It's the sprouts, it's not the sprouts, it's the sprouts

Breakthrough?  Sprouts have been in, then out, now in again as the possible source for the E. coli outbreak in Europe.  4 Interesting snippets in the news today:


Glossary - EHEC - Enterohemorrhagic E. coli
               STEC - Shiga toxin producing E. coli
               Spiegel Online and WHO call it EHEC, the CDC is calling it STEC.  
               HUS - Hemolytic uremic syndrome (involves the kidney failure)
               
1)  Scientists 'Find EHEC Bacteria at Sprout Farm' from Spiegel International Online:
http://www.spiegel.de/international/germany/0,1518,767935,00.html   6/10/2011

"Health authorities in Germany have finally been able to show that the pathogens which caused the deadly EHEC outbreak came from sprouts at an organic farm in the Uelzen district. According to SPIEGEL ONLINE information, the breakthrough was made by scientists in the state of North Rhine-Westphalia. Final verification, however, is still pending.

As of Friday it remained unclear how the dangerous bacteria came to be present at the farm."


2)   Check out what the Center for Science in the Public Interest had to say about the 0157 vs non-0157 STEC (Shiga toxin producing E. coli) in April 2011.
"A strong public interest is served by improving our understanding of non-O157 STEC."

http://cspinet.org/new/CDC-Non-O157DataCollectionComment-OMB%20Apr%202011.pdf



3)  One of the sprout farm workers was hospitalized and reports eating the sprouts (article from Spiegel Online International):
http://www.spiegel.de/international/germany/0,1518,767434,00.html

"In addition, three female workers at the farm suffered from diarrhea in the first half of May, and one of them is known to have been contaminated with EHEC. Their work included packaging the sprouts.

The ministry spokesman said it was possible that one of the women accidentally "fed the pathogen into the operations of the company." Or they might have been infected with EHEC at the farm.

Reuters reported that a local doctor said a worker at the farm had become severely ill with E. coli and had part of her intestine removed. The 54-year-old woman developed bloody diarrhea followed by serious blood disorders.

Anton Schafmayer, a doctor who operated on her, said she had eaten the sprouts. "It went very fast. Such a pace is very rare," he told Reuters. "The surgery probably saved her. We removed a large part of the lower intestine."

The Lower Saxony ministry spokesman said that despite the additional clues pointing to the sprout farm, it was still possible that the nationwide epidemic stemmed from several sources.

Four company canteens and three restaurants where people caught EHEC are now known to have been supplied by the Bienenbüttel farm -- infecting about 100 of the more than 2,600 EHEC patients in Germany. So far, no EHEC bacteria have been found at the farm."

4)  World Heath Organization update 12 on EHEC Europe outbreak:
http://www.euro.who.int/en/what-we-do/health-topics/emergencies/international-health-regulations/news/news/2011/06/ehec-outbreak-update-12

Country	HUS		EHEC		Comments
	Cases	Deaths	Cases	Deaths
Austria	1	0	3	0
Canada	0	0	1	0
Czech Republic	0	0	1	0	A tourist from USA who travelled in Germany
Denmark	8	0	12	0
France	0	0	2	0	+7 cases of bloody diarrhoea not yet confirmed as EHEC
Germany	722	18	2086	8
Greece	0	0	1	0	A German tourist
Luxembourg	0	0	1	0
Netherlands	4	0	2	0
Norway	0	0	1	0	Contact with a German in Norway
Poland	2	0	0	0
Spain	1	0	1	0
Sweden	16	1	30	0
Switzerland	0	0	5	0
United Kingdom	3	0	2	0	All 5 cases confirmed
United States of America	3	0	1	0	3 HUS cases (1 confirmed and 2 suspected) and 1 suspected EHEC case without HUS
Total	760	19	2149	8

Note: There are 2909 HUS and EHEC cases in total. Update 12 6/9/2011."


5)  CDC's updated travel notice 6/10/11
http://wwwnc.cdc.gov/travel/notices/outbreak-notice/2011-germany-europe-e-coli.htm


Advice for Clinician's


"If you care for a patient with bloody diarrhea or HUS who has recently been in Germany or has been in contact with someone recently returned from Germany, it is important to test for STEC O104:H4. Complete testing for STEC O104:H4 includes simultaneous culture of stool for E. coli O157 and assay of the stool for non-O157 STEC with a test that detects Shiga toxin. Clinicians and clinical laboratories should send E. coli O157 isolates and Shiga toxin-positive samples to public health laboratories as soon as possible for additional characterization. Any suspected STEC O104:H4 and HUS cases should be reported to health departments."