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A jack-in-the-box is not always just a harmless toy.

Most of us in the eastern half of the United States probably never heard of the Jack in the Box restaurants until earlier this year. For that matter, fewer had probably heard of Escherichia coli 0157:H7 (or EC0157, as it is sometimes abbreviated). Yet it was first learned 11 years ago that this obscure strain of a ubiquitous intestinal bacterium was responsible for a dysentery-like disease that afflicted 26 people who had eaten hamburgers at a particular McDonald's restaurant in Orgon.

Since then, some 10 outbreaks have occurred in which EC0157 was the cause of severe intestinal illness that occasionally led to kidney failure and death in persons who had eaten undercooked hamburgers, roast beef, or unpasteurized milk.

What is this creature? E. coli bacteria are nothing new--they have been known to inhabit the intestinal tracts of man and beast throughout the world. We all enjoy a symbiotic relationship with billions of them in our gut--more than one billion of them live in a pea-sized chunk of feces, in fact. They are part of the normal "intestinal flora"--microorganisms that help protect the intestine from foreign invaders and assist in digestion.

Sometimes, however, less friendly strains of E. coli make their way into our gut in the food or drink we ingest, causing vomiting and diarrhea. Most cases of traveler's diarrhea are caused by such strains of this pathogenic E. coli.

EC0157 is found in South America, Europe, and Asia, but it seems to be at its nastiest in the northern United States, where it occurs in beef, milk, and sometimes in water. Because it has frequently been associated with epidemics involving inadequately cooked hamburger, cows are thought to be its major source.

In some cows, it probably exists as a harmless intestinal bacterium. When they are slaughtered for beef, however, their feces may contaminate meat that is then made into hamburger. Hamburger has a large surface area due to the many small pieces of meat of which it is made, allowing it to hold a large number of bacteria. If cooked for too short a time or at too low a temperature, all the bacteria may not be destroyed.

All meat sold in shops is contaminated with bacteria, and cooking is the only way to sterilize it. Fortunately, EC0157 is rare, having been found in only 25 of 6,894 cows from 1,100 different herds recently surveyed by the U.S. Department of Agriculture. In another survey of beef products, only two of 1,668 samples were found to contain the bacterium--one case involved hamburger, the other veal breast.

The worst epidemic of EC0157 infection, however, had nothing to do with beef. It involved 243 persons in a small town in Missouri who became ill in 1989 when water mains burst during a cold spell, allowing contamination of the public water supply. Four of them died, suggesting that EC0157 was a particularly virulent strain of E. coli--a view supported by the recent deaths that have occurred in the West Coast Jack in the Box cases.

A rare, occasionally fatal condition called "hemolytic-uremic syndrome" was first described in 1955. Characterized by rupture of red blood cells and formation of clots in the kidneys, it is more common among children than adults and is often preceded by diarrhea. EC0157 is now known to be its major cause.

In the current epidemic, the disease has been transmitted by fecal contamination from children who ate contaminated hamburgers to others who did not. Not only is it important, therefore, to be sure that hamburgers are cooked to the proper internal temperature, but that proper hygiene is observed in homes, child care centers, etc., when intestinal disease strikes.
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Title Annotation:Escherichia coli outbreak at Jack in the Box restaurants
Publication:Medical Update
Date:Apr 1, 1993
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