California sisters fighting to recover from E. coli

The Public Health Agency of Canada may think Shiga-toxin producing E. coli is no biggie, but tell that to the Niles sisters of southern California, who were both hospitalized with hemolytic uremic syndrome (HUS).

ABC 30 reports that Mariska and Willow were active and healthy kids with no medical history. Their parents thought it was a terrible case of the flu. Originally their pediatrician thought it was norovirus. But after days of worsening symptoms, they were admitted to Valley Children’s Hospital with E. coli.

13-year-old Mariska Niles is finally starting to improve after 16 days in the hospital. She’s had more blood transfusions than she can count along with excruciating stomach pain and she was hallucinating.

The sisters were diagnosed with E. coli HUS or typical hemolytic uremic syndrome but the girls had unique cases.

Dr. Molly Dorfman said, “There’s was pretty atypical. Particularly the severity of Willow’s case was very very severe.”

This form of bacteria usually originates from contaminated food or water products. Pinpointing the exact source has been difficult. They haven’t traveled anywhere recently. The family hadn’t eaten out lately. It’s likely other family members also ate what the girls did but did not become violently ill. Even more puzzling, Mariska and Willow rarely eat the same things.

9-year-old Willow’s kidney’s still are not working. She has been debilitated by toxins from the infection, and at one point couldn’t wake up. Both sisters have had blood transfusion and dialysis.

Hucksterism fail: Ells out as CEO at Chipotle

Joe Rubino of The Denver Post writes the man who turned a tiny burrito shop near the University of Denver into an international brand will soon be out as Chipotle Mexican Grill’s CEO.

Steve Ells, the founder of the Denver-based fast-casual chain, will leave his post as chairman and CEO to become executive chairman after a replacement has been found, the company announced Wednesday.

A committee that includes Ells and directors Ali Namvar and Robin Hickenlooper, wife of Colorado Gov. John Hickenlooper, has been formed to find a leader with demonstrated turnaround expertise, the company said.

Whoever takes the job will be tasked with helping the chain climb out of protracted market malaise caused, in part, by outbreaks of foodborne illness linked to some of its restaurants, first in 2015, then again earlier this year

Co-CEO Monty Moran stepped down in December, leaving Ells with control of the company as it faced pressures from activist investor Bill Ackman, whose Pershing Square Capital hedge fund took a nearly 10 percent stake in September 2016. Ackman said then that he wanted improvement in Chipotle’s “operations, cost structure, management and strategy.”

E. coli: Flour fights not such a good idea

In June, 2009, an outbreak of shiga-toxin producing E. coli (primarily O157:H7) in Nestle Toll House cookie dough sickened at least 77 people in 30 American states. Thirty-five people were hospitalized – from cookie dough.

The researchers could not conclusively implicate flour as the E. coli source, but it remains the prime suspect. They pointed out that a single purchase of contaminated flour might have been used to manufacture multiple lots and varieties of dough over a period of time as suggested by the use-by dates on the contaminated product.

The study authors concluded that “foods containing raw flour should be considered as possible vehicles of infection of future outbreaks of STEC.”

So it wasn’t much of a surprise when 56 people fell sick from with the outbreak strain of E. coli O121 from Dec. 2015 to Sept. 2016 were linked to raw General Mills flour.

The peer-reviewed summary of the outbreak investigation was published last week in The New England Journal of Medicine.

Abstract below:

In 2016, a multijurisdictional team investigated an outbreak of Shiga toxin–producing Escherichia coli (STEC) serogroup O121 and O26 infections linked to contaminated flour from a large domestic producer.

Methods

A case was defined as infection with an outbreak strain in which illness onset was between December 21, 2015, and September 5, 2016. To identify exposures associated with the outbreak, outbreak cases were compared with non-STEC enteric illness cases, matched according to age group, sex, and state of residence. Products suspected to be related to the outbreak were collected for STEC testing, and a common point of contamination was sought. Whole-genome sequencing was performed on isolates from clinical and food samples.

Results

A total of 56 cases were identified in 24 states. Univariable exact conditional logistic-regression models of 22 matched sets showed that infection was significantly associated with the use of one brand of flour (odds ratio, 21.04; 95% confidence interval [CI], 4.69 to 94.37) and with tasting unbaked homemade dough or batter (odds ratio, 36.02; 95% CI, 4.63 to 280.17). Laboratory testing isolated the outbreak strains from flour samples, and whole-genome sequencing revealed that the isolates from clinical and food samples were closely related to one another genetically. Trace-back investigation identified a common flour-production facility.

Conclusions

This investigation implicated raw flour as the source of an outbreak of STEC infections. Although it is a low-moisture food, raw flour can be a vehicle for foodborne pathogens.

Shiga toxin–producing E. coli infections associated with flour

N Engl J Med 2017; 377:2036-2043, November 23, 2017, DOI: 10.1056/NEJMoa1615910

Samuel J. Crowe, Ph.D., M.P.H., Lyndsay Bottichio, M.P.H., Lauren N. Shade, B.S., Brooke M. Whitney, Ph.D., Nereida Corral, M.P.H., Beth Melius, M.N., M.P.H., Katherine D. Arends, M.P.H., Danielle Donovan, M.S., Jolianne Stone, M.P.H., Krisandra Allen, M.P.H., Jessica Rosner, M.P.H., Jennifer Beal, M.P.H., Laura Whitlock, M.P.H., Anna Blackstock, Ph.D., June Wetherington, M.S., Lisa A. Newberry, Ph.D., Morgan N. Schroeder, M.P.H., Darlene Wagner, Ph.D., Eija Trees, D.V.M., Ph.D., Stelios Viazis, Ph.D., Matthew E. Wise, M.P.H., Ph.D., and Karen P. Neil, M.D., M.S.P.H.

http://www.nejm.org/doi/full/10.1056/NEJMoa1615910

85 sick with shiga-toxin E. coli at Marines base

About 85 U.S. Marines-in-training remained ill last week after an apparent shiga-toxin producing E. coli outbreak at Marine Corps Recruit Depot San Diego and Camp Pendleton amid a week-old outbreak of diarrheal illnesses at the military installations, authorities reported.

Among the medical cases were 19 new ones diagnosed since Oct. 31, 2017, according to MCRD public affairs. In all, 16 recruits were receiving treatment at an off-base hospital, with the remainder being cared for at military medical facilities.

Base officials initially announced a total of about 300 cases of intestinal ailments at the 2 San Diego-area installations on Oct. 30, 2017.

 That tally was down to roughly 215 a day later. The cause or causes of the debilitating bacterial exposure remain under investigation.

12-year-old Oklahoma girl lives with constant reminder of E. coli outbreak nine years ago

In Aug. 2008, 26-year-old Chad Ingle had a meal at the Country Cottage in Locust Grove, Oklahoma, a popular family-owned buffet-style restaurant.

Nine days later, Chad was dead from E. coli O111.

By the end of the outbreak, 341 people had been sickened with E. coli O111, all from eating at the country diner in a town of 1,423 people.

A paper describing the investigation was published in 2011 in Epidemiology and Infection and concluded from epidemiological evidence the outbreak resulted from cross-contamination of restaurant food from food preparation equipment or surfaces, or from an unidentified infected food handler.

Ethan Hutchins of ABC News writes that at first glance Machaela Ybarra is a typical 12-year-old going through the struggles any pre-teen faces. But like the words on the pages of her textbooks, Machaela has a story to tell, a story she only wishes was fiction.

“Whenever I understood what happened to me, I couldn’t believe it,” said Ybarra.

Machaela was just 2 when she contracted E. coli. It happened at Country Cottage restaurant in Locust Grove.

A Sunday afternoon lunch nine years ago changed Machaela’s life forever.

“It sounds scary even though I don’t remember much,” said Ybarra.

Her mother will never forget that day. Christina Ybarra still knows what her daughter ate: Fried chicken, meatloaf, green beans, mashed potatoes and gravy.

“It was a buffet so we went and got one plate, her and I both ate off of it and I didn’t get sick at all,” said Christina Ybarra.

It’s a miracle, she says, since Christina was seven months pregnant at the time with Machaela’s little sister.

Of the hundreds who got sick from E. coli, one person died. The restaurant closed, but was back in business two months later, and now years later Country Cottage remains open. Folks here in town say they still eat here, not blaming the restaurant for those dark days years ago.

No one in Locust Grove at the restaurant or even with the city likes to talk about the outbreak. It’s fair to say, it’s a bad time most people there would like to forget.

But for Machaela, there are daily reminders.

“I’m on seizure medication because I can just stare sometimes and just be unconscious,” said Ybarra.

 

UK woman critically ill with E.coli O55

A young woman from Guildford has been left in a critical condition in hospital after she contracted E.coli O55.

Alexander Brock of Get Surrey writes the victim and her sister, whose family have asked us not to name, both fell ill within hours of each other on Saturday September 16.

Public Health England (PHE) confirmed it was investigating “a confirmed case of E.coli O55 in Surrey.”

The eldest of the two sisters, aged 22, recovered after a few days of having symptoms such as diarrhoea and abdominal pain.

However, the health of the younger sister, 19, quickly deteriorated and she was rushed to Royal Surrey County Hospital in Guildford a few days after becoming ill.

She then suffered kidney failure, which developed into hemolytic uremic syndrome.

This led to several of her organs failing, including her heart. The woman has been in critical condition at St Bartholomew’s Hospital in London since September 27.

The strain has been confirmed as E.coli O55, which 31 people contracted in an outbreak in Dorset between July 2014 and November 2015.

In a statement, PHE added there had been other recorded E.coli cases in children in neighbouring areas which have been “identified as being potentially linked.”

 

South Korea McDonald’s offices raided after outbreak of HUS

The UK Daily Mail reports investigators have raided McDonald’s offices in Seoul, South Korea after allegations that several children fell ill after eating the U.S. chain.

At least five children have allegedly suffered life-threatening kidney disease as a result of an infection, after being served under-cooked hamburger patties at McDonald’s.

The raid on Wednesday saw the Seoul central district prosecutors’ office confiscated documents and evidence local news reports said.

Investigators also carried out raids at three other companies, including an ingredient supplier.

A spokeswoman at McDonald’s Seoul office confirmed the raid to Reuters, but gave no reason or further details.

In July, a consumer filed a complaint against the U.S. firm, saying her daughter was diagnosed with hemolytic uremic syndrome – also known as hamburger disease – following the consumption of a McDonald’s hamburger last year.

The parent said that the four-year-old girl had been left with irreversible kidney damage.

Complaints were also filed by parents of four more children who became sick after eating McDonald’s burgers.

Fancy food ain’t safe food: UK E. coli cheesemaker edition

Jane Bradley of the Scotsman reports an artisan cheesemaker which is embroiled in a court case with food hygiene authorities after being forced to withdraw its products amid an outbreak of E.coli which killed a three year old girl, has been named one of Britain’s top cheese producers in an industry awards ceremony.

Errington Cheeses, which is awaiting a court date against South Lanarkshire Council, which ordered the manufacturer to stop production of its raw milk cheeses amid an investigation following the outbreak of the food poisoning bug last summer, was given runner up in the Best Artisan Producer category at the Great British Cheese Awards. The Lanarkshire-based business also came runner up in the category of Best Blue Cheese for its Lanark Blue cheese, at the awards at Marcus Wareing’s Gilbert Scott restaurant in London, hosted by food website Great British Chefs.

The company is currently only making one type of cheese – made from ewe’s milk – pending its court case against South Lanarkshire Council. Owner Humphrey Errington, who launched the firm in 1985, has insisted that his cheese is not the source of the food poisoning outbreak – which saw 19 people hospitalised – and has claimed that the authorities, including Food Standards Scotland, are trying to curb production of raw milk cheese. A Just Giving campaign launched to help Errington cover its legal costs, raised £34,000 from supporters. Twitter user Artisan Food wrote: “Chefs vote of confidence @ErringtonCheese Resilience in face of harassment/bias/ignorance.” In March, an official report from Health Protection Scotland into the E.coli outbreak claimed that Errington’s Dunsyre Blue was the source of the bacteria.

Was it the bulgogi burger? HUS outbreak in S. Korea linked to McDonald’s

Bulgogi is literally “fire meat,” a Korean-style grilled or roasted dish made of thin, marinated slices of beef or pork, grilled on a barbecue or on a stove-top griddle. It is also often stir-fried in a pan in home cooking

A Bulgogi burger is the same idea.

Korea Centers for Disease Control and Prevention is conducting an epidemiological investigation into a case of 7 children and 1 adult who showed symptoms of food poisoning with vomiting and diarrhea after eating McDonald’s hamburgers on 25 Aug 2017 at a Jeonju branch in North Jeolla.

Authorities are not ruling out the possibility that the 8 individuals contracted hemolytic-uremic syndrome (HUS), widely known as “hamburger disease,” a bacterial infection that can leave the renal system severely damaged.

On 25 Aug 2017, a group of 15 adults and elementary school students from the same church in Jeonju visited McDonald’s Jeonju branch and ate bulgogi burgers together. A day later, 7 children and 1 adult experienced diarrhea and vomiting. The authorities declared an epidemiological probe into the case on Sat 2 Sep 2017.

As the case was publicized, McDonald’s Korea halted selling bulgogi burgers nationwide starting on Sat 2 Sep 2017. On its website, a notice says, “We have decided to stop selling bulgogi burgers pending the outcome of the ongoing investigation by authorities,” adding that the multinational company’s Korean branch was taking the issue seriously. It also said the company will do its best to help patients recover, though without elaborating on how or when.

The outcome of the ongoing probe is expected to be made public around Wed 6 Sep 2017.

ProMED-mail reports classic bulgogi recipes use a marinade of soy, ginger, garlic, and gochujang (Korean chili paste) to flavor and tenderize strips of meat. Because combining a marinade into ground beef would change the consistency of the hamburger, making it more of a “sloppy-joe”, usually a bulgogi inspired sauce is used on top of the burger although a Korean inspired spice combination can be added to the ground beef.