E.Coli O104: H4 Outbreak in Germany - Report Example

E.Coli O104:H4 Outbreak in Germany 17th June Introduction In the 1800s, a German bacteriologist-pediatrician, Theodore Von Eschrich, discovered a new strain Escherichia Coli in the gut that was later called Bacterium Coli Commune. This became the most common microorganism in the prototype bacteria of nonpathogenic members of the intestinal flora. Moreover, they are known to cause diseases of the central nervous system, urinary and gastrointestinal (Rubino, Capucinneli, Kelvin, 2011; p. 1). Germany experienced its first real case of these pathogens in May 2011 when 3167 cases of diarrhea caused by Hemolytic Uremic Syndrome (HUS) were recorded in many of its major hospitals. However, by July the same year, 908 of the cases were noted to have been caused by non-hemolytic uremic syndrome, and there were 34 related deaths countrywide. These increased cases caused a real strain on the medical system as specialists struggled to find the cure. Moreover, the German major hospitals were forced to borrow medical equipment from other medical institutions in the continent in order to handle the outbreak (Marie, A. C. et al, 2011 p.1). Following the outbreak, German officials reacted very fast by setting up a contingency measures to combat the outbreaks. The German government laid down a task force called the German EHEC that was given the task of investigating the cause and spread of the outbreak. The German EHEC results showed that this was the largest outbreak to be ever reported in German history. Moreover, it found out that the outbreak was caused by sprout root and undercooked food products by people, and some of the cases were also said to have been from travelers who came into the country from other regions where such infections had been reported. In addition, it described the spread of the outbreak in two ways; first, it occurred through human-to-human interaction and secondly through transmission from food in restaurants and public events (Joint Release Press, 2011 and Center for Disease Control and Prevention, 2011). On the contrary, when the European Food Safety Authority took over the investigation in the European region, the results showed that the origination of the seeds that caused the outbreak was in Egypt. In addition, test and lab research showed that the reason 0104:H4 caused diseases was its ability to stick to cells in the human body, and also the production of Shiga toxin that caused some harm in the intestine tract (Joint Release Press, 2011 and Center for Disease Control and Prevention, 2011). Later, the main causes of spread of the disease among victims were analyzed to be brought about by Shiga-toxin producing E-Coli serotype 0104:h4 in the Escherichia Coli structure and composition. Moreover, after studies were undertaken, it was found out that majority of the cases in German affected women above 20 years, more than the men of the same category. Furthermore, the spread of the disease was linked with the victims consuming raw vegetables. However, by the end of June Germany health care facilities had managed majority of the cases, since preventive measures had been taken and the cases of the outbreak were on the decline (Rubino, Capucinneli, Kelvin, 2011; p. 3). Types of E-Coli Strains Detected Through studies it has been revealed that there are different strains in the evolution of the disease. The first diagnosed strain in the outbreak was of Sequence Type (ST) 678, Serotype 0104:H4, found in the EAEC sequenced strain and the HUS causing 0104:H4. The main types of pathogens include the following Enteroaggeregative E-Coli (EAEC) and Enterohemorhagic E-Coli (EHEC) (Davis, P. C, MD and PHD). Enteroaggeregative E-Coli (EAEC) This is a diverse diarrheaegenic causing pathogen from the Diarrheagentic E-Coli pathogroup and has been identified in other industrialized and developing countries. It causes acute diarrhea among young children in these regions. Moreover, industrialized nations have also reported a high number of intestinal diseases cases that are said to be caused by this pathogen. However, there have been problems of detection of this pathogen in developing countries, as the cases are not being given a high priority, although the true nature and effects of the disease to the human health has not been fully researched (Marie et al. 2011, p.3-4). Although reported cases of the disease in Japan are believed to be caused by children eating food contaminated with the pathogen. Whiles United Kingdom also experienced such cases arise from the use of restaurant foods by travelers and locals. Enterohemorhagic E-Coli (EHEC) The pathogen EHEC is believed to cause inflammation of the intestinal tract of the human beings as they release toxins. This is achieved, as the pathogen is known to release several toxins such as verotoxin and serotoxin causing a condition called hemorrhagic colitis. The victims who experience severe cases of bloody diarrhea, (Marie et al.2011, p. 6-8) normally show the presence of this pathogen. The cases of diseases caused by this pathogen have been reported in industrialized nations such as Japan, United States and in Germany. Symptoms Associated With the E-Coli Pathogens Due to the presence of several types of pathogens of e-coli is present; there are different symptoms that are associated with the infection of these pathogens. The main symptom is acute cases of diarrhea that reveals itself in two ways; where at first, the victim may just experience a severe watery case, which often leaves the victim dehydrated. Secondly, the victim may experience a case of bloody diarrhea that is often very serious and severe to the victims. In addition, victims also show signs of abdominal pains, which is the mainly caused by the pathogens presence and excretion of chemical in the victims’ intestinal tract. Moreover, vomiting and nausea are also problems that are identified on the victims who were infected. Furthermore, there are few cases have been reported where the victim experiences some cases of low-grade fever and some loss of appetite (Kaur, Chakraborti and Asea 2010, p.2). Identification of the Pathogens There a number of distinct steps, which are taken in the identification of the e-coli pathogens among the affected victims. The first step consist of enrichment and isolation of the pathogens in a sample normally faeces taken from a victim thought to be infected. Then the faeces matter is added with modified Tytrone soya plated with selective Caffeine Telluride Sorbidal Mac-Monkey and a mixture or residue that is pink creamy in nature is seen. However, the researches done when trying to identify pathogens present in genes have led to a number of problems arising. There is the problem of Antiaggregation Transporter Gene in the sample, the problem of the EAST gene and thirdly, is the problems arising from the Chromosomal Gene in the PheU pathogenic island in the residue (David, et al.2011, p.3). The next step is DNA sequencing and analysis of the residue in order to try discovering the strain of E-Coli present. In this case, the residue is taken and tested against 0104:H7, and then molecular testing is taken and tested on the residue. For there to be positive identity of E-coli pathogens in the victim, results from the molecular testing of 0104:H7 in the residue should be positive on presence of antibodies. In the cases of testing for unknown pathogen in the e-coli, several tests may also need to be under taken to identify the different types of E-Coli strains that are available (Kaur, Chakraborti and Asea, 2010, p. 4). Moreover, DNA analysis is used to identify the virulence in the identified residue, which is a sub-typing scheme for identification is present. In addition, generic vtx2 primers is normally used to identify the presence of EAEC pathogens in the strain, and in cases for identification of multiple strains of E-Coli there is the use of a regulator of different strains of EAEC strains. Detection of Other Types of E-Coli Most of the research in the past has been for the identification of the regular strain of 0104:H7, even though there are other strains that have been identified, but assumed by researchers. Identification of new strains of E-Coli has led to the design of new multiple PCRs through DNA based diagnostics, which has seen to be the best option of identifying the virulence strains. However, the strains are seen to be taking different forms depending on the genes of the victims (David, et al, 2011, p.4).   The 0104:H4 strain is seen as a relatively unique strain by most of the researchers, for instance it has been seen to lack two of the common stains that are in other VTEC strains. Furthermore, it lacks some pathogens that other strains of E-Coli contain like Entrecote Effacement (LEE), pathogenicity, and the EHEC virulent plasmid. In order to aid in the adherence process to the victims intestinal wall, it has strains of adhesive pathogenic plasma that does this. Pathogenesis of the E-Coli The strains of E-Coli pathogens work in distinct steps, firstly, they adhere to the intestinal wall of the host in a formed termed by many microbiologists as stack brick formation. This is only available with the presence of aggregative adherence in the pathogens molecular formation though some have other types of adherence factors that enable them to attach themselves to the mucus membrane of the victim’s intestine. In the second stage, the victim experiences an increased production of mucus by the intestines mainly in children of the developing world who suffer from EAEC. In addition, this adherence is also caused by the presence of DNA genes in these pathogens where patients suffer from bouts of diarrhea and in many cases malnutrition. The third stage is when the pathogens begin secreting chemical toxins in the victim’s intestinal lining. These toxins are highly toxic to the patients’ intestinal endings and the villi tips resulting to increased inflammation of the victim, mucosal toxicity and increased intestinal secretion. Treatment of the Outbreaks After the researches that have been done on these pathogens, there is no distinct cure for these outbreaks, but remedies that have been identified in the struggle to cure the disease are the use of antibiotics to combat the pathogens. However, the use of pathogens such as noladixic acid has been seen to be highly effective. In the developing countries and industrialized states, for instance Germany, vaccination has been also sought to try combating the outbreaks. In addition, the main agent that pathogens use in the intestines is aggregative adherence factors. Furthermore, the main concern for researchers and microbiologist has been to control the adherence of the pathogens to the intestines. This has been made possible by the use of lactoferin that is extracted from the human milk, which if given regular doses inhibit the adherence of the aggregative adherence to the intestinal walls (Nettleman, M.D, MD, M AND MACP). Conclusion The handling of the outbreak by Germany officials and the way Germany health care providers responded by grouping resources together and studying the cases very fast is regarded as the starting point for developing nations in handling their related cases. Despite the cases of misinformation from the media and other professionals, there is a great need for sharing of resources and technology will assist in the long-term. Moreover, Germany should try to assist developing nations that are struggling to combat these outbreaks by providing helpful information since developing countries lack the resources and expertise (Rubino, Capucinneli, Kelvin, 2011; p. 4). References Center for Disease Control and Prevention. 2011 July 8. Investigation Update: Outbreak of Shiga toxin-producing E. coli O104 (STEC O104:H4) Infections Associated with Travel to Germany. Retrieved on 12th June 2012 From http://www.cdc.gov/ecoli/2011/ecolio104/ David, A, et al. (2011, 25 August). Origins of the E. coli Strain Causing an Outbreak of Hemolytic–Uremic Syndrome in Germany. The New England Journal of Medicine. Davis, P.C; MD, PhD . Escherichia coli 0157:H7 (E. coli 0157:H7) Infections. Emedicine Health. Retrieved on 12th June 2012from http://www.emedicinehealth.com/e_coli_escherichia_coli_0157h7_e_coli_0157h7/article_em.htm Joint Press Release. 2011 June 5. Germany clarified: sprouts of fenugreek seeds imported from Egypt as underlying cause. BFR.ORG. Retrieved on 12th June 2012 from http://www.bfr.bund.de/en/press_information/2011/21/ehec_o104_h4_outbreak_event_in_germany_clarified__sprouts_of_fenugreek_seeds_imported_from_egypt_as_underlying_cause-83273.html Kaur,P, Chakraborti, A, and Asea A. (2010, January). Enteroaggregative Escherichia coli : An Emerging Enteric Food Borne Pathogen. Interdisciplinary Perspectives on Infectious Diseases. Marie, A. C. et al. (2011, 22 July). Enteroaggregative E. coli O104 from an outbreak of HUS in Germany 2011, could it happen again? Journal of Infections in Developing Countries: 5(6):437-440. Nettleman, M.D. MD, MS, MACP. Shiga Toxin: E. coli 0104:H4. Emedicine Health. Retrieved on 12th June 2012 from http://www.emedicinehealth.com/script/main/art.asp?articlekey=145366 Rubino, S, Cappucinnelli, P & Kelvin, D, J. (2011, 22 July). Escherichia coli (STEC) serotype O104 outbreak causing haemolytic syndrome (HUS) in Germany and France. Journal of Infections in Developing Countries: 5(6):437-440. Read More