Bit by bit, gene by gene, doctors and researchers in Germany and around the globe are cobbling together a profile of the microbe responsible for Europe’s alarming outbreak of food poisoning.

Even as the grim toll climbed to 3,800 sick and 44 deaths, online articles in medical journals continue to shed light on the suspect bacteria known as E. coli O104:H4. And the authors appear to support the conclusion that the rare strain has properties that make it unusually toxic to its victims.

“Taken together, these data suggest that the pathogen in the current outbreak is exceptionally virulent,” concluded a team of German doctors whose article was published online this week by the New England Journal of Medicine.

However, health authorities in the U.S. continued to cast doubt on the staggering statistics coming out of Germany.  While the epidemic has undoubtedly been unusual, actual statistics depend on how health authorities define and diagnose illnesses, and how many less-severe cases may have gone unreported.

Either way, the latest papers affirm previous reports that the German E. coli strain has the pathogenic traits of two previously known strains  — a Shiga toxin similar to that of the more familiar E. coli O157:H7;  and an ability to stack itself like bricks and cling to the interior surface of the intestine, thereby maximizing its ability to convey poison to its host.

Another team of doctors reached the same conclusion in an article published by the journal Lancet Infectious Diseases. That article was summarized in Thursday’s New York Times.

Researchers explained that other toxic bacteria may adhere to intestinal walls, but less tightly and less densely, and yet other strains do not carry the Shiga toxins. 

Scientists increasingly believe that these traits may explain why the outbreak that raged through the northern provinces of Germany appears to have been more deadly, with perhaps 25 percent of E. coli patients developing the complication called hemolytic uremic syndrome, or HUS.  In previous outbreaks of O157:H7, fewer than 10 percent of patients develop HUS.

But that statistic is being questioned by U.S. epidemiologists, who suspect that the overall number of illnesses was probably far greater.

While illnesses are still being reported and treated in Germany and elsewhere, epidemiologists now agree that the outbreak began about May 8 in Northern Germany, reached its peak about May 23, and has been tapering off ever since. However, German health authorities reported four more deaths yesterday, and more are expected.

Other factors that emerge from this week’s publications:

— The great majority – 89 percent — of the HUS victims are adults, which is in stark contrast to the normal E. coli outbreak pattern, which usually targets children with weaker immunity.

— Women are overrepresented among case patients and especially among HUS cases, but it is unclear whether this is due to their greater exposure (i.e., they may have been more likely to consume the implicated sprouts) or the properties of the outbreak strain — or both.

— The majority of the HUS deaths are senior citizens, the median age being 74 years.  However, they also include some younger adults and a two-year-old boy.

–The O104:H4 bacteria appears to have an incubation period of about eight days, which is twice the incubation period for E. coli O157:H7, the strain responsible for most  serious E. coli outbreaks. If this is true, it means it could take longer for health authorities to detect an outbreak, aggravating their efforts to trace its source.

— Many patients appeared to be recovering from their initial cases of diarrhea, then reverted horribly, many of them eventually being diagnosed with kidney failure.

Eurosurveillance, the online European journal of epidemiology, reported that doctors were observing “severe neurological symptoms, ranging from mild disorientartion and cognitive dissoc iation to stupor or severe, life-threatening seizures.”  And patients experiencing such symptoms responded “weakly” to standard treatments for those symptoms.

— Unlike other toxic E. coli, which originate in cows or other ruminants, the O104:H4 microbe appears to have evolved in human hosts. And some epidemiologists have asked if the suspect sprouts could have been contaminated with human waste.

Meanwhile,  Eurosurveillance, the online European journal of epidemiology, published two case studies from the outbreak. One was the case of a German woman in her 80s hospitalized June 1 in Munster, Germany, with intense abdominal pain and diarrhea.  Surgeons removed part of her colon and monitored her condition for HUS.  But, despite the severity of her illness, she has not been diagnosed with HUS.

In another case, a Dutch woman in her 30s contracted the illness while visiting the north of Germany, and was hospitalized in the Netherlands. Four days later, her condition lapsed into severe HUS. More recently, she has been recovering, but her 10-month-old child has come down with a secondary case which has caused seizures and kidney failure, leading to three weeks of kidney dialysis an uncertain prognosis.

Doctors believe the child was infected by the mother, who was suffering with diarrhea and had not been advised as to hygiene.

Cases of HUS have been reported from all of Germany’s 16 states, but with the exception of two clusters of illnesses linked to restaurants in eastern North Rhine-Westphalia and southern Hesse, the highest incidences of illness were from “the northern Germany outbreak area,” the New England Journal of Medicine reported. In those areas, centered around the city of Hamburg, “the outbreak has been almost simultaneous,” the NEJM stated, adding that most of the cases in other states were linked to travel in the outbreak area.

Meanwhile, the Centers for Disease Control and Prevention announced Thursday that a North Carolina resident is the fifth person in the United States to be confirmed ill with the outbreak strain of E. coli O104:H4 linked to German sprouts. The CDC said it is also investigating the death of an HUS patient in Arizona who had recently traveled to Germany.

Four of the five confirmed case patients — from Massachusetts, Michigan and Wisconsin, in addition to North Carolina — had been in Germany. A second case patient in Michigan likely has contracted a secondary infection, the CDC reported.

  • Doc Mudd

    Remarkable. This outbreak, fundamentally due to inadequate hygiene, exposes Europe’s elaborately regulated food system as being little safer than some in the 3rd world.
    All of the EU’s over-abundance of caution to restrict and track GMOs, their strict regulation of imported foods from developing countries, all of that amounted to no more than a modern day food safety version of France’s military Maginot Line in the early days of WWII (the Germans simply marched around it and captured it from the rear).
    Distractedly erecting elaborate defenses against imagined food-related risks, consumed by irrational fear and the precautionary principle, the EU was completely blindsided by very real, very fundamental food safety risks in the form of E. coli and unhygienic organic farming practices. Some little ol’ local organic farmer mixed turds with the food somewhere along the line and, just like the textbook warned in junior high health class, people got sick. No rocket science required. Indeed, it was probably aided by a prevailing penchant for beating back modern agriculture to a more primitive (or “natural”) state.
    History repeats itself. The EU didn’t learn anything from the French experience with the Maginot line, and we will probably learn nothing from the German local organic food poisoning outbreak.
    The death toll is now at 43 – remarkably sad.

  • Peka

    Doc Mudd: why are you so complacent about the EU? Your comments reflect an over simplistic view of what happened in Germany. Your comments about inadequate hygiene and old style farming as opposed to “modern” style (where? in the USA? check for the eggs or meat recalls just in 2010). You are right about the history of the Maginot’s line, but at the same time you are building your own if you believe the USA can stay immune of any outbreaks of this kind. It is a universal problem, and blaming such or such country or community is miserable.

  • Doc Mudd

    I think you’re right, Peka, the USA is wide open for an identically grungy organic food poisoning event to occur, in exactly the same preventable fashion as the German experience. We came mighty close with Tiny Greens Organic’s outbreak just a few months ago (they sickened nearly 100 organic consumers):
    Heck, with the Tester amendment to FSMA we’ve blithely given tens of thousands of American “small producers” carte blanche to handle your family’s food and mine just any damned way they please – no FSMA-style preventive food growing & handling practices for them.
    And, to hurry the next US organic food poisoning outbreak along, the very agencies responsible for certifying and overseeing the production practices of organic growers are powerfully complicit in freeing them from any food safety compliance.
    NOFA (Northeast Organic Farming Ass.) is a lurid one-stop shop for food safety shenanigans; USDA accredited certifier and anti-technology activist organization lobbying hard against consumer safety regulations (no conflict of interest there?). A watchdog that leads the burglar right to where the family silver is kept!
    So, I agree with you, Peka, the U.S. doesn’t have much of a fighting chance to prevent a serious food poisoning outbreak like that in Germany. Who can say what loopy superstitious manure-based alchemy one of NOFA’s disciples might be brewing up for us right now?
    At the farmers market and the CSA – caveat emptor, baby, caveat emptor!

  • Steve

    Yup while “Doc’ is up to the old mudd-slinging disinformation tricks again, readers might like to know about his prevarications and allegations of conflict-of-interest….
    FYI, the NOFAs and other membership farming organizations are Not — and can Not be– organic certifiers, period. USDA accreditation rules require independent 3rd party organizations to fill this role –and their accreditation is closely monitored by USDA. Further, the farm inspectors are also separate and independent from the certifiers as well as the farming organizations.
    And somehow the muddy one can’t get over an extremely childish manure fixation. As has been documented time and time again in these pages — organic farmers are actually the only farmers who are NOT allowed to use raw manure — or human sewage sludge — on crops. Conventional farmers are under no such restrictions, however, and with the high cost of petrochemical fertilizers (which are formulated with cheap industrial toxic waste by-products in case you thought chemical equals “cleaner”) and with all that virulent CAFO E.coli feedlot effluent heaping up — there’s super plenty to dispose of…
    And while Docky likes to keep simplistically pointing fingers regarding the outbreak in Germany — the science does not agree with his depictions — things are much more complicated than that. Readers might want to check out the NYT article mentioned in the story by Ross Anderson:
    “Dr. Karch also realized that the O104:H4 strain had been seen before in bloody diarrhea and kidney failure, but only on rare occasions — first in Germany in 2001, then sporadically in a few other countries. And in each outbreak, at most a few people were ill.
    Why, then, was the German outbreak so widespread, and where did the bacteria go between outbreaks?
    Many experts assumed the bacteria lived in animals, probably cattle. That is where the strain that usually causes severe illness, E. coli O157:H7, is found. And that is why it has spread all over the world as animals, and their meat, transmit it to humans. In fact, Dr. Karch said, E.coli O157:H7 is thought to have traveled to Europe from America in 1610, spread by cattle.
    But the strain that caused the German outbreak does not seem to live in animals.
    “I think it is human-specific,” Dr. Karch said. And that increases the mystery of where it goes between outbreaks.”

  • ecofood

    Yes another simplification by muddie, not an ironic handle.
    The Tiny Greens incident to which muddie refers would not happen at a farm that I visit and buy from. My farmer friends don’t have processing areas hydrologically connected to manure piles. It may be risky to buy from small production houses that are trying to compete with the corporate frankenfood producers for whom muddy advocates. Purchasing from a trusted, inspected and known farmer or cooperative is at least as safe as buying from a supermarket… And you don’t feel like an ass for sending your money to the ends of the earth for a CEO bonus. Give it a try muddie, it will help your bowel problem and your mood.:-)
    Here is another simplification, albeit more inclusive of salient facts… Such problems as Tiny Greens would be averted by better funding of inspection agencies less threatened by funding cuts from a Congress, which depends significantly on campaign donations by frankenfood producers.
    I have some respect for muddie’s quisi-compassionate desire to inflate the human population to 9B in 2050. (It’s hard to tell folks not to make babies.) On the other hand, it’s unethical to support profiteers who control water and nourishment for the half-dead, who exist on processed tur-duck-in-on-a-stick or such inventions of the nutritional-industrial complex. Why does Monsanto own patents on the genetic material of crops that they did not modify? Why are university legal clinics’ funding threatened for challenging food producers who pollute excessively and have legislative influence?
    Are you feeling the need to change the subject muddie? Please reach into your muddled bag and identify who profits most from the ultra-preserved food you promote. Not people who are serious about nutrition. The profiteers are those who can afford the influence to sell trash as “food like substances.” I hope they are sending muddie a tip for services.
    I’ll continue to eat food from producers that I know. In the first half of my life I was hospitalized twice for food poisoning from improperly stored supermarket food. But I have only visited a doctor for check-ups since reducing my processed food intake. That is not enough evidence to establish clear correlation, but over ten years of better health is enough evidence for me. ef

  • Doc Mudd

    Well, Gilman, we’ve been over two thirds of this mucky organic ground before, you and I.
    It has become so routine a matter to debunk your redundant nonsense we can now do it forward and backward…so, to add interest, let’s chase down and burst your pathetic BS balloons in reverse order this time. Tally ho, tally ho – seems we must hunt these same weary dogs one more time…
    Your loose mouthed hound constantly bawls up an empty tree to appease your desperate hope that the German organic food poisoning outbreak is some accidental magically appearing uber-complicated terrifying deadly new mutant bug, uuhhh nope.
    It’s shaping up to be pretty straightforward microbiology; unusual but certainly not new or even unheard of. Now, the epidemiology (which is a feature of the investigators, not the bug) has lurched to-and-fro and been made overly complicated, but even that is becoming less muddled as cooler and more experienced heads prevail.
    You and your frantically babbling grade hound never had any two-headed raccoon treed – just faking at a slick tree…pawing together a lump of pseudoscientific cooncrap, spinning it frantically and flinging hard against the door of the pickup in the desperate hope it sticks. Y’all are just talkin’ trash.
    Some little ol’ organic farmer mixed turds with the food somewhere along the line to cause this historic outbreak of organic food poisoning.
    That is the logical explanation, indeed the only explanation: e. coli is a fecal bacteria; it comes from feces; it gets spread around with feces by ignorant unhygienic practices. There is no such thing as spontaneous generation, Gilman – pathogenic bacteria do not magically appear. If they are found on organic food (as they frequently are and as they repeatedly were in the German outbreak) it is a clear indication that your laughable sacred honor code of organic manure handling etiquette has been violated. That in itself is an act of negligence, isn’t it, then? So, your silly hound runs baying into the distance again, all mouth, no head. You’re zero for two.
    Now, on the matter of the NOFA anti-agriculture cult/organic certifying agent conflict of interest, you and your organization have managed to lay down a deceptive set of tracks. But no problem for any cold nosed hound worth its kibble. Intelligent hounds will tree three times just like clockwork on this little hunt…
    If we de-truck and unkennel the dogs at the NOFA website
    Click around in the “Chapter Websites” menu on Vermont, New York, Massachusetts to follow the corporate subdivision trail…
    go to “Programs” then “Organic Certification Program”
    We easily tree “Baystate Organic Certifiers” spun off from NOFA/Mass
    click on “NOFA-NY Certified Organic” logo
    we tree NOFA-NY Certified Organic, LLC; a subsidiary of NOFA-NY, Inc.
    go to “OUR PROGRAMS”…scroll down, click on “Organic Certification”
    we promptly corner “Vermont Organic Farmers (VOF), the certification branch of NOFA-VT“
    It would appear, Gilman, that your inbred organization’s various subdivisions and subsidiaries are merely a convoluted legal mechanism to punk all of us, one that would make R.J. Reynolds or AIG proud. All an elaborate front for an anti-agriculture agenda, accredited by USDA! Not a too shabby flim-flam for insincere poseurs who profit by projecting a false image of quaint, provincial “organic” innocence.
    I smell dung. Looks mighty similar to any other evil “big corporation”. You’re the cult’s “policy man”, so you would know. But, technically legal organizational chart or not, Gilman, nobody trusts a lying coon dog, nor should they.

  • Steve

    eeeasy there Dock — with all your aggravation, I’m worried about your heart — assuming you have one….
    ….cutting through your latest disinformation prevarications and coon dog rantings (!) it’s like I said:
    FYI, the NOFAs and other membership farming organizations are Not — and can Not be– organic certifiers, period. USDA accreditation rules require independent 3rd party organizations to fill this role –and their accreditation is closely monitored by USDA. Further, the farm inspectors are also separate and independent from the certifiers as well as the farming organizations. For a look at the federal rules, go to the National Organic Program at USDA.
    And, since Mudd has once again intentionally muddied up the waters with insults and his usual crackpot crankiness, here’s a little history:
    NOFA, the Northeast Organic Farming Association, celebrates its 40 Anniversary this year and is one of the oldest organic farming organizations in the U.S. Members include farmers, gardeners and consumers. It has seven independent chapter organizations in NY, VT, NH, CT, MA, RI and NJ that also work together on a regional, national and international basis independently and in coalition with other groups. I invite any readers living in those states to check us out on the web, attend some events and conferences, meet some folks and become members — it’s a great bunch of people who care deeply about our environment and alternatives to our industrialized food system.

  • Doc Mudd

    I smell dung, Gilman. You’re spinning and flinging it again – but of course that’s your job as a NOFA operative (some who comment on these threads would call it ‘shill’) shamelessly bombarding us with your slippery industry talking points.
    There is simply no excusing away the reality that NOFA is a big ol’ honkin’ multi-state business with a stable of obedient subservient companies (corporations and LLCs), including several that have been cleverly ‘set up’ to barely meet the letter of the USDA accreditation rules (if not the intent) as organic certifiers.
    NOFA actively lobbies against FSMA & consumer safety in the foreground as its subservient puppet companies play the role of industry “watchdogs” in the background, claiming to assure strict compliance among their friends and fellow cult members in at least seven states. Heh, some watchdogs; more like foxes in the henhouse. Blind trust is a remarkable marketing ploy!
    There is, however, a limit to how far blind trust can be stretched before credibility begins to erode: ‘trust us when we tell you successful modern agriculture is just evil, it is causing the sky to fall’; ‘trust us when we tell you science is unnecessary and scary, trust our superstitous and vacuous parable of “healthiness” instead’; ‘trust us when we tell you at point of sale we’re “a great bunch of people”, now hand over your grocery money’; ‘trust us when we facetiously wish you “good luck” with your organic food purchase and invoke the time-honored standard of caveat emptor’; ‘trust us when we tell you big multi-state businesses with layers of shifty subsidiary entities are greedy and unethical except us at NOFA, of course, where our big crafty insidious business is as large and tentacled as our love of good old fashioned laissez-faire capitalism’.
    Yeah, just trust us. I guess Bernie Madoff didn’t invent that line.