A stomach bug turns deadly

 

By John Hawes, Senior Editor

I was originally assigned to write about blowing the conch shell, something I traditionally do to announce Happy Hour and other office events, but that will have to wait. I want to talk to you first about something else . . . bacteria. About one bacterial species in particular—Escherichia coli—and actually one specific type—E coli O157:H7.

Last month, my family celebrated the 19th anniversary of the day my youngest daughter Sophia received a kidney transplant, which saved her life. She needed a kidney because both of hers had failed after becoming sick following an E coli O157:H7 infection when she was 3½ years old.

It was October, and the daycare center where she went to for a half day in northeastern Westchester County gave the kids fresh, unpasteurized apple cider from a local farm. Although the Department of Health never conclusively identified the source of the infection, the culprit was most likely the cider, contaminated by including unwashed apples that had fallen on the ground in a pasture also used to graze the farm’s cows. Cattle (cows to non-farmers) are common, asymptomatic hosts for O157:H7, harboring the bacteria in their gastrointestinal tract. If you buy apple cider at a store, it will have most likely been pasteurized, meaning the cider has been heated to a temperature to kill any disease-causing microorganisms present in the juice. But fresh apple cider is usually unpasteurized.

I’m sure the smart Millennial readers will know that certain types of E coli are an important part of our digestive system. Depending on the strain of E coli, it can be either beneficial, indifferent, or pathogenic (ie, causing disease). The O157:H7 type is not one of the good types. As Wikipedia tells us, “It is a cause of disease, typically foodborne illness, through the consumption of contaminated and raw food, including raw milk and undercooked ground beef.” What do both of those examples have in common? Well, undercooking food but also, yes, cows.

Typically, infection with O157:H7 causes stomachache with severe diarrhea. Most kids suffer with it for several days but then are fine. However, in very young children (like Sophia back then), the infection can cause a complication called hemolytic uremic syndrome or HUS. HUS is life-threatening and can occur, paradoxically, in strong, healthy children. Several other children in Sophia’s daycare later developed GI problems, but Sophia got HUS.

One of the first instances of an E coli outbreak to become widely known in the United States was the Jack in the Box incident in 1993 during which 4 children died after eating a hamburger, and scores were left with permanent kidney or brain damage. There have been other outbreaks since then, but the Jack in the Box incident resulted in E coli O57:H7 becoming mandated as a reportable disease by the Centers for Disease Control and Prevention. As such, it now must be tested for, and cultures ordered, by healthcare personnel when anyone presents with symptoms of gastric distress.

As an Editor at CultHealth, I am accustomed to helping teams get up to speed on various disease states and treatments related to the brands we represent as part of an initial, wide-ranging briefing process, which almost always involves extensive online research. After a review of the literature on O157:H7, I’m fairly certain that the irreversible organ damage and deaths associated with O157:H7 outbreaks are due to HUS. E coli O157:H7 produces an endotoxin, which when released from the bacteria causes widespread clotting of the body’s fine blood vessels, such as those in the kidney, which can lead to multiorgan failure.

After waiting that October for Sophia’s “stomach bug” to go away, my wife took her to the pediatrician, who on his own decided to test her for a little-known strain of E coli he had recently read about. This was 1995—one year after the infamous Jack in the Box outbreak but before E coli O157:H7 infection was required to be reported. Very few doctors knew about it. The test came back positive, and Sophia was admitted to the hospital. The infectious disease specialist on call that evening prescribed what is normally given—a broad-spectrum antibiotic. What we know now is that antibiotics are contraindicated with O157:H7 because the action of many commonly used antibiotics in killing bacteria will cause a massive release of endotoxin when used for E coli O157:H7 infection. During the night, Sophia went into acute renal failure—both kidneys failed—and she needed emergency hemodialysis at the nearest pediatric ICU. She would spend the next 4 weeks there.

Sophia’s story that winter is a long and scary one. Suffice it to say that after transferring her care to a larger hospital and keeping her alive without dialysis for 5 years, she finally needed a transplant. It’s been almost 20 years since the day of her transplant surgery. Although she unfortunately developed insulin-dependent diabetes almost immediately following the operation and needs anti-rejection medications every day, Sophia has had an otherwise happy and healthy life, and her transplanted kidney continues to do its job. She is now 27 and will receive her master’s degree in applied behavior analysis this fall.