“The Hoopla About Hamburgers”

What is E. coli?
E. coli is short for Escherichia coli -- a general name for a common germ (bacterium) that usually lives peacefully in our colons (lower digestive tracts). There are many different types (strains) of E. coli. Most are harmless or actually beneficial, but some can cause severe illness in humans.

The “strain” of E. coli called E. coli 0157: H7 is one of these dangerous types. For simplicity sake, I will refer to this pathogen as E. coli 0157 for the remainder of this article. These bacteria are “cousins” to our bodies’ own beneficial E. coli, but are acquired from an outside source, i.e. via contaminated food. Once inside the body the bacteria produce toxins (poisons) that can make us very sick. Though symptoms of E. coli 0157 are very unpleasant, they are likely to be more severe in children, in the elderly and in those with weakened immune systems. These infections are more common during the summer months and in northern states.

How can I “catch” E. coli 0157 infection?
You can “catch” an E. coli 0157 infection in the following ways:

• Eating undercooked meat, ground beef particularly
• Drinking unpasteurized (raw) milk or raw milk products
• Eating unwashed produce grown in soil fertilized with feces
• Working with cattle

People have become infected with E. coli 0157 in their own kitchens after handling raw meat or failing to wash raw produce prior to consumption. Leaky packages of poorly wrapped raw meat stored on refrigerator shelves above other food items, have also been implicated in human infections

Healthy beef and dairy cattle sometimes carry the E. coli 0157 germ in their intestines. Contamination can occur during the slaughtering process and the bacteria can then be spread throughout the meat as it is ground to hamburger. Though thorough cooking kills these bacteria, individuals who eat undercooked ground meat may develop an infection.
Additionally, E coli 0157 can be passed from person to person in families, day care centers, nursing homes, etc. Poor hand washing after bathroom use or diaper changing and before preparing food is a likely mode of transmission in such settings.
E. coli 0157 is very contagious. Children should not attend day care until they have 2 negative stool cultures (proof that the infection is gone). Nursing home residents also require 2 negative stool cultures and will be monitored closely by staff and their facilities’ Infection Control Officer.

What are the symptoms of E. coli 017 infection?
Symptoms usually start 2 to 4 days after exposure, but can take up to 8 days to begin and include:

• Sudden onset of severe abdominal cramps (“stomach ache”)
• Watery diarrhea that rapidly becomes bloody
• Low-grade fever in some cases
• Nausea and vomiting in some cases

Frequent diarrhea can cause dehydration and make you feel tired and “sick all over”. The toxin (poison) that the E. coli 0157 bacterium produces causes inflammation and bleeding in the intestines. Some people report that their stools become “all blood and no stool”.

Are there any complications from E. coli infection?
The most serious complication is called hemolytic uremic syndrome or “HUS”. People with this problem get hemolytic anemia (low red blood cell count), thrombocytopenia (low platelet count) and renal failure (kidney damage).

Hemolytic uremic syndrome occurs in only about 2-7% of all cases of E. coli 0157 and usually begins the week following the diarrheal stage. It is a very serious complication and is most common in children. Thrombotic thrombocytopenic purpura (TTP) is a similar complication and is seen predominantly in adults. People who develop HUS or TTP require hospitalization.

How is E. coli 0157 infection diagnosed?
If you have symptoms (watery diarrhea, bloody diarrhea, cramps, fever, nausea or vomiting), regardless of what you have eaten, call you doctor right away. He or she will have you submit a stool culture to determine if you have E. coli 0157 in your intestines. The culture should be obtained within first 48 hours of bloody diarrhea.

E. coli 0157 is a reportable disease in New York State. If your culture is positive, your doctor or the lab will notify the local health department. A public health representative will contact you to discuss your food history in an attempt to determine the source of your infection. Through this investigation perhaps additional cases can be prevented.

How is the infection treated?
There is no specific treatment for E. coli 0157 other than maintaining hydration (drinking plenty of fluids), resting and watching for complications. Anti-diarrheal medications and antibiotics are not recommended as they may increase the risk of developing kidney complications. IV fluids may be necessary for re-hydration or pain medication for severe cramping. Additionally doctors may order blood and urine tests to monitor electrolyte balance and kidney function.

How can I protect myself from E. coli and other GI (gastrointestinal) infections?

• Wash your hands carefully with soap before preparing food. Wash regularly during the cooking process, especially after handling raw meat.
• Cook ground beef and other meats thoroughly.
  • Cook all hamburgers to at least 155°F. A meat thermometer can be extremely helpful as you test your food for “doneness”.
• Do not “sample” bites of raw ground beef during preparation.
• Do not put cooked foods on an unwashed plate that previously held raw meat.
• Defrost meats in the refrigerator or the microwave, rather than at room temperature.
• Store raw meats and poultry in the refrigerator separately from other foods in sealed containers.
• Use hot water and soap to wash cutting boards and dishes if raw meat and poultry have touched them.
  • Plastic cutting boards are safer than wooden cutting boards as they are less porous.
• Do not drink raw (unpasteurized) milk or consume cheese or ice cream made from raw milk.
• Thoroughly wash all produce prior to eating.
• Keep hot food hot and cold food cold.
• Refrigerate leftovers or throw them away.
• Allow hot leftovers to come to room temperature prior to putting in the refrigerator.
  • A hot leftover creates a hot spot in your refrigerator, allowing germs on other foods to grow.
• If experiencing diarrhea, be sure to wash hands frequently and thoroughly using plenty of soap. If possible, avoid preparing food for others while you are sick.
• If you work in food service, tell your employer if you are experiencing diarrhea and stay home from work

What do I do if I think I have an E. coli 0157 infection?

• Call your doctor and get his/her advice
  • Stay in touch with him/her especially if you develop a fever.
  • Keep a diary of how you feel each day
• Wash your hands frequently, using warm water, plenty of soap, and 20-30 seconds of friction (rubbing/lathering).
• Avoid contact with other family members; don’t prepare food for them.
  • Try to avoid contaminating the toilet flusher, water faucets, bathroom doorknob, etc. with unwashed hands.
• Drink enough fluids to keep your urine a light color. Dark urine is a sign of dehydration.
  • Your doctor may recommend clear fluids (any fluid you can read a newspaper through) such as water, tea, Gatorade, Jell-O, broth, etc. If you are diabetic or on a special diet, be sure to check with for your physician for his/her recommendations about your food intake.
• When you start to feel better, SLOWLY advance your diet to thin soups, toast and other bland foods.
• If you do not have a private physician and are having symptoms consistent with E. coli 0157 (bloody diarrhea, cramps, etc.) proceed to the emergency department of your local hospital.

Will I recover?
Every spring/summer we see an occasional case of E. coli 0157 in Ontario County. Most individuals recover within a week, but it may take longer for some. It is usually difficult and sometimes impossible to determine how an individual became infected. Though symptoms of E. coli 0157 are extremely unpleasant and sometimes hospitalization is required, most people recover without difficulty. Only a very small percentage go on to develop severe complications.

For more information see: http://www.cdc.gov/NCIDOD/DBMD/diseaseinfo/escherichiacoli_g.htm

To speak with a Communicable Disease Nurse at Ontario County Public Health concerning E. coli 0157:H7 or other New York State reportable diseases, call 585-396-4343.

Revised 4/2007 Kate Ott, RN, BSN