E. coli infection can act like ‘acid on the intestinal wall,’ expert says

E. coli infections like the one that has sickened hundreds of children in daycare centres across Calgary are so brutal because the bacteria can act “like acid” on the wall of people’s intestines, a doctor says.

The recent outbreak has led to more than a dozen children hospitalized, with some requiring dialysis. Hundreds of others have fallen ill following exposure to this potentially life-threatening bacteria.

The bacteria, known as a Shiga toxin-producing E. coli, can cause kidney failure, bloody diarrhea, blood clots and even death, explained Dr. Iris Gorfinkel, a family physician based in Toronto.

“Most E. coli is not a concerning disease — we carry E. coli in our intestines — but the problem is the Shiga toxin-producing E. coli. This is different,” Gorfinkel told Global News’ The Morning Show on Tuesday.

“So if a person ingests as few as 10 of these bacteria, it produces a toxin in the intestine that works like acid on the intestinal wall. It causes initially watery diarrhea, but then because it’s like acid on the wall, it causes bloody diarrhea, and boy does it hurt, a lot of cramping.”

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The outbreak in Calgary daycares was first reported on Sept. 4, and since then there have been 329 lab-confirmed cases of bacterial infection related to it. Thirteen children are still in hospital, 10 of whom have hemolytic uremic syndrome — a complication affecting the blood and kidneys. Six of those children are receiving dialysis.

A report released by Alberta Health Services earlier this week said inspectors found improper sanitation, live cockroaches and issues around food handling in a central kitchen for the daycares.

Investigators are still looking for the source of the outbreak.

At a press conference on Friday, the Alberta government announced a one-time payment to affected families of $2,000 per child. Alberta Premier Danielle Smith said information on how to apply for this funding will be available soon

E. coli is typically spread through infected food products and water, which is known as fecal-oral spread, Gorfinkel said. For example, it can be from undercooked meat, a vegetable that was not washed properly or juice that wasn’t pasteurized.

However, there are instances where the transmission can be from an infected person who had E. coli, did not properly wash their hands and then handled food in a kitchen setting.

Gorfinkel predicted that a majority of the children infected with the bacteria would “get better on their own.” However, she said a small percentage may get very sick with hemolytic uremic syndrome, which can shut down their kidneys.

“Overall, one in 200 will pass away from the disease,” she said.

“It is a frightening disease because it can take a well child and turn them very sick, put them on dialysis, and even be responsible for chronic kidney failure,” she said. “If that toxin gets into the bloodstream, it acts like an acid to the blood vessel wall … it can cause hyperinflammation, which is associated with blood clots and kidney failure.”

Dr. Ted Steiner, an infectious diseases physician in Vancouver, said Shiga toxin-producing E. coli is much more infectious than other types, meaning you don’t need a lot of bacteria to get sick.

This heightened infectiousness could explain why the outbreak in Calgary daycares spread so extensively, he said.

“In daycare centres, it’s pretty easy for it to spread because you have kids in diapers and you have little kids who are sticking their hands in each other’s mouths and who can’t really practise some hand hygiene like older kids or adults can,” he said.

“The most common type of outbreak is from contaminated food. But these types of person-to-person daycare centre outbreaks have been reported.”

Children and older adults are also more at risk of developing hemolytic uremic syndrome as a result of the illness.

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“I don’t think we completely understand why, but children seem to be at a quite elevated risk compared to adults,” he said.

“The biggest concern is that the kidneys could shut down completely or you could get enough damage to blood vessels that you could have some permanent problems that won’t improve.”

Steiner said there is also evidence that children who do recover still have a significantly higher risk of developing long-term kidney problems.

When it comes to E. coli, Gorfinkel said people are constantly taking chances. This is because the bacteria lack any scent, flavour or visible presence, making them very difficult to detect.

“The best protection is to make sure that we don’t rely on just what we are seeing and smelling,” she cautioned.

E. coli can be transmitted in various ways, including contact with animals.

For example, at a petting zoo, animals like sheep, cows and goats can serve as carriers of the bacteria.

“That is what that hand sanitizer is for. So washing hands is extremely important to try and prevent this disease,” she said.

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When it comes to food, undercooked meat can pose a significant risk of E. coli infection if it contains the bacteria. That’s why it’s crucial to check the meat’s temperature, and it should reach a minimum of 70 C (or 160 F) to guarantee it has been cooked sufficiently, Gorfinkel emphasized.

And then there’s the possibility of bacteria residing on fresh produce.

“Think about the vegetables: E. coli can be on lettuce, it can be hidden on fruit,” she said. “You have to wash it because you are not going to see, smell or taste that E. coli if it’s there, so washing is key.”

— with files from The Canadian Press