e coli presentation 26 june 2011

7/29/2019 E COLI Presentation 26 June 2011

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Dr. Erick Saputra


2/18

A large outbreak of the bacteria E.coliis underway in Germany.

The strain responsible is

enterohemorrhagic Eshcerichia coli(EHEC) 0104:H4.

The outbreak is causing a high

number of severe bloody diarrheacases as well as hemolytic uremicsyndrome (HUS).


3/18

A number ofdeaths have occurred. The source of the outbreak is likely

contaminated raw vegetables, in particularsprouts, tomato, cucumber and lettuce.

As the source of the outbreak has not yetbeen pinpointed, it is possible that thecontaminated food is still in circulation.

Everyone in Germany is advised to avoid

eating raw salads, especially thosecontaining sprouts, tomato, cucumber, orlettuce at this time, particularly innorthern Germany.


4/18

The outbreak

Over 700 cases of life-threatening hemolytic-uremic syndrome (HUS, sudden kidney failurewith bleeding problems) and more than 2000cases of enterohemorrhagic Escherichia coli

(EHEC, bloody diarrhea) have beendocumented since the second week of May.

Most of the cases have been adult women,who were likely infected by eating

contaminated raw vegetables. At least 18 fatalities from HUS, and eight from

EHEC have been confirmed.


5/18

The outbreak

Many people are hospitalized, with asignificant number of them requiringintensive care management and dialysis

Most cases have been reported innorthern Germany - Schleswig-Holstein,Lower Saxony, Hamburg and North Rhine-Westphalia. However, both the eastern

and southern regions of Germany havereported possible infections.


6/18


7/18

The outbreak

More than ten other countries havereported cases of EHEC and/or HUSassociated with this outbreak Austria,Czech Republic, Denmark, France,

Luxembourg, Netherlands, Norway,Poland, Spain, Sweden, Switzerland, theUnited Kingdom and the United States.

The vast majority of cases are in peoplewho have been in northern Germany,whilst at least one case occurred insomeone who had contact with a travelerfrom northern Germany.


8/18

The outbreak

The total number of infections is expectedto rise as the source of the outbreak stillhas not been pinpointed.

Investigations to date have determined

those affected appear to have eaten rawtomatoes, cucumber and lettuce.

Initial reports ofE. colicontaminationfound in some cucumbers from Spain have

been disproved on further testing. Other sources of EHEC, such as raw milk

and meat, are not associated with thisoutbreak.


9/18

The outbreak

The World Health Organizationadvises that while the strainresponsible, enterohemorrhagic

Eshcerichia coli(EHEC) 0104:H4, israre, it has been seen in humansbefore.

However it has never previouslybeen responsible for an outbreak.


10/18

The disease

Though most strains ofE. colido not cause illness, somestrains - such as Escherichia coliO104:H4 or O157:H7 -can make people sick.

They sometimes cause severe and life-threateningsymptoms.

About three to four days (as long as eight days) afterexposure, symptoms develop. The most common symptoms caused by enterohemorrhagic

E. coli(EHEC) strains, are cramping and diarrhea, whichcan become bloody.

A fever and vomiting may occur. Most people recover withsupportive measures in about 10 days.


11/18

The disease

However about 8% of cases can develop a moreserious condition called hemolytic-uremicsyndrome (HUS) which can be fatal.

This involves anemia (low red blood cell count),

sudden kidney failure and an increased tendencyto bleed (due to a low platelet count).

Long-term kidney damage and neurologiccomplications can occur.

Usually children under 5 years old and elderlypeople are more susceptible to developing HUS.


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13/18

The disease

The bacteria are usually present in the intestines of cows. The bacteria are killed by heat. People most often become infected by eating contaminated

food such as : undercooked beef,

raw milk,

unpasteurized cheeses or juices, and produce such as lettuce and sprouts that has been fertilized

with contaminated manure and/or unsafe water.

People may also get infected by swimming in or drinkingcontaminated water.

The disease can spread from person to person, especially infamily and child care environments.


14/18

The disease

Children, and some adults, can carry the bacteriawithout showing symptoms.

Treatment is supportive giving fluids.

Antibiotics should not be used, and may increase

the risk of developing HUS. Infected people should not take anti diarrheal

agents, such as loperamide (Imodium) ordiphenoxylate with atropine (Lomotil).

In the case of HUS, hospitalized management isrequired, with intensive care treatment, dialysisand blood transfusions.


15/18

To prevent infection:

Avoid consuming raw vegetables, especiallysalads containing sprouts, tomatoes,cucumbers and lettuce at this time.

Avoid raw salads which contain sprouts /tomatoes / cucumber / lettuce.

The regular food precautions of washing andpeeling vegetables are probably not sufficient inthis outbreak, as a very small dose of thebacteria can cause illness.

It is safest to avoid all raw salad at thistime.

The bacteria are killed by heat. All food should bethoroughly cooked and served hot.


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Maintain a high level of hygiene. Wash hands well and often. Wash after using the bathroom.

Wash before eating / serving / preparing food. When preparing food, be careful to prevent cross-

contamination.

Keep uncooked foods away from cooked food. Thoroughly wash hands and all utensils after they have

touched raw foods. The disease can spread from one person to another if you

are in contact with someone who has symptoms, payattention to hygiene.

Wash hands after contact with potentially contaminateditems, do not touch your face / mouth.


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If you develop symptoms:

Seek medical attention immediately.

Do not handle food or prepare mealsfor others

Do not take antidiarrheal agents,

such as loperamide (Imodium) ordiphenoxylate with atropine(Lomotil).


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Terima Kasih

e coli presentation 26 june 2011

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