC contamination has "rubbed off" onto the food item (which in turn, is one of the reasons the elucidation of the epidemic is so hard; remember the palette of cucumbers). Therefore, I am not quite sure if pickling would work, but I suspect it would: The salty and acidic environment should be enough to kill off small contaminations, which is what we are dealing with here.

Independent of that: Pickled food is safe simply because it was processed long before the onset of the epidemic.

In other news, there seems to be no real letup so far: 2648 EHEC/689 HUS/24 dead as of today, 10 a.m.

My favourite newspaper doesn't carry the usual front page photos; they usually have some quirky photo or graphic with a likewise quirky text below which describes the main topics of the day. Yesterday, they had one that related to both the state visit of our chancellor in the US and to the EHEC epidemic: The First Lady doing work in the First Vegetable Gardens, under the heading: Finally, salad again! :lol:
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Postby Мастер » Wed Jun 08, 2011 3:52 pm

Arneb wrote:Yes, preservation. A very German mistake - a food can is a "Konserve", while a condom is a "Präservativ" :D . In my opinion, German is truer to the Latin original here, but that point is moot.


I've heard of people getting into trouble asking if the canned foods have preservatives :P
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Postby Arneb » Sat Jun 11, 2011 11:26 am

2988/759/31

Reports of new infections have dropped during the last days.

The source has been finally identified: The organic farm/vegetable trade firm which I talked about earlier spread the current EHEC (type O:104H:4, or HUSEC 41, if you must know) bacterium in packages containing mung bean sprouts. Several of the company's products have now tested positive, and the organism has been found on the farm. The warning for other raw vegetables have been lifted. Yummy.

The mechanism of contamination is still unclear. The sprouts are planted to germinate at 38 °C in moist soil jars - a challenging setting from the POV of food hygiene. Maybe the seeds were already contaminated when the company bought them, maybe the bacteria were introduced and multiplied during incubation. Investigations are ongoing. Three of the farm's employees cought EHEC disease.

Everyone, especially Spanish farmers is calling for damage payments, of course.

Another correction: This is not the largest EHEC epidemic ever. There was an outbreak in Japan (interestingly, froum sprouts) in the 90s (The culprit was EHEC O:157H:7) brought about 9000 sick schoolchildren :shock: .

For comparison: The background HUS rate in Germany is about 80-100 /year, mostly children. This epidemic will be very interesting scientifically, as O:104 has never been implicated with HUS, and the disease caused by the bug has some unusual characteristics, especially the preponderance of adult people. It's usually thought of as a children's disease.

I suspect my wife will make a big salad today...
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Postby Arneb » Wed Jun 15, 2011 7:20 am

3235/782/35
The last victim that died was a two-year old boy.

New infections are dropping sharply, as the source has dried up.

The farm that spread the bacterium got EHEC in their seeds. They never had a chance, they propagated their sprouts according to protocol. The EHEC source on the seeds is unknown. There is a lot of scientific speculation about that point - the usual suspects (especially the bovine gut) seem to be unlikely. Maybe this will lead to the identification of a new source.
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Postby Arneb » Sat Jul 02, 2011 5:57 pm

3999/845/48, new reports dropping qute steeply now.

The epidemic has now been traced to a single batch of fenugreek seeds produced in Egypt and sold to the incriminated farm in Northern Germany via an intermediary trader.

One batch contaminated. One intermediary. Sprouts hatched according to procedure. Distributed under the auspices of Germany's quite strict food hygiene system: 4000 infected, 50 dead. Presumably, a large number of people will remain on dialysis indefinitely.

A sobering experience.
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Postby Мастер » Sat Jul 02, 2011 6:15 pm

Arneb wrote:3999/845/48, new reports dropping qute steeply now.


What is the middle number?
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Postby tubeswell » Sat Jul 02, 2011 6:19 pm

Mactep wrote:
Arneb wrote:3999/845/48, new reports dropping qute steeply now.


What is the middle number?


And for that matter, what are the other two lots of numbers?
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Postby Arneb » Sat Jul 02, 2011 6:28 pm

I introduced the format a few posts up: Number of EHEC infections/of those, number of HUS patients/number of deaths since the start of the epidemic, from EHEC diarrhea and/or HUS.
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Postby MM_Dandy » Wed Jul 06, 2011 6:21 pm

Is there any way to get more details on the Egyptian fenugreek? I help out at a imported goods store which carries fenugreek (although I can't recall if he's gotten any lately, and if it's from Egypt or Ethiopia).
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