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Escherichia Coli O157-H7 Montiel 1

Escherichia Coli O157-H7


Athena Montiel
California State University- San Bernardino

Introduction
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In 1982, Escherichia Coli O157-H7 was first recognized as human pathogen due to some

bloody diarrhea outbreaks in Oregon and Michigan, (Lim). It was also linked to some

Hemolytic-Uremic Syndrome outbreaks in 1983, (Lim). However, it was until 1994 that it

became a nationally notifiable infection and in 2000, reporting cases was mandatory for 48

states, (Rangel). Furthermore, it has been named one of the most important foodborne pathogens

since cases continue to be reported ever since the outbreaks. It is estimated that every year about

73,480 illnesses, 2,168 hospitalizations, and 61 deaths are caused by E. Coli 0157-H7, (Rangel).

Escherichia Coli O157-H7 is known as the worst type of E.Coli and it creates a Shiga toxin. Due

to this Escherichia Coli O157-H7 is also known as a Shiga-producing E.Coli (STEC), (Food

Safety). In addition, this Shiga toxin produces virulence factors that harm human beings by

causing severe damage to the lining of the intestine and is known to be one of the most powerful

toxins, (CDC). The most recent outbreaks of E.Coli 0157-H7 have occurred in 2016 with beef

products produced by Adams Farm and alfalfa sprouts produced by Jack and The Green Sprouts,

(CDC Outbreak).

Reservoir & Sources

The major known reservoir for E. Coli 0157-H7 is cattle; however, pigs, turkeys, sheep,

and goats have also been found to carry it, (Lim). It has also been discovered that usually the

reservoir host is asymptomatic, meaning that they shown no symptoms of the disease, (Lim).

According to WHO, these reservoir hosts tend to carry E. Coli 0157-H7 in their lower intestines.

Other sources are contaminated food, contaminated water, the animals environment, and the

feces of infected individuals, (Food Safety).

Transmission
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According to WHO, the primarily main source of transmission is contaminated food.

Food becomes a source of E.Coli 0157-H7 when it is contaminated by the feces of infected

animals. This is mostly commonly found in undercooked beef, unpasteurized milk and juices,

cheeses made from unpasteurized milk, and raw fruits and vegetables, (Food Safety). Cross-

contamination of food during food preparation can also lead to transmission. Likewise, water

becomes contaminated when it carries E. Coli 0157-H7 and is untreated. The transmission of the

disease occurs when people either drink untreated water or swim in contaminated water, (Food

Safety).

Raw fruits and vegetables can also become a source of transmission if they come into

contact with an infected animal during handling or cultivation, (WHO). In addition, if a person

touches an animal that is infected or touches its environment, then he or she will become prone

to infection. An individual can also become infected if they come into contact with the feces of

an infected person. Child care facilities and contact with family members are common ways of

transmission, (WHO).

Sources of Transmission of E. Coli 0157-H7

Source: WHO General Info E.Coli 0157-H7

Symptoms & Complications


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The incubation period between exposure to E. Coli 0157-H7 and the onset of symptoms

is usually between one to ten days. (Food Safety). However, this varies in every infected

individual. The symptoms that begin to develop are fever, nausea, vomiting, stomach cramps,

bloody diarrhea, malaise, little to no food intake, and mild dehydration, (Food Safety). The most

commonly known symptom is bloody diarrhea. Often these symptoms are referred to as

hemorrhagic colitis, (CDC). The duration of the illness usually lasts between five to ten days,

(MDH).

Complications tend to develop in young children and the elderly because they progress

to more serious symptoms more frequently than other populations, (FDA). Hemolytic Uremic

Syndrome is a potentially life-threatening complication derived from E.Coli 0157-H7 and only

about 5-10% of infected individuals develop it, (CDC). This syndrome is characterized by

hemolytic anemia, abnormal destruction of red blood cells. and acute renal failure. People who

develop this show symptoms of decreased frequent urination, feeling very tired, paleness, edema

fainting, and weakness along with hemorrhagic colitis, (NIDDK). These individuals must be

immediately hospitalized because they can develop serious renal failure. According to the CDC,

most individuals tend to recover after a few weeks; however, some people can suffer permanent

damage or die.

Diagnosis & Treatment

In order for a proper diagnosis to take place, a fecal sample must be analyzed along with

an accurate history and physical exam, (CDC). A tentative diagnosis is set only after a

connection to E.Coli 0157-H7 through contaminated food, contaminated water, or infected

people is made. It is recommended to contact a doctor after three days of diarrhea accompanied

by excess vomiting, blood in stool, and high fever, (CDC). The CDC recommends that
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community-acquired diarrhea should be tested using immunologic test systems since these tests

are able to identify all types of Shiga toxins and can recognize E.Coli 0157-H7 more effectively

unlike the bacterial culture techniques, (CDC). However, it is recommended that both bacterial

culture and immunologic tests should be taken.

There is no actual cure for the infection, no relief of symptoms, or prevention of

complications. However, the treatment for most people includes rest and fluids to prevent

dehydration and fatigue, (Mayo Clinic). It is recommended to avoid taking anti-diarrheal

medications because they will prevent the body from getting rid of the toxins and to avoid

antibiotics because they can increase the risk of complications, (Mayo Clinic). However, if

individuals have developed Hemolytic Uremic Syndrome, then they should hospitalized to

receive proper treatment, which would consist of IV fluids, blood transfusions, and kidney

dialysis, (Mayo Clinic). There is currently no vaccine for E.Coli 0157-H7, (CDC).

Prevention

According to WHO, in order to prevent the transmission of E.Coli 0157-H7, then

control measures at all stages in the food chain must be taken such as the agricultural production,

processing, handling, manufacturing, and food prepping. At the industrial level, methods such as

pre-screening the animals before slaughter, hygienic measures, and education in hygienic

handling of foods for workers are good methods to reduce the risk of transmission, (WHO).

However, the only proper method to make sure that no transmission or contamination for foods

takes place is to have a bactericidal treatment take place, such as heating, pasteurization, or

irradiation, (WHO).

Preventive methods can take place at the household by following basic good food

hygienic practices. According to WHO, the following five keys can help prevent overall food-
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borne illnesses: keep clean, separate raw and uncooked, cooked thoroughly, keep food at safe

temperatures, use safe water and raw materials. Other methods such as heating food at a proper

temperature and washing fruits and vegetables before consumption can also help prevent the

illness. The elderly and young children should take more precaution and avoid eating raw food or

liquids since they are the most targeted populations, (WHO). It is also important for producers of

fruits and vegetables to take preventative methods such as: practicing good overall hygiene,

protect fields from animal faecal contamination, use treated faecal waste, evaluate and manage

risks from irrigation water, and keep harvest and storage equipment clean and dry, (WHO). This

will help prevent contamination at any stage of the food process such planting, growing,

harvesting, and storing.

Sites of Prevention for Escherichia Coli 0157-H7

Source: WHO General Information E. Coli 0157-H7

Summary

Escherichia Coli O157-H7 was first discovered due to outbreaks that occurred in the

1980s, but it was until a decade later that it would be nationally known as an infection. It is

considered the worst type of E.Coli because it can lead to serious complications such as death.

E.Coli 0157-H7 produces a Shiga toxin which helps the growth of E.Coli inside the body and
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attacks the lining of the intestine. This in turn leads to many symptoms, such as bloody diarrhea

and high fever. The spread of this illness is through contaminated foods, water, and infected

animals and people. Most people are able to treat this illness through rest and drinking lots of

fluids to help prevent dehydration and fatigue. Young children and the elderly are the most

targeted populations and must take more precautionary methods. In order to prevent the

transmission of E.Coli 0157-H7 to foods and help prevent illness, overall proper hygienic

measures need to take place at the industrial, farming, and household level. Proper food

sanitation needs to take place in order to prevent contamination. However, people should still be

aware of heating food properly and making sure they wash their hands before handling food. If

these measures are taken, then any risk of infection will be reduced.

Works Cited

Bad Bug Book - BBB - Escherichia coli O157:H7 (EHEC). (n.d.). Retrieved February 17, 2017,

from http://www.fda.gov/Food/FoodborneIllnessContaminants/

CausesOfIllnessBadBugBook/ucm071284.htm

E. coli. (n.d.). Retrieved February 17, 2017, from

https://www.foodsafety.gov/poisoning/causes/bacteriaviruses/ecoli/
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E. coli. (n.d.). Retrieved February 17, 2017, from

http://www.health.state.mn.us/divs/idepc/diseases/ecoli/basics.html

E. coli. (n.d.). Retrieved February 17, 2017, from

http://www.who.int/mediacentre/factsheets/fs125/en/

E. coli Treatments and drugs. (n.d.). Retrieved February 17, 2017, from

http://www.mayoclinic.org/diseases-conditions/e-coli/basics/treatment/con-20032105

General Information. (2015, November 06). Retrieved February 17, 2017, from

https://www.cdc.gov/ecoli/general/index.html

Hemolytic Uremic Syndrome in Children | NIDDK. (n.d.). Retrieved February 17, 2017, from

https://www.niddk.nih.gov/health-information/kidney-disease/children/hemolytic-uremic-

syndrome

Lim, J. Y., Yoon, J. W., & Hovde, C. J. (2010). A Brief Overview of Escherichia coli O157:H7

and Its Plasmid O157. Journal of Microbiology and Biotechnology, 20(1), 514.

Rangel, J. M., Sparling, P. H., Crowe, C., Griffin, P. M., & Swerdlow, D. L. (2005).

Epidemiology of Escherichia coli O157:H7 Outbreaks, United States, 19822002.

Emerging Infectious Diseases, 11(4), 603-609.

https://dx.doi.org/10.3201/eid1104.040739.

Reports of Selected E. coli Outbreak Investigations. (2017, January 10). Retrieved February 19,

2017, from https://www.cdc.gov/ecoli/outbreaks.html