E Coli: Avoiding foodborne disease | Bangkok Post: learning

About health

No one knows when or where E Coli may appear next. Precautions in eating, cooking and hygiene are never too early.

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Health: Keeping a close eye on E coli, The nasty O104: H4 strain of the bacteria hasn't yet made an appearance in Thailand, but that doesn't mean we should drop our guard by Arusa Pisuthipan

If we were to draw up a list of places where Escherichia coli, the bacteria that's better known as E coli, can thrive, Thailand would certainly be on it.

Cucumbers, tomatoes and beansprouts have all been suspected of carrying this deadly new strain of E coli, which has caused some countries to impose blanket bans or restrictions on the import of fresh vegetables from Europe.

"E coli can grow in temperatures ranging from seven to 50 degrees Celsius. But its optimum growth temperature is 37C, which is pretty much equal to the average temperature in Thailand and in many other tropical countries," said Dr On-Umar Banpamai, a specialist on infectious diseases.

The outbreak of the virulent O104: H4 strain of E coli that is thought to have originated in Germany last month has so far been responsible for more than 20 deaths, with almost 2,500 people falling ill in 14 European countries, the bulk of the cases being in Germany.

Even though no instances of E coli O104: H4 infection have yet been reported in Thailand, that doesn't rule out the possibility of the life-threatening bacteria making its way here; which is why, Dr On-Umar said, the Health Ministry has made close monitoring and surveillance by both public and private healthcare providers mandatory.

KNOWLEDGE IS PREVENTION

E coli is commonly found in the environment as well as in humans and other warm-blooded animals where it usually lives in the gastrointestinal and urinary tracts.

And, like other types of bacteria, there are several strains of E coli in existence. Most of these strains are harmless, especially those found within the human body where they serve a useful function by suppressing the growth of harmful bacteria and by synthesising significant amounts of vitamins.

Some strains of E coli can make people ill, however. We usually come in contact with these nasty strains by consuming raw or undercooked food or food that has not been processed in a hygienic fashion.

Human-to-human transmission is also possible. A person who is infected with E coli has the potential to spread the bacteria to others through shared food or liquids.

"E coli normally causes only mild symptoms such as common diarrhoea which the patient will usually recover from within three or four days," said Dr On-Umar. "Other symptoms include urinary-tract infection, pyelonephritis [an ascending urinary-tract infection that has reached the pyelum or pelvis of the kidney], lung and respiratory-tract infections. Death caused by common E coli is very rare.

IS THIS A NEW STRAIN OF E COLI

The culprit responsible for sickening so many Europeans of late is not any of the aforementioned common strains of E coli but a mutated strain called O104: H4. A new bacterial mutation can cause severe or even fatal symptoms, explained Dr On-Umar, because our bodies have never encountered it before and thus have no in-built resistance to it whatsoever.

There are a few factors that could explain the mutation of E coli. First, adaptive mutation is actually very common not only in E coli but also in other types of bacteria: They mutate their genes in order to survive. E coli that have been exposed to improper doses of antibiotics, for instance, will mutate in order to beat the drugs. And different strains of E coli can exchange genes among themselves and in so doing become a mutant species.

Laboratory tests are still being carried out on O104: H4 and the investigation into its ancestry is by no means complete, but a number of scientists have already gone public to suggest it might be a mutation containing genes from two particularly aggressive types of E coli: Entero-aggregative E coli (EAEC) and Entero-haemorrhagic E coli (EHEC).

All we know for sure so far is that this unwelcome arrival can cause a range of severe symptoms including abdominal cramps, vomiting, low fever and watery diarrhoea followed by bloody diarrhoea. It has an average incubation period of two to three days. In other words, symptoms can appear only a few days after the consumption of contaminated food. In some patients it has only taken a day for the bacteria to make its presence felt while in others the delay has been as much as 10 days.

Five to seven days after the first symptoms occur, the diarrhoea usually subsides. But this is often the beginning of something far worse: haemolytic uremic syndrome (HUS), a disorder caused by a toxin called Shiga which is released by this mutant strain of E coli.

Shiga triggers a serious inflammation of blood vessels. And when a blood vessel ruptures, there is a large build-up of platelets at the point of rupture.

The resultant clotting disrupts the flow of blood through the vessel and when red blood cells collide with the clot they break. Dr On-Umar said the clot tears red blood cells open rather like a thorn on a rose might rip into one's finger.

"Patients get progressively more anaemic and then develop acute kidney failure," the doctor explained, adding that HUS is fatal in five to 10% of cases.

A mutant strain of E coli bacteria has so far been responsible for more than 20 deaths and the hospitalisation of almost 2,500 people in Europe.

UNUSUAL BEHAVIOUR

Those who are most prone to becoming ill when exposed to common strains of E coli are children, the elderly and people with weakened immune systems, the same risk groups who are vulnerable to infectious diseases in general. But this, said the specialist, is not the case for O104: H4.

Strangely, the mutant E coli has been reported to cause sickness in adults of reproductive age more often than in children or the elderly.

CAUTION IS KEY

There is a high probability that this bacteria will mutate further given its adaptive nature so preventive measures must be taken by medical practitioners, food manufacturers, restaurateurs and the general population. Workers in the food-processing and catering industries should maintain the strictest standards of hygiene when handling food in order to ensure that it does not become contaminated and physicians will need to be alert for the symptoms of O104: H4 infection, especially in patients who have recently arrived here from European countries.

"As for the increasing number of bacteria which are resistant to antibiotics, we can see that the overuse of antibiotic medication has almost become a cliche these days," Dr On-Umar noted wryly. "Physicians should prescribe antibiotics only when they are absolutely necessary.

And patients should strictly follow their doctor's instructions and only take antibiotics as recommended. They shouldn't buy this type of medicine over the counter. And if they are prescribed antibiotics, it is crucial that they finish the entire course of tablets.

Inappropriate use of antibiotics can give rise to resistant genes in bacteria. It was recently reported that O104: H4 E coli is already displaying resistance to a number of antibiotic drugs.

5 KEYS TO SAFER FOOD

The World Health Organization (WHO) has published the ''Five Keys to Safer Food'' manual to raise public awareness on how to prevent foodborne illnesses, including the recent outbreak of E coli. The manual is available in 63 languages.

KEEP CLEAN

1. Wash your hands before handling food and often during food preparation.

2. Wash your hands after going to the toilet.

2. Wash and sanitise all surfaces and equipment used for food preparation.

3. Protect kitchen areas and food from insects, pests and other animals.

SEPARATE RAW AND COOKED

1. Separate raw meat, poultry and seafood from other foods.

2. Use separate equipment and utensils such as knives and cutting boards for handling raw foods.

3. Store food in containers to avoid contact between raw and prepared foods.

COOK THOROUGHLY

1. Cook food thoroughly, especially meat, poultry, eggs and seafood.

2. Bring foods like soups and stews to boiling to make sure that they have reached 70C. For meat and poultry, make sure that juices are clear, not pink. Ideally, use a thermometer.

3. Reheat cooked food thoroughly.

KEEP FOOD AT SAFE TEMPERATURES

1. Do not leave cooked food at room temperature for more than two hours.

2. Refrigerate promptly all cooked and perishable food (preferably below 5C). 

3. Keep cooked food piping hot (more than 60C) prior to serving.

4. Do not store food too long even in the refrigerator.

5. Do not thaw frozen food at room temperature.

USE SAFE WATER AND RAW MATERIALS

1. Use safe water or treat it to make it safe

2. Select fresh and wholesome foods.

3. Choose foods processed for safety, such as pasteurised milk.

4. Wash fruits and vegetables, especially if eaten raw.

5. Do not use food beyond its expiry date.

Visit www.who.int

(Source: Bangkok Post, Health: Keeping a close eye on E coli, The nasty O104: H4 strain of the bacteria hasn't yet made an appearance in Thailand, but that doesn't mean we should drop our guard, 14/06/2011,
Arusa Pisuthipan, link)


Health Vocabulary

bacteria - a very small single cell living thing with no nucleus (prokaryote), reproduces by cell division (meitosis), along with viruses the cause of many diseases, typically a few micrometres in length, have a wide range of shapes, ranging from spheres to rods and spirals, the oldest and most numerous living thing on earth (See Wikipedia)

E coli - a species of rod-shaped bacteria with many varieties commonly found in the lower intestine of warm-blooded organisms such as humans, most E. coli strains are harmless, but some types can cause serious food poisoning in humans, one the the harmless kinds of bacteria typically found in the human gut (See Wikipedia)
Escherichia coli - long form of "E Coli"

E coli O104: H4 - the variety of E Coli that caused the recent disease outbreak in Europe: "A currently ongoing Escherichia coli O104:H4 bacterial outbreak began in Germany in May 2011. Certain strains of E. coli are a major cause of foodborne illness. The outbreak started after several people in Germany were infected with bacteria leading to hemolytic-uremic syndrome (HUS), a medical emergency that requires urgent treatment. The agriculture minister of Lower Saxony has identified an organic farm in Bienenbüttel, Lower Saxony, Germany, which produces a variety of sprouted foods, as the likely source of the E. coli outbreak. The farm has since been shut down. Although the laboratories in Lower Saxony did not detect the bacterium in produce from the farm, it was later announced that a laboratory in North Rhine-Westphalia had found the deadly strain in a discarded package of sprouts from the suspected farm. A control investigation confirmed the farm as the source of the outbreak. While the threat of EHEC still exists, the number of new cases has been plunging. In addition to Germany, where 3,228 cases and 35 deaths had been reported as of 13 June, a handful of cases have been reported in several countries including Switzerland, Poland, the Netherlands, Sweden, Denmark, the UK, Canada and the USA. Essentially all affected people had been in Germany shortly before becoming ill" (See Wikipedia)

haemolytic uremic syndrome (HUS) - "a disease with hemolytic anemia, acute renal failure (uremia) and a low platelet count (thrombocytopenia). It predominantly but not exclusively affects children. Most cases are preceded by an episode of diarrhea caused by E. coli O157:H7, which is acquired as a foodborne illness. It is a medical emergency and carries a 5–10% mortality; of the remainder, the majority recover without major consequences but a small proportion develop chronic kidney disease" (See Wikipedia)
uremia (noun) -
uremic (adjective) 
outbreak - the sudden start of a disease, a war, violence, etc. การระบาดของโรค

virulence (noun) - the ability of a disease to harm and kill people (See Wikipedia)
virulent (adjective) - how harmful a disease for humans

blood vessels - the tubes that carry the chemicals necessary for life around the body (oxygen, carbohydrates, lipids (fats), proteins, nucleic acids, vitamins and minerals, electrolytes, hormones, white and red blood cells), arteries carry blood away from the heart and veins carry blood back to the heart (See Wikipedia)
red blood cells - erythrocyte, the cells that transport oxygen from the lungs to the tissues of the body where it used to produce energy (ATP) and transports carbon dioxide (the waste product produced) (See Wikipedia)
clot - blood clotting or coagulation, part of the process of  "hemostasis" the complex process that the body follows to stop blood flow when the there is a break in a blood vessel, consisting of: 1. damaged blood vessels constricting (vasoconstriction), 2. platelets adhere to damaged endothelium to form platelet plug, 3. then finally the blood coagulates to form a blood clot when fibrinogen turns into fibrin (See Wikipedia)

anaemia (noun) - the most common disorder of the blood, a decrease in number of red blood cells (RBCs) or less than the normal quantity of hemoglobin in the blood, it can include decreased oxygen-binding ability of each hemoglobin inside RBCs which carries oxygen from the lungs to the tissues, anemia leads to hypoxia (lack of oxygen) in organs (See Wikipedia)
anaemic (adjective) 
get progressively more anaemic - have decreasing blood cells over time (increasing anaemia)

immune system - the system in the human body that protects the body against diseases (See Wikipedia)
weakened immune system - a condition when the body is less able to protect itself from diseases
inflammation - a red, painful and often swollen area in or on a part of your body การอักเสบ, การติดเชื้อ

monitor - watch an activity closely and checking for problems จับตาดู
keep an eye on - watch closely or monitor an activity (to see if problems arise)
surveillance - the process of carefully watching a person or place การเฝ้าตรวจตราอย่างเข้มงวด
drop our guard - to not defend yourself, stop taking precautions (against dangers and risks)
keep up our guard - continue to take precautions and protect ourselves

tropical - relating to the hottest area of the Earth, between the Tropic of Cancer and the Tropic of Capricorn ในเขตร้อน
environment - the surroundings in which people live, work and exist (example: noice in the workplace environment can lower productivity)
warm-blooded animals - a kind of animal (such as a bird or a mammal) with a fairly high body temperature (hot body) that does not change a lot and is not affected much by the temperature outside the body (humans are warm-blooded) (See Wikipedia)

gastrointestinal tract - the "GI tract" or "gut tube", the path that the food you eat follows from mouth to stomach to intestine to anus and out of body (See Wikipedia)
abdominal - involving the front part of your body below your waist ช่องท้อง (ช่องพระนาภี)
cramp - muscle cramp, sudden strong pain in a muscle (when the muscle contracts) (See Wikipedia)
abdominal cramps - pains in the stomach area (abdomen) (See Wikipedia)

vomit - when food or drink comes up out of your stomach and through your mouth (See Wikipedia)
fever - an abnormally high body temperature ไข้ (See Wikipedia)
common - happens often, happens to many people

diarrhoea - when a lot of watery waste (stool, faeces) comes out of the body when you go to the bathroom because you are sick (See Wikipedia)
common diarrhoea - the kind of mild diarrhoea that people often get from time to time
subside - goes down, becomes less
diarrhoea subsides - diarrhoea becomes less or stops

kidney - one of the two organs in your body that clean your blood and remove waste ไต (See Wikipedia)
urine - the liquid that passes from your body when you go to the bathroom (created when the kidney filters the blood and creates waste products and excess water) (See Wikipedia)
urinary-tract - the tubes that carry urine from the kidneys to outside the body for disposal
urinary-tract infection -
pyelonephritis - a urinary tract infection that has worked its way up the urinary tract all the way to the pelvis of the kidney (See Wikipedia)
-itis - word suffix meaning: inflamation
pelvis of the kidney - a funnel shaped part inside the kidney that collects together urine before it is sent down the ureter to the bladder and then through the urethra and out of the body (See Wikipedia)
pyelum - another word for "pelvis of the kidney"
acute - very sudden and serious เฉียบพลันและรุนแรง

kidney failure  - when kidneys fail to remove waste products from the blood and keep the blood in the correct chemical condition (homeostasis), abnormal levels of potassium, calcium, phosphate and abnormal acid-base balance make regular hemodialysis with a dialysis machine kidney replacement to remove wastge products from the blood necessary until a kidney transplant can be found (See Wikipedia)

respiratory - relating to the process of breathing air in and out of the lungs (where oxygen is absorbed into the blood and carbon dioxide waste is released to the blod) ระบบทางเดินหายใจ, เกี่ยวกับการหายใจ
respiratory tract - the part of the body that brings air through the mouth down into the lungs where the blood takes up oxygen and releases carbon oxide waste products (See Wikipedia)
lung - one of the two organs in your chest that fill with air when you breathe ปอด

hygienic - clean and not likely to cause illness or disease ถูกสุขอนามัย
sanitise - clean completely (to remove germs and bacteria)
maintain - to keep รักษา
standards - an acceptable level of quality or achievement มาตรฐาน
hygiene - the degree to which people keep themselves or their environment clean, especially to prevent disease สุขลักษณะ
maintain the strictest standards of hygiene - continue to be perfectly clean all the time
perishable - food that can go bad (rot) if not refrigerated, so it cannot be eaten

contaminated - made dirty, polluted or poisonous by the addition of a chemical, waste or infection
raw food - food that has not been cooked
processed - treated in some way, e.g., pre-cooked, treated with chemicals, cut, etc.
food-processing - the processes inside factories of turning meat and plant crops into food products that can be sold in stores
catering - the business of providing food service at a remote site (See Wikipedia) การจัดเลี้ยง
expiry date - the date for throwing away food (after this date there is a risk of the food going bad or rotting and people getting sick if they eat the food)
pasteurised milk - milk that has been heated and processed to make it clean without germs (See Wikipedia)
piping hot food - very hot food
frozen - when water turns to ice, when something stops moving
thaw frozen food - unfreezing food (taking food out of the freezer and letting it sit until all the ice has melted)

patient - someone who is receiving medical treatment คนป่วย, คนไข้
medical practitioners - doctors, physicians
healthcare - the treatment and prevention of diseases and other medical problems

infect - when a disease is transmitted or passes from one person to another person ซึ่งติดเชื้อ (See Wikipedia)
infectious diseases - a disease resulting from an infection, the entering into the body and growth of disease-causing "pathogens" such as  viruses, bacteria, fungi, protozoa, parasites, and protein prions, transmission of pathogen from person to person can occur in various ways including physical contact, contaminated food, body fluids, objects, airborne inhalation, or through vector organisms, also called communicable diseases, contagious diseases or transmissible diseases (See Wikipedia)
in general - considering all of them, holding true for all of them
infectious diseases in general
pests - small living things that cause disease สัตว์ที่ทำลาย, สัตว์ที่รบกวน

disorder - a situation in which people behave in a noisy or violent way in public, often as a protest against something ความวุ่นวาย
exposed - exposed to a disease, not protected from something, openly affected by itได้รับ ได้สัมผัส (แดด หรือสารพิษ เป็นต้น)
transmission - transmission of disease, the spread of a disease from one person or animal to another การแพร่เชื้อ
spread - spread disease, to (cause to) cover, reach or have an effect on a wider or increasing area or number of people กระจายไปทั่ว

risk - a danger, the possibility that some bad event might happen ความเสี่ยง
vulnerable - easily damaged or harmed ซึ่งถูกทำลายได้ง่าย ที่เปราะบาง ที่ล่อแหลมต่อการเกิดภัยภิบัติ
recover - recover from disease, to become healthy and fit again after an illness or injury การฟื้นไข้
survive - survive a serious disease, still alive, not dead; to continue to live and exist after experiencing a dangerous or difficult situation รอดพ้นอยู่รอด สืบต่อไปได้  มีชีวิตรอด
severe - very serious and worrying ที่รุนแรง ที่น่าเป็นห่วง
fatal - causing someone to die ถึงตาย

symptom - symptom of a disease, something that is wrong with your body that shows that you have a disease
mild symptoms - weak signs of a disease (when something bad happens just a little to part of your body, not very dangerous)
severe symptoms - strong signs of a disease (when something bad happens a lot in your body, very dangerous)

strictly - completely อย่างเข้มงวด
strictly follow instructions - do exactly what they are told to do (without exception or relaxing the rules)
over-the-counter - medicine that you can buy without a doctor's permission
entire course of tablets - taking all the tablets that the doctor ordered you to take over a period of time
crucial - very important (because it effects the result of something) สำคัญยิ่ง

medication - a medicine, or a set of medicines or drugs used to improve a particular condition or illness
prescribe medication - when a doctor writes out the name of medicine for you to take, on an official piece of paper, when presented a pharmacy supplies you with the medicine สั่งยา
antibiotics - a drug that kills or inhibits the growth of bacteria (See Wikipedia)
resistant - not harmed or affected by something
resistant to antibiotics -
resistant genes in bacteria -
no in-built resistance whatsoever -

resistance - การต่อต้าน, การขัดขืน

mutate - to become physically different from other viruses, plants or animals as a result of a genetic change กลายพันธุ์, เปลี่ยนแปลง, เปลี่ยนรูป
mutant (adjective)
mutation (noun)
species - a set of animals or plants in which the members have similar characteristics to each other and can breed with each other พันธ์,จำพวก
mutant species - species that become physically different because of genetic changes
mutation - a change in the genes of a plant or animal that causes it to become different from others of its type การกลายพันธุ์
adaptive mutation - genetic changes
mutated strain -

factors - one of the things that effects a situation or event ปัจจัย

function - the useful thing that something does (example: the function of soap is to make our bodies clean)
suppress growth of - prevent the growth of
synthesise vitamins - make vitamins
vitamins - substances that are needed in small quantities to remain healthy, that can be obtained in food or from pills (examples: fat soluble vitamins A, ED, K) (See Wikipedia)
contact - meeting something or someone การพบปะ ติดต่อ  

toxin - a poison that causes damage to the body 
released - when something is allowed to leave a limited space and move into a larger area (example: the hormone was released into the blood stream)
shiga - shiga toxin, an exotoxin secreted by bacteria including E Coli (See Wikipedia)

rupture - when something tears and bursts open
disrupt - stop an activity or process from happening in the normal way

prone to - have a tendency to, this kind of thing usually happens to them (example: drivers prone to accidents should not be on the road)
elderly - older people, over 65 สูงวัย, อาวุโส, อายุมาก
reproductive age - all the years a woman is able to have a child (conceive a child) from her first period as a child until the onset of menopause later in life

awareness - the state of knowing about something การรับรู้, การทราบ
raise public awareness - make everyone know more about an important subject

General Vocabulary

bulk - large amounts เป็นจำนวนมาก เป็นกุรุศ
the bulk of the cases - most of the cases (in which people caught the disease)
instances of Y - cases or situations in which Y happened or was true 
rule out the possibility - find proof or evidence that something is not possible (that was thought to be possible)
mandatory - required (not optional) เป็นข้อบังคับ

draw up a list - create a list of things (for the first time)
nasty - bad or very unpleasant อันตราย, น่าวิตก
thrive - do well and be successful and strong
suspect - thought to be something bad (example: the police suspect that she is the murderer)  เป็นที่สงสัย

impose - to introduce something such as a new law or new system and require people to accept it การกำหนด, นำกฎหมายมาบังคับใช้
blanket -  to cover something completely
ban - make a law ordering something not to be done or not to be sold (example: a ban on all gatherings of more than five people)
impose blanket bans - a ban on all things (of a certain type)

import - to buy or bring in products from another country นำเข้า
optimum - the best possible
significant - important สำคัญ
potential - the possibility that something might happen ความเป็นไปได้
rare - not happening very often หาได้ยาก, เกิดขึ้นได้ยาก, ซึ่งหายาก
culprit - the person or thing responsible for something bad happening
of late - recently
aforementioned - mentioned or talked about before, earlier
encountered - experienced, especially something unpleasant เผชิญหน้า
beat - win ชนะ

investigation - the process of trying to find out all the details or facts about something in order to discover who or what caused it or how it happened การตรวจสอบหาข้อเท็จจริง
ancestry - the whole series of children that gave birth to further children (successive generations) and finally gave birth to you  
by no means - not (with emphasis)   
by no means complete - not complete (with emphasis)
go public- provide the public with information (that is normally private)
aggressive - forceful, determined to win or succeed and using forceful action to achieve victory or success, ซึ่งมีความมั่นใจสูง, ก้าวร้าว (See glossary)

unwelcome - something you don't want to have (but you didn't get)
arrival - when someone reaches where they are going (arrives) ขาเข้า การเข้ามา
range - a number of different things that are of the same general type ขอบข่าย, ประเภท
consumption - using, eating or drinking something การบริโภค

presence - when someone or something is in a place การอยู่ในสถานที่หนึ่ง (ของบุคคล)
delay - happening at a later time than originally planned or expected การเลื่อน

collide - (especially of moving objects) to hit something violently ชน,กระแทก
thorn - the sharp points on plants and trees
rip - to tear something quickly and with a lot of force

nature - the basic quality of feature of something ธรรมชาติ, ลักษณะที่แท้จริงของสิ่งต่างๆ
measures - actions taken to deal with a problem มาตราการ
population - all the people who live in a country (city, area, region)

ensure - to make certain that something happens or is done รับรอง ให้ความมั่นใจ ให้การยืนยัน รับรอง
alert - prepared to deal with something dangerous ตื่นตัว ระวัง see everything that is going on around and are able to act quickly if something happens

cliche - an over-used idea or phrase that has lost its meaning
absolutely - completely
promptly - quickly, without delay ทันที
manual - a textbook คู่มือ
poultry - birds that are raised for their meat and eggs such as chickens and ducks (See Wikipedia) เนื้อสัตว์ปีก
container - something such as a box or bottle that holds or "contains" other things