Slate's Explainer: The Health Perils of E. Coli

Scientists suspect bagged spinach may have caused an outbreak of E. coli that has resulted in one death and dozens of serious illnesses around the country. Doctor Syd Spiesel of Yale Medical School and the online magazine Slate discusses the dangers and treatment of E. coli infection.

MADELEINE BRAND, host:

We're joined now by our resident medical expert, Dr. Sydney Spiesel of the Yale Medical School and the online magazine Slate. Hi, Syd.

Dr. SYDNEY SPIESEL (Yale Medical School): Hi. How are you?

BRAND: Fine, thank you. Well, so how dangerous is infection by E. coli? How sick can someone get from this infection?

Dr. SPIESEL: Well, the particular kind of infection we're worrying about today is quite serious. Every time there's been an outbreak, on the average there've been about two percent of people who died as a result of this infection.

So it is quite serious.

BRAND: One person has died so far. So that doesn't indicate a large death toll by any means, but still it's serious?

Dr. SPIESEL: Well, it is. And we don't know how widely this is going to spread, how many more cases are going to occur. But I suspect there'll be a few more, probably not a tremendous number but probably a few more than we presently have.

BRAND: It is particularly dangerous for small children and the elderly. Why is that?

Dr. SPIESEL: This particular outbreak is less dangerous in a funny way for small children. The disease has several phases. One is it can give you sort of terrible diarrhea. And that's probably what happens most of the time. And I suspect that it's often not even diagnosed properly. You know, it's just some kind of food poisoning or an upset stomach or something.

Then there's the more serious form, which is called hemorrhagic colitis, in which there's actually bleeding from the bowel as part of the diarrhea. And then there's the most serious form, which is called hemolytic-uremic syndrome, in which the red cells break down and there's kidney failure and kidney problems.

BRAND: And could that be permanent kidney failure?

Dr. SPIESEL: Yes, it can be permanent. Young children are particularly susceptible to it. In this outbreak about 15 percent of the people so far have had this particular manifestation of the disease. There have been many fewer cases of children in this particular outbreak than we might expect.

Only probably about, I don't know, five or six percent of kids of the infection have been in children under five. And I think it's because children under five don't like spinach.

BRAND: Hmm. Well, normally we hear about these infections, these outbreaks of E. coli coming from tainted meat or meat that hasn't been cooked properly. So how is it that it could get into fresh vegetables?

Dr. SPIESEL: Well, it can get into fresh vegetables because fresh vegetables are rinsed with water. The reason it gets into tainted meat is because these are bacteria that are present in stool and including the stool of, for example, cows.

And so if a field is contaminated with cow droppings and that sort of seeps down into a water supply that is used to wash fresh vegetables, you can imagine that the bacteria that are present will wind up remaining on the fresh vegetables.

BRAND: And you can't get rid of this bacteria by just washing your vegetables?

Dr. SPIESEL: Well, you can get rid of most of it by washing it. But the trouble is that this particular organism multiplies very well. In some outbreaks it's been estimated that as few as 10 bacteria have been enough to set off an infection.

BRAND: What's the best way to treat it?

Dr. SPIESEL: Well, the best way to treat it is to treat the patient to make sure that they're getting adequate fluid replacement. And that means not just water but the electrolytes that they lose in stool. And just good nursing, just take care of them, because we have no medicine that can reverse this process. It's caused by a toxin which is released by the germ. And we just have to support the patient as best we can until the body's natural defenses help it go away.

BRAND: So antibiotics won't work?

Dr. SPIESEL: No. There's no value for antibiotics here.

BRAND: Thank you, Syd.

Dr. SPIESEL: You're welcome.

BRAND: Dr. Sydney Spiesel is a practicing pediatrician. He's also a professor at the Yale Medical School.

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