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Death Toll Reaches 37: Two-Year-Old Boy Dies in German E. Coli Outbreak 

The death toll from Germany's E. coli outbreak rose to 37 on Tuesday when a two-year-old boy became the first child to fall victim to the deadly bacteria. Authorities have discovered EHEC on red lettuce from a farm in Bavaria but say it may not be the lethal strain that caused the outbreak. They remain convinced that beansprouts from a farm in northern Germany are the source.

A field with red lettuce of the Lollo Rosso variety. Zoom

A field with red lettuce of the Lollo Rosso variety.

The death toll from the outbreak of EHEC, the lethal E. coli strain that has hit Germany this spring, rose by one to 37 on Tuesday after a two-year-old boy from Celle in northern Germany died from kidney failure caused by the infection. He was the first child to die from EHEC. Until Tuesday, the youngest victim had been 20.

The boy's father and 10-year-old brother are also suffering from the infection but are recovering, their doctor told a local newspaper. It remains unclear how they were infected.

The epidemic has now claimed 36 lives in Germany and one in Sweden. The Robert Koch Institute, Germany's national disease control and prevention agency, said that 782 people in Germany infected with EHEC are suffering from a severe complication called haemolytic uraemic syndrome (HUS), which affects the blood, kidneys and nervous system. About 69 percent of them are women. A further 2,453 people are suffering from EHEC but not from HUS.

The number of new infections with EHEC has been declining significantly in recent days, officials said.

Authorities confirmed on Friday that beansprouts from an organic farm in northern Germany were to blame for the outbreak and lifting their warning against eating raw tomatoes, cucumbers and lettuce. However, on Monday the Bavarian health and food safety office said it had discovered the bacterium on lettuce grown by a farm in Fürth near Nuremberg.

'Cautious Optimism'

The office said one of 617 samples of fruit and vegetables it had tested for the EHEC bacteria in food retail outlets in Bavaria came up positive -- red lettuce of the Lollo Rosso variety. "So far there are no indications that it is the serotype O 104 found in northern Germany," the office said in a statement. And there is no epidemiological information to suggest a link with events in northern Germany."

The lettuce has been taken off the market and health officials are conducting checks at the farm and analyzing its distribution.

It will take a week to establish whether the bacterium is of the aggressive strain that can cause HUS. Bavarian Health Minister Markus Söder said all indications at present suggested that the bacterium found on the lettuce was not the deadly strain.

"There is reason for cautious optimism," Söder said.

A spokesman for the Federal Institute for Risk Assessment (BfR) said that a total of 9,000 food samples had been tested across Germany since the outbreak in early May, focusing on cucumbers, tomatoes, lettuce and beansprouts. Given the intensity of the search, it wasn't surprising that other EHEC bacteria would be found that don't belong to the strain that has caused the outbreak, he said.

Meanwhile, health experts still haven't established how the deadly EHEC bacteria got into the organic farm in Bienenbüttel that supplied contaminated beansprouts to restaurants and cafeterias across northern Germany.

The BfR assumes that the seeds for the beansprouts may have been contaminated. But it is also possible that workers brought the bacterium into the farm.

Raw beansprouts are a notorious source of infection with dangerous germs including E. coli and Salmonella because of the warm, moist conditions in which they grow.

cro -- with wire reports


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Info Graphic
Unleashed Aggressor: How the E. coli serotype O104:H4 attacks the body

What to Know about E. Coli
Which E. coli strain is causing the outbreak?
There are hundreds of different types of Escherichia Coli, E. Coli, strains, most of which are harmless for humans. Strains are differentiated by their so-called serotypes -- variations within a subspecies of bacteria -- usually with the designations "O" and "H". "O" indicates the lipopolysaccharides, a type of sugar-fat molecule, found on the outer surface of the bacteria; "H" stands for the type of flagella found on the bacteria (flagella are the hairs the bacteria uses to move itself). E. coli bacteria are designated as enterohemorrhagic when they lead to bloody diarrhea in humans. This occurs because some subtypes, like the one currently causing panic in Germany, produce a certain poison, so-called Shiga toxins. The E. coli strain linked to the outbreak in Germany is being identified as E. Coli serotype 0104:H4. Experts have been especially surprised by the strain's aggressive nature and rapid spread. They first thought the strain to be a mutation of serotype 0104:H4. But initial genetic analysis suggests that the bacterium in question is actually a unique variant of the strain: According to the World Health Organization, this type of Enterohemmorhagic E. Coli (EHEC) has been seen in humans before but has never before been linked to an outbreak.
How can the risk of disease be reduced?
There is no vaccine currently available and treatment with antibiotics can be problematic. The reason: the E. coli bacteria in question release a dangerous (Shiga) toxin into the human body, and antibiotics can actually increase the amount of poison released. Good hygiene is one way to significantly decrease the risk of E. coli infection. Facial contact should be avoided after having handled animals or touched the floor. Raw meat and easily-spoiled foodstuffs should be stored at appropriate temperatures in a refrigerator or freezer. When cooking, foodstuffs should be cooked through in order to kill bacteria (at least 10 minutes at 70 degrees Celsius, 158 Fahrenheit). Wash hands regularly. Cutting boards, dishes and utensils should all be washed thoroughly. Avoid unpasteurized milk and unpasteurized milk products.
How can I tell if I've been infected by the E. coli bacteria?
The most common symptom of E. coli infection is heavy, and possibly bloody, diarrhea. Other possible symptoms include nausea, vomiting and, in rare cases, fever.
What can doctors do in the case of 0104:H4 infection?
The incubation period of O104:H4 is 10 to 13 days. Characteristic symptoms of the strain include bloody diarrhea, kidney failure and anemia. Experts have linked O104:H4 to haemolytic uraemic syndrome (HUS), which can lead to kidney failure and even death. With current knowledge, experts do not yet have the means necessary to effectively combat the O104:H4 pathogen. They are therefore treating the typical complications and symptoms as a whole, for instance through plasmapheresis, essentially a blood plasma transfusion. Some of those who are currently infected are also undergoing an experimental therapy of antibody treatment.
What should be done if symptoms arise?
In the case of serious diarrhea, saline- and fluid-loss need to be compensated for. If serious symptoms appear, medical treatment should be sought. In order to counteract potential complications as quickly as possible, those who are in extreme danger -- infants, small children or the elderly -- should be treated in a hospital.
What are other causes of gastrointestinal illnesses?
Gastrointestinal illnesses are among the most common infectious diseases in the world, and can be caused by germs other than E. coli. The norovirus circulates throughout the year and reaches its peak during the winter months. Its incubation period, at least six hours, is short. The norovirus also causes abdominal pains and fatigue, and is primarily spread via humans. During peak periods of illness, the victims are highly contagious.
The rotavirus is the most common cause of viral gastrointestinal disease in children. Ninety percent of children catch the virus before age three. Life-threatening dehydration is a possible effect. Other causes for gastrointestinal illnesses are salmonella and staphylococci.

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