The patient count in an E. coli outbreak linked to daycare centers in Calgary, Canada, now stands at 231.

Alberta Health Services officials say 26 of the sick are currently hospitalized, 25 of them children and one adult. Eleven other children have already been discharged from hospitals. Twenty-one children have hemolytic uremic syndrome (HUS) which is a type of kidney failure that also affects other organs.

A specific food has not been identified as the source of the E. coli O157:H7, but investigators have collected samples of leftovers and frozen food for testing. Eleven daycare centers that share a common kitchen were closed.

The central kitchen that serves the 11 daycare centers remains closed. 

Four daycare centers were given permission to reopen Monday. The four centers did not have any illnesses linked to the outbreak. The remaining seven will be allowed to reopen Tuesday. Staff and daycare attendees from those seven centers must test negative before returning to any daycare center, according to Alberta Health Services.

Alberta Premier Danielle Smith has asked the provincial health minister and the provincial minister for children and family services to investigate the outbreak and provide a full assessment of the situation. 

About E. coli infections
Anyone who has developed symptoms of E. coli infection should seek medical attention and tell their doctor about their possible exposure to the bacteria. Specific tests are required to diagnose the infections, which can mimic other illnesses.

The symptoms of E. coli infections vary for each person but often include severe stomach cramps and diarrhea, which is often bloody. Some patients may also have a fever. Most patients recover within five to seven days. According to the Centers for Disease Control and Prevention (CDC), others can develop severe or life-threatening symptoms and complications.

About 5 percent to 10 percent of those diagnosed with E. coli infections develop a potentially life-threatening kidney failure complication known as a hemolytic uremic syndrome (HUS). Symptoms of HUS include fever, abdominal pain, tiredness, decreased frequency of urination, small unexplained bruises or bleeding, and pallor. 

Many people with HUS recover within a few weeks, but some suffer permanent injuries or death. This condition can occur among people of any age but is most common in children younger than five years old because of their immature immune systems, older adults because of deteriorating immune systems, and people with compromised immune systems such as cancer patients. 

People who experience HUS symptoms should immediately seek emergency medical care. People with HUS will likely be hospitalized because the condition can cause other serious and ongoing problems such as hypertension, chronic kidney disease, brain damage, and neurologic problems.

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