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Shiga E. Coli Outbreak, Death Reported in Texas

Mar 12, 2008 | Parker Waichman LLP

An outbreak of Shiga E. Coli has officials in Texas working frantically to determine its source.  The Texas Department of State Health Services (DSHS) issued a health alert after six cases of the serious diarrhea illness broke out in Bastrop County.  Health experts say it is unusual to have this many cases of what appeared to be a food borne illness related to the Shiga E. coli toxin in just a few days.  In addition to the six illnesses, one child died. Texas’s Lee and Fayette counties have joined Bastrop County in reporting outbreaks of the toxin. 


On Friday, a news release issued by the Texas DSHS stated that the, "Results of laboratory tests to identify a specific bacteria are pending.  Shiga toxin illnesses are typically food borne.  A common source for the illnesses has not been identified.”  The incubation period ranges from one to eight days, though typically it is three to five days and symptoms are gastrointestinal in nature.  The Shiga toxin is rare; the U.S. Health Department says it only sees 100 to 200 cases a year, so the Central Texas outbreak is cause for concern.

Shiga is short for Shiga toxin-producing Escherichia coli, which is a type of enterohemorrhagic—or E. coli—(EHEC) bacteria that can cause illness ranging from mild intestinal disease to severe kidney complications.  Other types of enterohemorrhagic E. coli include the common and often deadly E. coli O157:H7 which is quite virulent and produces a powerful toxin that can cause severe illness and even death and is the leading cause of food and waterborne illness in the U.S.

Typical symptoms of Shiga E. coli include severe abdominal cramping; sudden onset of watery diarrhea, frequently bloody; and sometimes vomiting and a low-grade fever.  Generally, Shiga E. coli is mild and self-limited, lasting one to three days; however, serious complications such as hemorrhagic colitis, Hemolytic Uremic Syndrome (HUS), or post-diarrheal thrombotic thrombocytopenic purpura (TTP) can occur in up to 10% of cases.  The toxin can also result in death in severe cases.

Cases and outbreaks of Shiga toxin-producing E. coli have been associated with the consumption of undercooked beef (especially ground beef), raw milk, unpasteurized apple juice, contaminated water, red leaf lettuce, alfalfa sprouts, and venison jerky.   The Shiga E. coli toxin has also been found in poultry, pork, and lamb.  Person-to-person spread, via fecal-oral transmission, may occur in high-risk settings like day care centers and nursing homes. Further studies are being done to better understand the modes of transmission.  And, although anyone can become infected with the Shiga toxin, the highest infection rates are in children under age five.  The elderly also account for a large number of cases.

In mild cases, antibiotics have not been shown to shorten the duration of symptoms and may actually make the illness more severe in some people.  Some severe complications, such as HUS, require hospitalization.

Health officials are warning, if you have severe or bloody diarrhea, go immediately to the hospital.  Patients may also experience abdominal cramps.


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