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Title: out break of E Coli


1
Outbreak of Shiga toxin-producing E. coli O104
(STEC O104H4)Edited by Dr Ihab Suliman
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What is Escherichia coli
  • Escherichia coli (abbreviated as E. coli) are a
    large and diverse group of bacteria. Although
    most strains of E. coli are harmless, others can
    make you sick. Some kinds of E. coli can cause
    diarrhea, while others cause urinary tract
    infections, respiratory illness and pneumonia,
    and other illnesses.

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  • A large outbreak of Shiga toxin-producing
    Escherichia coli O104H4 (STEC O104H4)
    infections ongoing in Germany.
  • The responsible strain shares virulence
    characteristics with enteroaggregative E. coli
    (EAEC).

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  • As of May 31, 2011, case counts confirmed by
    Germanys Robert Koch Institute include 470
    patients with hemolytic uremic syndrome (HUS) a
    type of kidney failure that is associated with E.
    coli or STEC infections and nine deaths.

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Disease background information
  • Shiga toxin-producing E. coli (STEC) is a group
    of pathogenic Escherichia coli strains capable of
    producing Shiga toxins, with the potential to
    cause severe enteric and systemic disease in
    humans.
  • The full serotype is usually defined by
    determining both O and H antigens.

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  • There are around 200 different E. coli O
    serotypes producing Shiga toxin, of which over
    100 have been associated with human disease.

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  • Two major Shiga toxin types (Stx1 and Stx2) have
    been associated with strains causing human
    disease. While the serotype O157H7 is considered
    as clinically the most important, it is estimated
    that up to 50 of STEC infections are caused by
    non-O157 serotypes.

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  • Haemolytic uremic syndrome (HUS) is considered as
    the most common cause of acute renal failure in
    European children. Even if the clinical
    presentation of non-O157 STEC infections may
    vary, they can be as virulent as O157H7
    infections.

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Transmission of STEC infection mainly occurs
through contaminated food or water
  • Transmission of STEC infection mainly occurs
    through contaminated food or water and contact
    with animals.
  • Person-to-person transmission is also possible
    among close contacts (families, childcare
    centres, nursing homes, etc).

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  • A wide variety of food has previously been
    implicated in outbreaks as suspected sources,
    including raw (unpasteurised) raw milk and
    cheese, undercooked beef, a variety of fresh
    produce (e.g. sprouts, spinach, lettuce),
    unpasteurised apple cider,

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The infective dose is very low.
  • The infective dose is very low.

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The incubation period ranges from three to eight
days.
  • The incubation period ranges from three to eight
    days.

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  • Many of these illnesses are in persons who report
    recent travel to Germany, but reside elsewhere.
  • In the United States, three suspected cases of
    STEC O104H4 infections have been identified in
    persons recently traveled to Hamburg, Germany.

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Investigation of the Outbreak
  • At this time, a specific food has not been
    confirmed as the source of the infections.
    Travelers to Germany should be aware that the
    German public health authorities have recommended
    against eating raw lettuce, tomatoes, or
    cucumbers, particularly in the northern states of
    Germany (Hamburg, Bremen, Lower Saxony, and
    Schleswig Holstein).

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Clinical Features/Signs and Symptoms
  • Symptoms of STEC infection include severe stomach
    cramps, diarrhea (which is often bloody), and
    vomiting. If there is fever, it usually is not
    very high.
  • Most people get better within 57 days, but some
    patients go on to develop HUSusually about a
    week after the diarrhea starts. Symptoms of HUS
    include decreased frequency of urination, feeling
    very tired, and losing pink color to skin and
    membranes due to anemia.

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What is the best treatment for STEC infection
  • Non-specific supportive therapy, including
    hydration, is important.
  • Antibiotics should not be used to treat this
    infection.
  • There is no evidence that treatment with
    antibiotics is helpful, and taking antibiotics
    may increase the risk of HUS. Antidiarrheal
    agents like Imodium may also increase that risk.

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How can STEC infections be prevented
  • WASH YOUR HANDS thoroughly after using the
    bathroom or changing diapers and before preparing
    or eating food. WASH YOUR HANDS after contact
    with animals or their environments (at farms,
    petting zoos, fairs, even your own backyard).
  • COOK meats thoroughly. Ground beef and meat that
    has been needle-tenderized should be cooked to a
    temperature of at least 160F/70C. Its best to
    use a thermometer, as color is not a very
    reliable indicator of doneness.
  • AVOID raw milk, unpasteurized dairy products, and
    unpasteurized juices (like fresh apple cider).
  • AVOID swallowing water when swimming or playing
    in lakes, ponds, streams, swimming pools, and
    backyard kiddie pools.
  • PREVENT cross contamination in food preparation
    areas by thoroughly washing hands, counters,
    cutting boards, and utensils after they touch raw
    meat.
  •  
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