Monday, June 13, 2011

Lethal E. coli Strain in Germany

"German authorities have indicated that food items including bean sprouts and other vegetables originating from a producer in Lower Saxony, Germany, are the most likely source of the infection. German health authorities have declared that all food products originating from the producer be pulled from the market, according to the ECDC."

BERLIN — An unusually lethal strain of E. coli bacteria has infected more than 1,500 people in Germany, mystifying public health officials, ravaging Spain’s agricultural heartland, and touching off panic in Europe as people weighed whether it was safe to eat raw vegetables.

The source of the outbreak, which has killed at least 16 people — 15 in Germany and a Swede who visited there recently — remained unknown.

Public health officials are alarmed because a startlingly high proportion of those infected suffer from a potentially lethal complication attacking the kidneys, called hemolytic uremic syndrome, which can provoke comas, seizures and stroke. Dr. Robert Tauxe, deputy director of food-borne disease at the Centers for Disease Control and Prevention in Atlanta, said the rate of cases of acute kidney failure in the outbreak was unprecedented. “That makes this an extraordinarily large and severe event,” he said.

While most of the infections were among people who had traveled to northern Germany, the authorities acknowledged that the outbreak had spread to virtually every corner of the country.

Scientists are at a loss to explain why this little-known organism, identified as E. coli 0104:H4, has proved so virulent.

The European authorities have reported several differences from previous outbreaks, including that women make up more than two-thirds of those affected and that young and middle-aged adults account for a very high percentage of the most severe cases. Dr. J. Glenn Morris, director of the Emerging Pathogens Institute of the University of Florida, said that the German strain might have undergone genetic changes or mutations to make it more potent.

The high number of cases of acute kidney failure represents a much higher percentage of the total number of illnesses than in previous outbreaks associated with different strains of E. coli. Generally, 5 to 10 percent of E. coli illnesses result in this complication. Among the confirmed cases, according to the Robert Koch Institute, Germany’s disease control agency, 470 people had been diagnosed with the kidney syndrome.

Dr. Phillip Tarr, a professor of microbiology at the Washington University School of Medicine in St. Louis, said that there were two main forms of shiga toxin found in E. coli, and that the strain detected in the outbreak in Germany appeared to have the more potent version. But he said the organism appeared to have other quirks that made it unusual, and potentially difficult to detect by conventional means.

After a lethal outbreak of E. coli in 1993, Dr. Tauxe said the United States created a government database that gathered information on laboratory testing of pathogens and shared it with health officials around the country. He said no similar system existed in Europe that would allow separate countries to quickly share lab results.

“This could be an important game-changing event in Europe,” he said.

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