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Marler Blog Providing Commentary on Food Poisoning Outbreaks & Litigation

The Reality is Non-O157:H7 Shiga-toxin E. coli Causes Human Illness – So, Why Does the USDA and FSIS NOT Consider it an Adulterant?

June Dunning, E. coli O146:H21, 2006, Death

Right up until the time of her death, Ms. Dunning remained an active, self-aware and outgoing woman. Her health had always been good too. For the last seven years of her life, June lived in Hagerstown, Maryland with her daughter, and her son-in-law. On August 28, 2006, June Dunning consumed some Dole baby spinach from a bag her daughter had purchased at the local grocery seven days earlier. The bag would later test positive for E. coli O146:H21.

June fell ill on September 2, 2006. Her illness quickly progressed, and she was taken to the hospital the following day. June was first seen by a triage nurse, who noted a history of a sudden onset of diarrhea the night before, which had progressed to bloody stools and severe abdominal pain in the morning. June rated her pain at “9" on a 1-10 scale. Further examination and blood tests soon revealed a number of disturbing problems. A CT scan showed revealed diffuse thickening and swelling of the colon, with severe, acute inflammatory colitis of the ascending and transverse colon. June’s blood pressure was elevated. Also, June’s blood work demonstrated the onset of renal insufficiency. She was admitted to the hospital, and started on IV fluids.

Admission to the hospital did not slow the deterioration of June’s condition. She began to lose her mental faculties. She spoke, but did not make sense. She spoke of going to see her husband, deceased since 1996. All the while, she continued to suffer from frequent, painful, bloody diarrhea. Her renal failure deepened. The doctors worried about her colitis leading to systemic toxemia, and opted for surgical removal of a portion of her colon.

June survived the surgery, but continued to deteriorate. She became anemic and was placed in ICU. She stopped producing urine, and progressed to a coma-like state. In the early morning hours of September 7, she suffered a grand mal seizure, and underwent an MRI of the brain. On September 9, she suffered another seizure, followed by a drop in her oxygen levels. She was placed on mechanical ventilation. Her medical bills while hospitalized were nearly $50,000.

From this point forward, it was plain what the outcome would be. An EEG on September 11 showed slowing of brain activity. June’s daughter and son-in-law stayed with her for the final hours. Late on September 11, the ventilator and all medical support save Morphine were disconnected. The doctors said they expected June to pass within the hour. Instead, June persevered without life-support. For most of the next 36 hours or so, she appeared to be resting comfortably. In one frightening episode in the wee hours of September 12, June experienced one more seizure. She gripped her daughter’s hand, eyes wide open, moaning and sighing. Thankfully, the seizure passed. June remained until just after dawn on September 13, passing away at 6.45 a.m.  Click HERE to see video.

Megan Richards, E. coli O121:H19, 2006

Megan Richards, of Millville, Utah, was a young wife, mother, and educational conference coordinator in 2006, when she consumed a take-out lunch from a Wendy’s restaurant in Ogden, Utah, on June 30, 2006. Her illness was later determined to be one of many illnesses in an outbreak of E. coli O121:H19 linked by public health officials to food served at Wendy’s. Megan fell ill with significant diarrhea on July 3, 2006. Despite treatment by her regular physician her condition did not improve, and on July 10, she developed persistent vomiting. She was seen that day in the emergency room in Logan, Utah.

Blood tests in the emergency room indicated that Megan’s kidneys were failing, and she was admitted to the hospital. Over the next day, her kidney functioned continued to slow, and then halted altogether. She was transferred to McKay-Dee hospital in Ogden, Utah, to receive more specialized care. There, the diagnosis of hemolytic uremic syndrome (HUS) was confirmed. On July 14, Megan endured a kidney biopsy. The results were frightening: “…necrosis of nearly the entire specimen [noted to be kidney cortex].” The renal cortex is where the kidney’s filtering units are located and cortical necrosis indicates permanent loss of those filters—a finding typically found only in the most severe cases of HUS. The finding carried dire prognostic significance.

That same day, the nurses found Megan unresponsive and exhibiting seizure-like activity. A code was called. Dr. Pittman responded and arrived on the unit to find Megan with a heart rate of 160 per minute and tonic clonic seizures, with rigid posturing activity. Also, her oxygen saturation level was shockingly low at 71%. The physicians were able to get Megan’s seizures under control, and her oxygen levels back up, but it was clear at this point that she was fighting for her life. On July 15, Megan began hemodialysis and plasmaphoresis to replace the functions her kidneys could no longer complete. Megan remained hospitalized through July 28. When she was discharged, she still had not recovered kidney function, and was started on a program of out-patient hemodialysis.

Megan returned to the hospital three days a week for hemodialysis through September 7, when she was reduced to two sessions a week. Her kidney function remained abnormally low throughout. Megan was finally freed from regular dialysis in early October. Medical bills were over $350,000. Still, the damage to her kidneys was permanent and irreversible. Her prognosis as of 2008 was reported as follows:

Based on the severity of her HUS, the evident extensive damage to her renal cortex, her markedly reduced estimated filtration rate of currently only 35 mls/min and the fact that Megan also now has evidence of significant proteinuria, it is my opinion, based on reasonable medical probability, that Megan will develop end stage renal disease (ESRD) and require renal replacement therapy in the form of chronic dialysis or kidney transplantation in the future.

It is estimated that Megan will require renal replacement therapy or transplant by age 40 to 45. These are some of the challenges that await Megan once she undergoes a kidney transplant:

Megan will need to take immunosuppressive medications for the rest of her life. Those medications are not only very costly, but they also have significant side effects including causing high blood pressure, diabetes, osteoporosis, altered appearance (such as moon faces due to steroids and hair loss or excessive hair growth with calcineurin inhibitors), memory problems, and others. Immunosuppressive medications also significantly increase the risk for life-threatening infection or cancer.

Shiloh Johnson, minor, E. coli O111, 2008

Shiloh Johnson was one of hundreds sickened in the E. coli O111 outbreak at the Country Cottage restaurant in Locust Grove, Oklahoma, in August 2008. Shiloh developed bloody diarrhea, and was hospitalized on August 24, 2008. She would not be discharged until October 3.

Once admitted, Shiloh’s stool was cultured, returning positive for E. coli O111. At this time, she very quickly descended into hemolytic uremic syndrome (HUS): her kidney’s failed, and her red blood cell and platelet counts plummeted. With a complete loss of kidney function, Shiloh needed dialysis to survive. She was placed on continuous renal replacement therapy.

48 hours into her dialysis treatment, though, disaster struck. Shiloh developed a significant pericardial effusion (fluid around the heart) with tamponade (the stoppage of blood flow caused by fluid). Shiloh went into cardiorespiratory arrest. She was endotrachoeally intubated, and the pericardial fluid was drained. She was given a round of epinephrine, and the cardiorespiratory arrest was reversed. Shiloh remained on a ventilator through September 12. The fluid that was overwhelming Shiloh also filled the area around her lungs – bilateral pleural effusions. This required the placement of chest tubes.

Throughout this time, Shiloh remained in full renal failure. She received round the clock dialysis. The doctors placed a periotoneal catheter on September 10, and converted her to peritoneal dialysis. The dialysis continued through September 27. Her medical bills amounted to $450,000.

The severity of Shiloh Johnson’s HUS, and in particular the length of her renal failure puts her at serious risk of future complications including end stage renal disease. The extent of her long-term injury is still being assessed.

So, really why are these deadly pathogens not considered an adulterant by the USDA and FSIS when E. coli O157:H7 is?