When she was 10 years old, Brianne Kiner became the public face of one of the country's worst outbreaks of food poisoning.
Television cameras zoomed in as she left Seattle's Children's Hospital in June 1993, six months after eating an undercooked Jack-in-the-Box hamburger contaminated by \o7E. coli\f7. It was the same virulent strain that recently has been linked to California-grown spinach.
Doctors called her survival a miracle. What most people outside her family didn't know then -- and may not realize now -- was that her recovery was just beginning.
"She had to learn to walk again. Think again. Learn her colors," said her mother, Suzanne Kiner. "She had such total body atrophy that she could not chew."
Brianne suffered from hemolytic uremic syndrome, or HUS, the most dreaded consequence of \o7E. coli \f7O157:H7 infection and the most common cause of kidney failure in children under 18. Of the 171 cases identified so far in the current spinach-related outbreak, 27 have been diagnosed with HUS. One person has died. Two other deaths are under investigation.
Not everyone who ingests this strain of \o7E. coli\f7 falls ill, and not everyone who becomes ill develops the bloody diarrhea described by doctors and patients as worse than kidney stones, more painful than childbirth. But about 10% of those who do -- the proportion is slightly higher for children and the elderly -- come down with HUS.
As the Kiners' experience shows, the consequences can be devastating, lingering far longer than most people's memories of the original outbreak.
The death rate from HUS is 3% to 5%, doctors say. Ten percent of patients survive but have long-term kidney damage and may eventually require dialysis or a transplant. The vast majority recover complete kidney function, but experts say even they should be tested regularly for abnormalities that may not be obvious but could cause high blood pressure or diabetes.
Brianne's case was so severe that just about everyone expected her to die. She was the last to leave the hospital among those stricken in the Jack-in-the Box outbreak that sickened hundreds and killed four.
During the months she was laid up, the toxin produced by the bacteria attacked her brain, kidneys and liver, putting her in a coma for 40 days. She suffered strokes and seizures. Her infected pancreas lost the ability to produce insulin, and she developed diabetes. Doctors removed part of her inflamed intestine.
