e-coli-2711.jpgWhat follows are just three of the personal stories associated with non-O157 STEC outbreaks. These stories are presented to give a small insight into the significant harm that results when the STEC already present in the national food supply causes illness.

Shiloh Johnson, E. coli O111, 2008

Shiloh Johnson was one of hundreds of persons sickened in the August 2008 E. coli O111 outbreak at the Country Cottage restaurant in Locust Grove, Oklahoma. Shiloh developed bloody diarrhea, and was hospitalized on August 22, 2008.

Once admitted, Shiloh’s stool sample was tested and subsequently cultured positive for E. coli O111. Immediately after the start of the hospitalization, she began to suffer from hemolytic uremic syndrome (HUS). Her kidneys failed and her red blood cell and platelet counts plummeted. With a complete loss of kidney function, she required dialysis to survive. She was placed on continuous renal replacement therapy.

Forty-eight hours into the dialysis treatment, disaster struck. Shiloh developed a significant pericardial effusion (fluid around the heart) with tamponade (stoppage of blood flow caused by fluid). She went into cardiorespiratory arrest. She was endotrachoeally intubated and the pericardial fluid was drained. She was given a round of epinephrine, and the arrest was reversed. Shiloh remained on a ventilator through September 12. Soon, the area around her lungs also became inundated with fluid, necessitating the placement of chest tubes.

Throughout this time, Shiloh experienced full renal failure. She received dialysis treatment around the clock. On September 10, her doctors placed a periotoneal catheter and switched her to peritoneal dialysis. The dialysis continued through September 27. She was finally discharged on October 3. By this point, 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.

Two more stories:

Megan Richards, E. coli O121:H19, 2006

In 2006, Megan Richards, of Millville, Utah, was a young wife, mother, and educational conference coordinator with a bright future. On June 30 of that year, she consumed a seemingly safe take-out lunch from a Wendy’s restaurant in Ogden, Utah. Three days later, Megan fell ill with significant painful diarrhea. Despite treatment by her regular physician, her condition did not improve and, on July 10, she developed persistent vomiting. That afternoon, she was rushed to an emergency room in Logan, Utah.

Blood tests in the emergency room indicated that Megan’s kidneys were failing, and so she was admitted to the hospital. 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. Over the next day, her kidney function continued to slow, eventually halting altogether. She was transferred to McKay-Dee hospital in Ogden, Utah, to receive more specialized care. There, a 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 to find Megan with a heart rate of 160 beats per minute and tonic clonic seizures. Her oxygen saturation level was shockingly low at 71%. Fortunately, the physicians were able to get her seizures under control and her oxygen levels back up; it was clear, however, at this point that she was fighting for her life. On July 15, she began hemodialysis and plasmaphoresis to compensate for loss of kidney function. She remained hospitalized through July 28. Upon discharge, her kidneys were still not functioning normally, thus she continued treatment in an out-patient hemodialysis program.

Megan returned to the hospital three days a week for hemodialysis through September 7, at which point she was reduced to two sessions a week. Throughout this time, her kidney function remained abnormally low. She finally was able to discontinue regular dialysis in early October 2006. Her medical bills were over $350,000. Despite the extensive medical treatment, 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 a transplant by age 40 to 45. And after that, her future is still uncertain.

Megan will face many challenges once she undergoes a kidney transplant operation. She will need to take immunosuppressive medications for the rest of her life. Such medications are not only very costly, they also have significant side effects including high blood pressure, diabetes, osteoporosis, altered appearance (such as moon faces due to steroids, and either hair loss or excessive hair growth with calcineurin inhibitors), and memory impairment. Immunosuppressive medications also significantly increase the risk for life-threatening infection or cancer.

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

Right up until the time of her death, June Dunning remained an active, self-aware, and outgoing woman. Her health had always been good. For the last seven years of her life, she lived in Hagerstown, Maryland with her daughter and son-in-law. On August 28, 2006, June consumed a small amount of Dole baby spinach from a bag her daughter had purchased at the local grocery store seven days earlier. The bag later tested 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. She was first seen by a triage nurse, who noted that June had experienced 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 10 point scale. Further examination and blood tests revealed a number of disturbing problems. A CT scan showed diffuse thickening and swelling of the colon, with severe, acute inflammatory colitis of the ascending and transverse colon. Her blood pressure was elevated and she was beginning to show signs of renal insufficiency. Concerned about her worsening condition, her physician admitted her to the hospital and started her on intravenous fluids.

Admission to the hospital did not slow the deterioration of June’s condition. She began to lose her mental faculties. She spoke, but her words did not make sense. She often spoke of going to see her husband, who has passed away ten years prior. All the while, she continued to suffer from frequent, painful bloody diarrhea. Her renal failure worsened. Her doctors were concerned that the colitis would soon lead to systemic toxemia, and thus determined that she needed surgical removal of a portion of her colon.

June survived the surgery, but her overall health continued to deteriorate. She became anemic and was placed in the intensive care unit. She soon stopped producing urine, and progressed to a coma-like state. In the early morning hours of September 7, she suffered a grand mal seizure. On September 9, she suffered another seizure, followed by a drop in her oxygen levels. In reaction to her failing bodily functions, she was placed on mechanical ventilation. By this point in the hospitalization, her medical bills totaled nearly $50,000.

From this point forward, it was painfully clear what the unfortunate outcome of June’s condition would be. An EEG on September 11 showed slowing brain activity. Her daughter and son-in-law stayed with her for the final hours. Late in the evening on September 11, the ventilator and all medical support except for morphine were disconnected. The doctors said they expected June to pass within the hour. Instead, she persevered without life-support. For the majority of the next 36 hours, she appeared to be resting comfortably. In one frightening episode during the early hours of September 12, however, she experienced one final seizure. She gripped her daughter’s hand, eyes wide open, moaning and sighing. Thankfully, the seizure passed. June clung to life until just after dawn on September 13, passing away at 6:45 AM.