The 44-year-old and her colleagues have been caring for a flood of patients over the past two weeks who have been infected with the enterohaemorrhagic Escherichia coli (EHEC) bacteria, and are experiencing its alarming symptoms first hand.

The cause of the outbreak - which has spread across Europe but is centred in northern Germany - remains unclear, and little research has been done on its treatment.

Doctors and nurses, patients and their relations have all been pushed to their limits.

'We're sleeping badly, and have bad dreams,' Kiemes says quietly. 'We can't get the images of suffering patients out of our heads.'

The neurological breakdowns of patients are particularly concerning. 'When their condition gets worse, then it's dramatic.'

The clinic is currently treating around 180 patients suffering from EHEC, of whom 95 have life-threatening haemolytic-uraemic syndrome (HUS), a form of kidney failure caused by E coli. Around every other HUS patient suffers serious neurological complications.

The patients become disoriented, have difficulty expressing themselves, suffer convulsions. Some become apathetic, others make strange noises. Some get such strong cramp attacks they have to be restrained.

Since the first EHEC patients arrived in the hospital, the wards treating them have been on a 'complete emergency footing,' Kiemes says.

Doctors and co-workers have worked through weekends and days off, delaying their holidays in order to help out. In daily meetings they examine the situation from all angles.

The patients 'spend all their time thinking,' says Keimes. 'They're mentally exhausted because they don't know what EHEC is, where it's come from and what happens next.'

What's worst is when patients realize that particularly severe cases have been taken to intensive care. 'Then they wonder whether they'll come back and are afraid of what will happen to them.'

The situation is also a nightmare for relatives. Like the doctors  and nurses, they have to disinfect themselves thoroughly before entering the wards, as well as donning green overalls, gloves and masks to cover their mouths.

The protective clothing then has to be left behind after each visit. In the corridor outside they have to change immediately into new overalls, in order to minimize the chances of spreading the infection.

'Is she worse?' asks one mother, sounding frightened and shocked, when she discovers that her daughter is not in her usual room. The 40-year-old has been moved to intensive care.

Her partner is carrying two plastic bags filled with her belongings out of the room. 'The uncertainty is horrible,' the mother and partner say.

They are despondent because they do not know where their loved one caught the infection - or whether she will get better.

Doctors are battling in the dark, surprised by the length of the illness and its unpredictable developments.

Gastroenterologist Stefan Schreiber bemoans the fact that, despite intensive questioning about eating habits, there has as yet been no eureka moment, when doctors discover which food links the cases.

'It will only be over when we find the source of the infection and we don't have any infections for two, three weeks,' he says.

'It really annoys me that we still haven't found the cause.'

Schreiber believes that the blame lies with cheap, mass-produced and easily contaminated food. 'That will always create weak points.'

Germany says beansprouts may be behind E.coli

HANOVER, Germany (Reuters) - A German official said on Sunday that locally grown beansprouts may be the "most convincing" cause of the deadly E.coli outbreak that has killed 22 people and made more than 2,000 ill across Europe.

Gert Lindemann, agriculture minister in the northern state of Lower-Saxony near Hamburg, told a news conference that a company in the Uelzen region had been shut down and further test results were expected on Monday.

"There was a very clear trail (to this company) as the source of the infection," Lindemann said in a news conference broadcast on N-TV television. He urged consumers in northern Germany to refrain from eating all types of sprouts.

"It is the most convincing...source for the E.coli illnesses," he said.

Earlier, a state government official told Reuters that investigators had identified beansprouts as the possible source of the bacteria. He said that officials were able to trace rather precisely the supply routes of the sprouts.

Authorities have been racing to track down the source of the pathogen, which has infected people in 12 countries -- all of whom had been traveling in northern Germany. Many of those infected have developed haemolytic uraemic syndrome (HUS), a potentially deadly complication attacking the kidneys.

The rare strain of E.coli has the ability to stick to intestinal walls where it pumps out toxins, sometimes causing severe bloody diarrhoea and kidney problems. Some patients have needed intensive care, including dialysis.

In a statement, the ministry said that the sprouts from the company in question were delivered to restaurants and food operations in the states of Hamburg, Schleswig-Holstein, Mecklenburg-Vorpommern, Hesse and Lower Saxony.

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E. coli confirmed in SWVA child that died, possible "outbreak" in NETN under investigation
Dryden, VA girl dies from possible E. coli infection, brother also taken to hospital

Credit: Associated Press

Lab results confirm the presence of E. coli in the child that died this weekend and the presence of the bacteria in a close contact of the child, Virginia Department of Health Public Information Officer Robert Parker said.

By Nate Morabito
Published: June 06, 2011
» 1 Comment | Post a Comment
DRYDEN, Va. --

UPDATE: 5:16 pm

Lab results confirm the presence of E. coli in the child that died this weekend and the presence of the bacteria in a close contact of the child, Virginia Department of Health Public Information Officer Robert Parker said.

"The lab results confirm the presence of E. coli 0157:H7," Parker said. "That's a strain of E. coli that causes severe illness."

Northeast Regional Health Office Medical Director Dr. David Kirschke also confirms a similar severe strain in Northeast Tennessee.

"We have one case of the severe type in Tennessee," Dr. Kirschke said. "It may be similar to what the two kids from Virginia had."

In the Tennessee case, Dr. Kirschke said a Northeast Tennessee child is suffering complications in a Knoxville hospital.

Meanwhile, he says there are seven other confirmed cases of E. coli from four Northeast Tennessee counties.

“Everyone is doing fine,” Dr. Kirschke said of those seven people. “From the initial tests, these look like the less severe type of E coli. We are treating it like an outbreak. We are investigating it like an outbreak.”

The Northeast Regional Health Office is urging people to cook their meat thoroughly, wash their raw fruits and vegetables, and avoid swimming in recreation waterways like rivers and lakes that may be prone to agricultural run-off. Meanwhile, the health department is continuing to search for the cause of the “outbreak.”

“We’ve interviewed all of the people,” Dr. Kirschke said. “Some people have eaten ground beef, others have not. Some have eaten fresh fruits, but not everybody. Some have swam in lakes and rivers, but not everybody.”

----------------------------------------------

A two year-old Dryden, VA girl died at Johnson City Medical Center Sunday after potentially being exposed to E. coli.

According to a Washington County, TN Sheriff's Office Coroner's Report, the two year-old was brought to the medical center Pediatric Intensive Care Unit with bloody diarrhea after she was "believed to be exposed to E. coli from a contaminated pool."

According to Capt. Shawn Judy, the report says the girl was transferred from a Southwest Virginia community hospital. The Washington County Sheriff's Office has now ordered an autopsy.

Her brother was also brought to the hospital with the same symptoms, Capt. Judy said. However, the WCSO is not aware of his condition.

Mountain States Health Alliance Communications Manager Teresa Hicks also did not know the boy's condition. He has since been transferred to a different hospital, Hicks said.

As for his sister, a Virginia Department of Health spokesperson confirmed the agency is investigating the death of a child, but would not go into specifics. Southwest Virginia Regional Public Information Officer Robert Parker said it’s too early to tell the exact cause of the child’s death.

"We can confirm the death of a child (within the last few days) in the Western Region of Virginia," Parker said. "The child was ill with a toxin-producing bacterial infection in the gastrointestinal tract. The investigation is continuing. We are awaiting lab results. E. coli is one of a number of things that can cause these types of infections.”

While the Virginia Department of Health waits on those results, Parker urges people to be cautious.

"It's important for everyone to keep in mind the ways they can prevent the spread of illness," Parker said. "Cook meat thoroughly. Avoid raw or undercooked meats like hamburger. Make sure food prep surfaces are clean (avoid cross-contamination). Wash your hands frequently. Avoid water that may be contaminated: rivers, lakes, pools. Don't drink water in a swimming pool, river, or lake. Any child with diarrhea should seek medical attention, because of how quickly diarrhea can lead to dehydration.”

Mountain States Health Alliance Infection Prevention Corporate Manager Rebecca Bartles echoes that advice. She urges people to watch out for the warning signs.

“Usually it starts out with abdominal pain, cramping, diarrhea, and then can progress to bloody diarrhea,” Bartles said. “If a child has those symptoms of abdominal pain and diarrhea that have gone on for any period of time, it’s best to take them to see their physician. Of course, bloody diarrhea is something that warrants immediate health care attention.”

In the most serious cases, E. coli can lead to kidney failure and even death. The bacteria can enter the body through oral contact with human feces or animals feces.

Outbreak of Shiga toxin-producing E. coli in Germany (7 June 2011, 11:00)

 

On 22 May, Germany reported a significant increase in the number of patients with haemolytic uremic syndrome (HUS) and bloody diarrhoea caused by Shiga toxin-producing E. coli (STEC).  Since 2 May 2011, 674 cases of HUS and 1755 non-HUS STEC cases have been reported from European Union Member States, including 642 HUS cases and 1683 non-HUS STEC cases in Germany. Sixteen of the HUS cases and seven non-HUS STEC cases in EU Member states have died. See table below.

While HUS, caused by STEC infections, is usually observed in children under 5 years of age, in this outbreak the great majority of cases are adults, with more than two thirds being women.

Laboratory results indicate that STEC serogroup O104:H4 (Stx2-positve, eae-negative, hly-negative, ESBL, aat, aggR, aap) is the causative agent. PFGE results shows indistinguishable pattern of 7 human O104:H4 outbreak strains in Germany and 2 strains of O104:H4 in Denmark.

The source of the outbreak is under investigation, but contaminated food seems the most likely vehicle of infection.

Most cases are from, or have a history of travel to the North of Germany (mainly Schleswig-Holstein, Lower Saxony, North-Rhine-Westphalia and Hamburg). In the EU also Denmark, the Netherlands, Poland, Spain, Sweden and the United Kingdom have reported cases of HUS, related to the ongoing outbreak as well as cases of non-HUS STEC cases.

Number of HUS and non-HUS STEC cases and associated deaths per EU Member States as of 7 June 10:00

EU Member States reporting cases	Number of HUS cases (deaths)	Number of non-HUS STEC cases (deaths)
Austria	0 (0)	2 (0)
Czech Republic	0 (0)	1 (0)
Denmark	7 (0)	11 (0)
Finland	0 (0)	1 (0)
France	0 (0)	10 (0)
Germany	642 (15)	1683 (7)
Luxembourg	0 (0)	1 (0)
The Netherlands	4 (0)	4 (0)
Norway	0 (0)	1 (0)
Poland	2 (0)	0 (0)
Spain	1 (0)	1 (0)
Sweden	15 (1)	32 (0)
The United Kingdom	3 (0)	8 (0)
Total	674 (16)	1755 (7)

Based on the available information, cases are associated with an exposure in Germany (mainly northern parts). The vehicle of the outbreak has not yet been identified and intensive investigations are ongoing. The results of these investigations will determine the assessment of this risk. Rapid identification of potential cases linked to this outbreak, within Germany or among persons who have travelled to Germany since the beginning of May, is essential to prevent the development of severe disease.

STEC is a group of pathogenic Escherichia coli (E. coli) strains capable of producing Shiga toxins, with the potential to cause severe enteric and systemic disease in humans.

AMSTERDAM (AP) -- Dutch authorities recalled red beet sprouts from three countries Thursday after samples were found to be contaminated with a strain of E. coli bacteria that was apparently less dangerous than the one causing Europe's deadly E. coli crisis.

German health officials, meanwhile, reported that three more people died of the ailment Thursday, raising the toll to 29 in less than six weeks.

The Dutch Food Safety Authority said laboratories were still trying to identify the Dutch strain of E. coli, but said there have been no immediate reports of serious illness from it.

Still, the agency said it was definitely not the same E. coli strain that killed 29 people, sickened 2,900 others and left hundreds with serious complications, most of them in Germany. The cause of that outbreak has so far eluded German investigators.

Only one Dutch grower, a company called Hamu, was found with contaminated beets, and other produce grown on its farms were cleared of suspicion, said Esther Filon, a spokeswoman for the Dutch regulation agency.

"It's not the same as in Germany. You can become ill, but as far as we know at this moment, it is not lethal," she told The Associated Press.

She said the authorities were trying to trace all shipments from the grower.

The agency said Hamu, based in the town of Kerkdriel, 44 miles (70 kilometers) southeast of Amsterdam, had exported beet sprouts to Belgium as well as selling them on the Dutch and German markets.

There are hundreds of E. coli bacteria strains in nature, but only a few are deadly to humans and the bacteria is more commonly known as a source of food poisoning or severe stomach problems.

People naturally carry several harmless E. coli strains in their intestines and the bacteria is also widely found in cows, sheep and other mammals. Strains which are harmless to animals can sometimes be lethal for humans. Experts worry about E. coli's constant evolution, which may result in dangerous mutations for humans.

The European Union informed the Netherlands late Wednesday that contaminated beet sprouts had been found in Germany, and tests in the Netherlands confirmed it.

Harald Wychel of the National Institute for Public Health said authorities are still investigating whether anyone has fallen ill from the Dutch strain.

In Berlin, the Robert Koch Institute said the rate of new illnesses was declining in the deadly E. coli outbreak. It said 2,808 people have been sickened in Germany, 722 of whom are suffering from a serious complication that can cause kidney failure. But it was not clear whether the epidemic was waning, or people were just successfully shunning fruit and vegetables.

The World Health Organization says 97 others have fallen sick in 12 other European countries, as well as three in the United States.

Germany's Lower Saxony state health ministry said two more people died after being infected -- a 20-year-old woman and an 68-year-old man.

At least five people were hospitalized following a family gathering for a 70th birthday late last month south of Hannover, and investigators were probing the catering firm for possible leads to the outbreak's source, the state ministry said.

European Union farmers say they have been losing up to euro417 million ($611 million) a week as ripe produce rots in fields and warehouses. The EU pledged Wednesday it would offer farmers compensation of up to euro210 million ($306 million) for the E. coli losses.

Russia and Saudi Arabia have issued a blanket ban on vegetable imports from the European Union.

Spanish farmers have been among the hardest hit, after authorities in Hamburg issued a warning that Spanish cucumbers could be the source of the outbreak. Further tests showed that while the Spanish vegetables did carry E. coli, it was not the strain behind the outbreak.

Spain's Secretary of State for European Affairs, Diego Lopez Garrido, said the compensation being offered by the EU is not enough and blasted the Russian ban on all EU vegetables as "inappropriate." Russia is a huge market for EU produce.

David Rising and Juergen Baetz in Berlin and Maria Cheng in London contributed to this report

Outbreak of Shiga toxin-producing E. coli in Germany

On 22 May, Germany reported a significant increase in the number of patients with haemolytic uremic syndrome (HUS) and bloody diarrhoea caused by Shiga toxin-producing E. coli (STEC). Since 2 May 2011, 809 cases of HUS and 2 434 non-HUS STEC cases have been reported from European Union Member States, including 773 HUS cases and 2 374 non-HUS STEC cases in Germany. 23 of the HUS cases and 12 non-HUS STEC cases in EU Member states have died. See table below.

While HUS, caused by STEC infections, is usually observed in children under 5 years of age, in this outbreak the great majority of cases are adults, with around two thirds being women.

Most cases are from, or have a history of travel to the North of Germany (mainly Schleswig-Holstein, Lower Saxony, North-Rhine-Westphalia and Hamburg). In the EU/EEA, Austria, Denmark, Germany, the Netherlands, Poland, Spain, Sweden and the United Kingdom have reported cases of HUS, while 5 other Member States have reported only non-HUS STEC cases.

Laboratory results indicate that STEC serogroup O104:H4 (Stx2-positve, eae-negative, hly-negative, ESBL, aat, aggR, aap) is the causative agent. PFGE results shows indistinguishable pattern of 7 human O104:H4 outbreak strains in Germany and 2 strains of O104:H4 in Denmark. STEC is a group of pathogenic Escherichia coli (E. coli) strains capable of producing Shiga toxins, with the potential to cause severe enteric and systemic disease in humans.

The clinical manifestations of the disease can be extremely severe.

Number of HUS and non-HUS STEC cases and associated deaths per EU/EEA Member States  as of 11 June 11:00

EU Member States reporting cases	Number of HUS cases (deaths)	Number of non-HUS STEC cases (deaths)
Austria	1 (0)	3 (0)
Czech Republic	0 (0)	1 (0)
Denmark	8 (0)	12 (0)
France	0 (0)	2 (0)
Germany	773 (22)	2 374 (12)
Greece	0 (0)	1 (0)
Luxembourg	0 (0)	2 (0)
The Netherlands	4 (0)	4 (0)
Norway	0 (0)	1 (0)
Poland	2 (0)	0 (0)
Spain	1 (0)	1 (0)
Sweden	17 (1)	30 (0)
The United Kingdom	3 (0)	3 (0)
Total	809 (23)	2 434 (12)

Please note that since 8 June, Member States have started reporting cases according to a new EU case-definition.  This resulted with marginal adjustments of figures compared to previous reports in five Member States, Finland (that is not reporting cases anymore), France, the Netherlands, Sweden and the United Kingdom.

The German Authorities have indicated that food items originating from a distinct producer in Lower Saxony (Germany) are the most likely vehicle of the infection. The German Authorities also declared that all food products (e.g. bean sprouts and other vegetables) originating from the mentioned producer in Lower Saxony shall be taken from the market.

Additional recommendations from the German Authorities are to adhere to good hygiene practices when handling food or caring for patients and to abstain from eating raw sprouts. Households and gastronomic businesses in Germany should dispose of any sprouts currently in stock as well as any food items that might have come in contact with these. The earlier recommendation from the German Authorities to abstain from eating cucumbers, tomatoes and lettuce in northern parts of Germany does not need to be upheld anymore

Further investigations are ongoing to identify the original source of the infection. The German Authorities are also declaring a decrease of the number of new cases.