Water, Dialysis Only Treatments for Deadliest European E. Coli Outbreak

Doctors treating the world’s deadliest E. coli outbreak have little beyond water and dialysis machines to help them clear the infection from patients, according to infectious disease specialists.

The new strain of E. coli, which has killed at least 18 people in Europe, produces a poisonous bi-product called shiga toxin that damages the kidneys of some patients and requires the use of dialysis to scrub the blood clean. Some patients need transfusions after the bacteria dissolve their red blood cells, said Robert Tauxe, deputy director of food-borne illness at the U.S. Centers for Disease Control and Prevention.

Germany, alone, has reported 520 cases of the kidney ailment. Overall, 1,823 cases of E. coli infection have been confirmed, according to the World Health Organization in Geneva. In less severe cases, doctors use fluids to maintain hydration and stream the diarrhea-causing toxins through the body. Antibiotics don’t help, and can worsen the illness.

“It’s clearly a more severe disease than is normally seen because of this kidney failure association,” said Stephen Calderwood, chief of the infectious disease division at Massachusetts General Hospital in Boston. “There is some data if you keep the patient hydrated it may lessen the kidney disease. What is recommended is supportive treatment -- no antibiotics but maintain hydration.”

Antibiotics can’t be used because they increase the release of toxins into the bloodstream, compounding kidney damage, Calderwood said. The one class of antibiotics that doesn’t do this, known as carbapenems, is unlikely to help with E. coli, though they may be useful for patients who are simultaneously fighting additional infections, he said.

Similar Symptoms

The new E. coli strain, previously identified in isolated cases but never linked to an outbreak, begins with symptoms similar to more common types of the bacteria. Diarrhea starts anywhere from two to seven days after eating tainted foods, though most cases occur in the three to four-day range.

Diarrhea often contains blood and can be accompanied by fever, abdominal cramps and vomiting, Claudia Stein, director of health information, evidence and research at the WHO, said in a telephone interview.

“It makes your guts bleed; the bloody diarrhea is really a hallmark,” Stein said. “Somebody with bloody diarrhea should not wait. Go straight to their medical practitioner and report this, and then they have to be hospitalized.”

At the hospital, patients will be given fluids to begin the cleansing process, intravenously if necessary, she said.

Usually Harmless

All humans and animals carry E. coli in their intestines, and those strains are usually harmless, according to the Stockholm-based European Centre for Disease Prevention and Control. Some variants cling to the walls of the intestines and produce toxins that cause illnesses ranging from diarrhea and nausea to the potentially fatal kidney complication, known as hemolytic uremic syndrome, or HUS.

In addition to the 520 German cases of the kidney illness linked to the spread of E-coli, another 30 have been reported in Sweden, Spain, Denmark, the U.K. and the Netherlands, said the European Centre for Disease Prevention and Control. Seventeen people in Germany and one in Sweden have died, the WHO and European disease agency have reported....