E. coli sickens 4 more victimsBy Christopher Sherman
Sentinel Staff Writer
March 30, 2005
A serious bacterial ailment spread to four more victims in Central Florida on Tuesday, bringing to at least 17 the number of people suffering from the condition that can lead to kidney failure and, in rare cases, death.
All 17 patients -- mostly children -- attended Orange County's Central Florida Fair or Plant City's Florida Strawberry Festival this month, and many had contact with petting zoos at both events.
Two were in "extremely critical" condition at Florida Hospital Orlando, and one remained in critical condition at the Arnold Palmer Hospital for Children & Women.
The new cases identified Tuesday include an adult admitted to Orlando Regional Medical Center, as well as 18-month-old twins and an older sibling who were at Florida Hospital Orlando.
The children had visited the petting zoo at the Central Florida Fair this month, and the adult had visited one of the fairs as well.
All tested positive for Escherichia coli O157:H7, a strain of bacteria that health investigators think is the common link in the outbreak. They were in good condition Tuesday.
"They are going through an extremely tough period now," Dr. Mehul Dixit, a pediatric nephrologist with Florida Hospital Orlando, said of the family.
Doctors are monitoring the children's symptoms, which include diarrhea. The biggest fear is that they will lapse into hemolytic uremic syndrome, or HUS, a sometimes-fatal kidney ailment caused by this strain of E. coli.
The most seriously ill patients in the outbreak suffer from HUS, which causes the kidneys to shut down. The three patients in critical condition are on dialysis, a machine that cleanses the blood when a person's kidneys fail.
Dixit said he thinks the number of new cases will ebb because E. coli has an incubation period of a week before symptoms show up. Both fairs ended March 13.
"We are cautiously optimistic that the worst is behind us," he said.
Even so, health officials were continuing to advise parents who took their children to either fair to watch out for the telltale symptom of the condition: mild to severe diarrhea.
It can take more than a week after the diarrhea stops for signs of HUS to show up.
The symptoms of HUS include lethargy and decreased urination. Doctors also watch for anemia and a falling platelet count -- signs that the blood is breaking down.
For the patients who have already successfully beaten back HUS, recovery will be measured in months or years.
Nearly half will suffer long-term damage to their kidneys or other organs, said Dixit, who did follow-up examinations Tuesday on three of the five patients who have been discharged. The patients he examined, Dixit said, were doing well.
Treatment was able to reverse their renal failure, Dixit said. While their kidneys recovered enough for them to be weaned off dialysis, they still have less than 100 percent kidney function and "will require months and years of monitoring."
Long-term complications for those recovering from HUS can include pancreatitis, intestinal perforations and blockages of blood vessels in the brain and belly. Some may need to return to dialysis years later.
Of the 17 cases identified so far, 15 were in Central Florida. Nine were taken to Florida Hospital Orlando and one to ORMC, and five to that center's Arnold Palmer Hospital for Children & Women.
As of Tuesday, six remained at Florida Hospital Orlando, where three were in good condition, two were "extremely critical," one remained serious and three had been discharged.
One patient remained in fair condition at ORMC. At Arnold Palmer, one was in critical condition, two were serious and two had been discharged.
Even as the cases continued to increase Tuesday, the Florida Federation of Fairs and Livestock Shows lobbied Lake County Fair organizers against plans next month to replace the petting zoo with racing pigs.
State health officials continued to stress that they had not pinpointed the sources of the bacterial outbreak, even though their suspicions centered on the two fairs.
Both fairs included petting zoos, where children could have contracted the bacteria by touching the animals.
But investigators were not ruling out other sources of E. coli, too, such as undercooked meat.
"I am concerned about the rush to judgment," said Heidi Herriott, executive director of the federation. "We will absolutely encourage our fairs to have petting zoos."
But fair manager Charles "Happy" Norris II said he wanted to be extra cautious until the source of the infection is found.
Nearly 6 million people attend fairs in Florida annually, and surveys have shown animals are a big draw, Herriott said. Because E. coli is fairly common in animals and can be avoided through hand washing with soap and water, "the fairs' responsibility here is to provide a good educational message," she said.
State agriculture officials tested hundreds of animals last week for E. coli and sent 37 positive results to the state Department of Health for additional testing to see whether any match the strain infecting humans. Results could be ready this week.
Investigators are awaiting tests to determine whether a 12-year-old Pasco County girl who died suddenly last week is connected to the current outbreak. She had visited the Florida Strawberry Festival before becoming ill.
Martin E. Comas of the Sentinel staff contributed to this report.
More on this outbreak: AgVenture Farms / Florida Fair E. coli Outbreak