E. coli out­breaks can be caused by con­tam­i­nated ir­ri­ga­tion wa­ter

Sherbrooke Record - - SPORTS - By Eve Glazier, M.D., and El­iz­a­beth Ko, M.D.

Dear Doc­tor: It seems like ev­ery time we turn on the TV there’s an­other re­call of ro­maine let­tuce be­cause of an­other out­break of E. coli. What’s the deal? How dan­ger­ous is it if I get in­fected?

Dear Reader: You’re right — there seems to be no end in sight to the safety is­sues hav­ing to do with ro­maine let­tuce and E. coli bac­te­ria. It’s un­der­stand­able that there would be oc­ca­sional safety is­sues in a food sup­ply chain as vast and com­plex as the one that serves the United States. When it comes to ro­maine let­tuce, though, the on­go­ing is­sues seem to be in a cat­e­gory all their own.

Let’s start with E. coli, the bac­te­ria that’s caus­ing salad lovers so much trou­ble. The full name is Escherichia coli, and it comes in many dif­fer­ent strains, which live in the in­testines of hu­mans and an­i­mals. Most strains are harm­less and co-ex­ist peace­ably with their hosts. How­ever, some strains pro­duce some­thing known as Shiga toxin, a par­tic­u­larly nasty pathogen. Once the “bad” E. coli strains are ingested and reach the large in­tes­tine, they mul­ti­ply rapidly. They then bind to the in­testi­nal lin­ing, which is rich in tiny cap­il­lar­ies. That gives the Shiga toxin a path­way to the kid­neys.

The in­flam­ma­tion re­sult­ing from the pres­ence of Shiga toxin is be­lieved to cause the ini­tial symp­toms, which be­gin with ab­dom­i­nal cramp­ing that can be­come quite se­vere. The di­ar­rhea that fol­lows of­ten be­comes vis­i­bly bloody. Some­times this is ac­com­pa­nied by vom­it­ing or, less com­monly, fever. The in­cu­ba­tion pe­riod is any­where from one to 10 days, but most peo­ple be­come ill within three to four days of in­fec­tion. This oc­curs when some­one in­gests con­tam­i­nated food or drink, and through the oral-fe­cal route. The ill­ness lasts any­where from a few days to close to two weeks. For most, E. coli in­fec­tion is ex­tremely un­pleas­ant but not life-threat­en­ing. But for young chil­dren and the el­derly, such an in­fec­tion can be fa­tal. That’s be­cause they are at in­creased risk of de­vel­op­ing hemolytic ure­mic syn­drome, a form of kid­ney fail­ure.

As for why ro­maine let­tuce ap­pears to be sus­cep­ti­ble to in­fec­tion with E. coli, the rea­sons aren’t com­pletely clear. One out­break was thought to be caused by wa­ter that flowed through an ir­ri­ga­tion canal be­lieved to be con­tam­i­nated by the bac­terium. In some cases, in­fec­tions have been traced back to live­stock op­er­a­tions that bor­der fields of ro­maine. Other points of po­ten­tial in­fec­tion are pro­cess­ing fa­cil­i­ties, where ro­maine is washed and bagged. The let­tuce in­dus­try has pledged mit­i­ga­tions to ad­dress each of these is­sues, par­tic­u­larly those hav­ing to do with con­tam­i­nated ir­ri­ga­tion wa­ter.

In the mean­time, it’s vi­tal to abide by the Food and Drug Ad­min­is­tra­tion’s di­rec­tives to steer clear of ro­maine. It may be tempt­ing to keep whatever you have in your fridge and sim­ply wash it thor­oughly. Un­for­tu­nately, that won’t work. E. coli can hide in mi­cro­scopic crevices, and it’s im­pos­si­ble to get rid of it all. In fact, the CDC rec­om­mends that con­sumers thor­oughly clean the place in the re­frig­er­a­tor where the con­tam­i­nated food was stored.

For the lat­est up­dates re­gard­ing food­borne ill­nesses and con­tam­i­nants, in­clud­ing the ro­maine re­calls, visit www.fda.gov/food.

Eve Glazier, M.D., MBA, is an in­ternist and as­so­ciate pro­fes­sor of medicine at UCLA Health. El­iz­a­beth Ko, M.D., is an in­ternist and as­sis­tant pro­fes­sor of medicine at UCLA Health.

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