E. Coli poisoning: Treatment, symptoms, advice and help

Definition
There is no definition or even illness called E. Coli poisoning, but the phrase is now used frequently in the mass media. It refers to a particular complication of E. Coli food poisoning by E coli 0157, which then causes further problems in the gut, blood and kidneys. These are the complications that can occasionally, sadly, cause deaths following food poisoning.

E Coli, or to give its full name Eschericia Coli, is one of the main bugs that live in our gut and indeed has an important function in the gut. As long as it stays in the gut it is harmless. However, there are many different strains of E coli, several of which cause diarrhoea and vomiting, food poisoning. ‘Uncomplicated’ food poisoning is the upset stomach that mars many a foreign holiday, but clears up without treatment in a day or so. Several bugs including E coli cause ‘Gippy tummies’ and no specific treatment is needed other than to make sure that your child is well hydrated and eventually the bug is eradicated from the gut.

Symptoms
There are several types of E coli that cause diarrhoea and vomiting by slightly different mechanisms. This particular type, Eschericia coil 0157, causes diarrhoea and vomiting but also produces a poison called verotoxin. It is this toxin that causes the complications. Initially the child has diarrhoea but the toxin causes damage to the gut lining so the child begins to pass bloody diarrhoea. The toxin can easily pass from the gut into the body where it attacks both the blood and kidneys producing a very sick child who is pale, sweating and may not be fully conscious.

Complications
The toxin destroys the red blood cells (haemolytic) and may cause a serious anaemia. The red cells carry oxygen to the cells of the body. If there are fewer red cells in the blood stream then, in order to get the same amount of oxygen to the cells the heart must pump the blood more quickly. This can put a strain on the heart, which may be beating very quickly. Despite the efforts of the heart the child may also have a low blood pressure, which actually reduces the ability of the blood to get oxygen to the body’s cells.

The toxin also damages the kidneys, possibly by the fragments of the damaged red cells clogging up the very small arteries in the kidneys causing kidney failure (uraemic), hence the medical term haemolytic-uraemic syndrome. Those people most at risk of developing these complications are the very young and the very old.

Treatment
There is no specific treatment for this syndrome. The verotoxin has been analysed, but there is no clinically effective anti-toxin, which can be used like an antibiotic to reverse the complications. The mainstay of treatment is to control the kidney failure. Fortunately in young children this type of sudden kidney failure usually improves by itself with time so the doctors have to make sure that they control the complications of kidney failure. The anaemia may be severe and blood transfusions might be used. However, transfusions must be used with care as the verotoxin still in the body can destroy the transfused red cells worsening the problem. In very severe cases plasmapheresis can be used. This is a sort of washing of the red cells when the child’s plasma, liquid part of the blood, is exchanged for fresh plasma.

Outcome
The vast majority of children with E coli poisoning make a full recovery although they may require intensive medical help. A few have some degree of continuing kidney damage. Tragically, a very very few cannot be saved. In the recent outbreaks it has been the elderly who have been most at risk of dying.

Prevention
The most effective method of preventing infection with E coli is by careful hand washing with normal soap and water before handling or eating food. This will stop the spread of any E coli from the hands to food. However, the most recent worst outbrea