YOU ARE HERE: LAT HomeCollections


A Mom Suspected Spinach

As public health officials looked for the source of lethal E. coli, the mother of two sick children began to focus on their salad.

October 09, 2006|Maria L. La Ganga | Times Staff Writer

MILWAUKEE — On a Sunday afternoon early last month, 3-year-old Caroline Zientek began to complain. Her stomach hurt, she said, and she had diarrhea.

She didn't get better. By late Tuesday night, the normally happy toddler was shrieking in pain. And on Wednesday at 5 a.m., her mother, a nurse, was worried enough that she packed her daughter into the family's blue Nissan and sped through the darkness to Children's Hospital of Wisconsin.

"I think it's food poisoning," Ana Maria Zientek told the emergency room nurse, describing the waves of cramping that had her daughter doubled over in pain every 20 minutes.

When Dr. Jane Machi examined Caroline at 7:30 a.m., she found her lethargic, clingy, seriously dehydrated and unable to urinate. She had dark circles under her eyes.

Machi ordered a stool sample and a series of blood tests. Without waiting for the lab results, she started Caroline on intravenous fluids and admitted the child to the hospital.

Machi had seen these symptoms before. The last time, the diagnosis had been Escherichia coli O157:H7.

E. coli bacteria ordinarily live harmlessly in the digestive systems of animals that chew their cuds. But after the pathogen is excreted in feces, it occasionally ends up in human food. It can be spread from a cow's intestines to meat during processing. Water and passing birds can spread it to fields where crops are grown.

E. coli has many forms, and O157:H7 is one of the most virulent. Particularly in young children and the elderly, it can sometimes cause hemolytic uremic syndrome, in which red blood cells break down and platelets clump up in the kidneys, causing them to fail. Many patients with the syndrome end up on dialysis. Some die.

When doctors told her their suspicions, Ana Maria Zientek knew her daughter was in grave danger. What neither Zientek nor the doctors knew Sept. 6 was that Caroline was not alone. Physicians around the country had begun seeing patients with bloody diarrhea and abdominal cramps.

But no one knew where the E. coli was coming from. For Ana Maria Zientek, that became a galvanizing question.

'Sentinel Event'

A day after Caroline Zientek was admitted to Children's Hospital, the medical director of a nearby blood center called Dr. Jeffrey Davis, Wisconsin's chief medical officer for communicable diseases.

He told Davis that five adults in separate hospitals in the area had undergone a blood-cleansing procedure called plasma exchange over the previous few days. They all had hemolytic uremic syndrome, with its signature kidney failure and anemia.

Davis was immediately concerned. It had been 20 years since the veteran scientist had last seen so many patients with hemolytic uremic syndrome in so short a time in such a small region.

E. coli infections had been confirmed in three of the patients. "I asked if it was O157:H7. He said yes," Davis recalled. "This was a very powerful sentinel event."

By itself, a small outbreak of E. coli O157:H7 is neither unusual nor alarming. Wisconsin sees about 200 cases each year. Summer months bring the most infections, because people swim in lakes and rivers, where the microbes can be found, and they eat undercooked hamburgers at backyard barbecues.

But because of the hemolytic uremic syndrome and other reports of O157:H7 from around the state, Davis had a bad feeling.

He set his staff to work, calling hospitals across the state for more information. From Children's Hospital of Wisconsin, they learned about Caroline Zientek and another child, both now confirmed to have the bacterium.

By the end of the day, microbiologists at the state hygiene lab had teased out the DNA fingerprint in stool samples given by each of the patients. More than 3,000 unique strains of E. coli O157:H7 have been identified. In Wisconsin, eight patients had identical forms, suggesting a common -- but unknown -- source of infection.

Wisconsin public health officials knew they had a serious problem. They also had a responsibility to alert health officials in other states in case the outbreak was larger than they knew.

So on Friday, Sept. 8, microbiologist Linda Machmueller sat at her computer in the Wisconsin State Laboratory of Hygiene in Madison and posted a terse message on PulseNet, a federal Web board run by the Centers for Disease Control and Prevention that allows scientists around the country to communicate about possible disease outbreaks.

"Wisconsin has a cluster of 8 E. coli O157:H7," she typed, including seven local cases and one from Illinois. They all appeared to "match the pattern" for a strain of the organism that the U.S. Department of Agriculture had isolated earlier in hamburger patties from Texas. The microbiologist attached a copy of the deadly organism's DNA fingerprint.

She had no idea what would happen next. "You never know when you post these things if it's going to amount to anything," she said.

Spreading the Word

Los Angeles Times Articles