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What Parents Need to Know About E. Coli

September has proven to be a tragic month in terms of E. coli infecting children.

At the beginning of the month, two young girls in the Pacific Northwest died from unrelated E. coli O157:H7 infections. First, the bacteria took the life of 4-year-old Oregonian Serena Profitt on Sept. 8, and then, days later, 3-year-old Brooklyn Hoksbergen died in Washington state.

Both girls suffered from hemolyic uremic syndrome (HUS), a kidney disease caused by the most severe E. coli infections. And now, five children in Kentucky have been hospitalized with E. coli infections, some of whom are suffering from symptoms of HUS.

While E. coli infections can sometimes prove deadly despite high-quality medical care, healthcare experts advise parents to be as knowledgeable as possible about the signs of E. coli infection and what to do when they suspect their child may be infected.

Parents should request a test

First, the single most important thing a parent can do when they suspect their child might have E. coli is to not just take them to a healthcare provider, but to request that the child receive a test for E. coli, said Kirsten Larson, foodborne epidemiologist and manager of the Food Safety Program at the Association of Public Health Laboratories (APHL).

Even if a child is experiencing signs of an E. coli infection, including extreme diarrhea, there is no guarantee that the observing physician will request an E. coli test.

“I always encourage parents to ask for it. I don’t feel that parents should wait for the physician to take a test,” Larson said. “If you’re concerned, just ask.”

What are the symptoms of an E. coli infection?

Children are more likely than adults to develop symptoms of E. coli infection, especially if they are younger than 5.

The most telling sign of an E. coli infection is diarrhea. First it’s often watery, but it will often become bloody when a child suffers from a serious infection.

Those infected with E. coli often also experience severe stomach cramps, nausea and vomiting.

Fever is less commonly a symptom of an E. coli infection compared to other bacterial infections, and the lack of fever may, in conjunction with the other symptoms, be a sign of an E. coli infection, Larson said.

E. coli and other harmful bacteria can infect children not just from risky foods, but from places in their environment such as other children at daycare or even drinking fountains, Larson said.

What are the signs of HUS?

Only a small percentage of patients develop HUS from their E. coli infections. However, parents of a child sickened by E. coli should carefully keep watch for fatigue, decreased urine output, slow responses, swelling of the limbs, or unusual bruising.

“Basically, if they’re acting tired and unresponsive, you want to get them seen by a doctor,” Larson said.

Once HUS fully develops, it can cause seizures, altered mental states, confusion, fatigue, dehydration and neurological complications. The condition has a 3-5 percent mortality rate.

What are the riskiest foods?

Raw milk, undercooked ground beef, and raw sprouts have been linked to a number of E. coli illnesses in children and adults, although fresh produce has also caused several outbreaks.

Some risky foods are easier to avoid than others, Larson said. For example, parents should give their kids pasteurized milk and make sure that their hamburgers are thoroughly cooked.

How are E. coli tests performed?

When a physician suspects an E. coli infection, or when a parent requests a test, the healthcare provider will collect a stool sample from the patient.

At that point, the clinical laboratory will test for the presence of shiga toxin, the poison produced by harmful strains of E. coli. Some labs might also run a culture test to check for E. coli bacteria. The U.S. Centers for Disease Control and Prevention (CDC) recommends that labs do both.

Traditional methods of testing for E. coli will take 24-48 hours to produce a presumptive positive result, meaning there’s an early sign of E. coli infection. In the past year, a select number of labs around the country have acquired new technology, multiplex assays, which can detect a presumptive positive in a few hours, Larson said.

When clinical labs receive a presumptive positive, they are supposed to ship the sample to a public health laboratory. The public health lab will then retest and confirm the E. coli and look for the specific strain, such as E. coli O157:H7 or O104:H4. That process takes another 24 to 48 hours.

It’s the public health labs that keep a lookout for potential outbreaks. One concern, however, is that not all clinical labs are guaranteed to forward those presumptive positive samples on to the public health labs.

“The unfortunate thing is that not all states have mandatory isolate submission,” Larson said. “You have to rely on the good will of the clinical lab tech. Even if you have mandatory laws in place, they might not have timeframes or regulatory teeth.”

Once again, Larson reiterated the importance of asking for an E. coli test when parents suspect their child may have an E. coli infection.

“As a parent who’s had kids with Salmonella myself, and as an epidemiologist, ask for a stool specimen,” she said. “Parents definitely need to stay educated about the risk of E. coli, and part of that is knowing when to ask.”

© Food Safety News
  • MN Born

    Thank you for providing some guidance! I read this aloud to my husband – with small children in our household, a response beyond fear when children are sickened is more than a comfort.

  • Debbie Treen

    Thank you for this very important article. My husband had to demand that he be tested for e-coli, which turned out to be positive and related to the sprouts at Jimmy John’s last May.
    The doctor did not think it was necessary, and our insurance did not cover it! He insisted and we paid for it.
    It seems to me that we should be testing anyone who has severe enough diarrhea to see a doctor. That should be a standard medical test. Until we identify the sources of food poisoning more often, we aren’t going to reduce the incidence.
    Again, thank you for your article.

  • Bill Pilacinski

    Mukherjee, et al, 2007, in Intl J of Food Micro, found a higher incidence of E coli in organic vs. conventional fruits and vegetables produced in in MN and WI due to the greater use of animal waste (i.e., manure) as fertilizer.

  • A. Nordyke

    If a parent is in that scary place where two days for results seems like forever; they could also request bloodwork, specifically a complete blood count – results in under an hour. According to our nephrologist, the CBC is the most important when it comes to watching out for HUS. lt will tell if the red blood cells are in trouble. Those damaged red blood cells lead to kidney failure. My son’s e.coli tests came back negative (we know e.coli was the culprit, however, because my daughter’s culture showed shiga toxin), but a CBC would have shown the big picture.