What
to Do If You Think Your Child Has An E. coli Infection
Children, particularly young children, are
most vulnerable to E. coli O157:H7 infections and are in the
most danger of possible complications. Catching and managing
this disease early is critical to your child's long term health.
While at present no antibiotics are known to stop an E. coli
O157:H7 infection, dehydration can hasten complications. Drug
trials in which it might be possible to participate require
positive diagnosis within the first few days of the illness.
If you or your doctor suspect your child has
a pathogenic E. coli diarrheal illness, it is imperative that
you NOT let your child be treated with antibiotics, narcotics
or antimotility drugs (i.e. Kaopectate, Pepto-Bismol, Imodium).
These drugs are specifically contraindicated in many cases
of foodborne illness. Antibiotics can wipe out good bacteria
that are needed to keep pathogenic bacteria in check, thus
exacerbating the disease. Narcotics, typically prescribed
to ease the intense pain of foodborne cramping, slow down
the action of the intestines and colon thereby potentially
exacerbating the disease. Antimotility drugs, e.g. "anti-diarrheal"
medications that can cause the body to stop flushing out the
intestines and colon and essentially "plug you up,"
can make foodborne illnesses more severe as well. Antimotility
drugs should never be prescribed to children.
Symptoms
Some of the symptoms of an E. coli O157:H7 infection are difficult
to distinguish from those of other foodborne illnesses, such
as Shigella, Campylobacter, Salmonella and a number of viruses.
A certain type of Shigella, S. dysenteriae, can cause the
same complications as an E. coli infection, but will initially
be treated differently. Also, over the course of the illness,
some symptoms may disappear or be obscured. In Shigella, for
example, the child may have a seizure or an initial high fever,
but by the time the child visits the doctor, these symptoms
may no longer be present. Therefore, diagnosing E. coli O157:H7
symptoms can be difficult and may require that you educate
your doctors.
Should your child have bloody stools or severe
abdominal cramps with non-bloody diarrhea, you should seek
medical treatment immediately. Do not accept a rote diagnosis
of "stomach virus" without a complete evaluation.
on the part of medical professionals. Do not be put off because
the stool does not appear bloody. Your child's life could
be at stake. The abdominal cramps caused by a pathogenicE.
coli infection distinguish it from other gastrointestinal
illnesses. They can be so painful as to wake the child in
the middle of the night. A young, but toilet trained child
may have difficulty making it to the bathroom in time because
of how much fluid is being lost. They will be going to the
bathroom more frequently than every four hours. Often, you
may have to put a toilet trained child back into diapers.
The primary symptoms caused by a pathogenic
E. coli infection are:
1. Diarrhea, which may not
be bloody
2. Severe abdominal cramps
3. A low grade or NO fever
4. Vomiting (occasionally)
If your child shows signs of this combination
of symptoms, you should contact your pediatrician immediately
and discuss the possibility of a pathogenic infection. Without
obvious blood in a child's stool or severe abdominal cramps,
most parents would take their child to the pediatrician's
after two days and that is considered correct timing unless
the symptoms appear to be unusually extreme (intense pain,
diarrhea or vomiting so frequent as to result in rapid dehydration).
Be on the lookout for symptoms of dehydration, such as dry
eyes, dry mouth, decreasing urination, and lethargy. which
would require intravenous fluids, and if you see such symptoms,
take your child to your pediatrician's office.
However, if your child has shown these four
symptoms and SUBSEQUENTLY shows signs of
5. Anemia, or
6. All over body skin rash,
you should insist on seeing your pediatrician
immediately, or if he or she is not available, go immediately
to an emergency room. Anemia is characterized by the color
draining out of the child's face. Lips and gums that are normally
deep rose to red in color will become increasingly gray, and
the child will become first irritable and then listless. An
all-over body rash would appear as little red or purplish
dots that don't blanche (clear) when you press on them.
Insist that medical professionals run the
stool samples and blood tests recommended below.
Demand These Tests On First Visit to Doctor
To be aggressive, as parents, S.T.O.P. recommends that at
the first visit to a doctor, regardless of how bloody the
stool is or not, you should insist that the labs run stool
tests for:
- Shigella
-
Campylobacter
-
Salmonella,
-
shiga toxin or verotoxin testing, which would indicate a
pathogenic E. coli infection, AND
- a
MacConkey-sorbitol test for E. coli O157:H7.
Note
that as of December, 1998, many clinical laboratories do NOT
routinely do cultures for pathogenic E. coli, despite the
availability of inexpensive tests. By not screening all diarrheal
stools for E. coli, money is saved. In the August 10, 2025
New England Journal of Medicine, doctors recommended "Laboratories
not already culturing all diarrheal stool specimens for E.
coli O157:H7 should begin doing so. If only specimens of bloody
stool are cultured for the organism, some infections will
be missed... We recommend that all clinical laboratories screen
for E. coli O157:H7, particularly if the stool is bloody."
Be sure that your doctor orders each individual test for these
organisms as opposed to requesting a panel of tests; labs
have been known to skip a test in a panel because in their
opinion the diarrhea did not appear "bloody enough."
Many
labs and doctors do not know that newer tests offered by Meridian
Diagnostics (513-271-3700) test for the chemical toxin produced
by the bacteria far more quickly than MacConkey-sorbitol test.
They do not require that the stool be cultured first. Because
some other bacteria produce similar life threatening toxins,
these tests will identify the poison in as little as three
hours without the need for a culture, allowing doctors to
move quickly to treatment. This is critical in the case where
a child is declining rapidly.
The
older stool culture test for E. coli O157:H7 is known as MacConkey-sorbitol.
It is the most well known and cheapest test, but it also can
take as long as 48 hours to return a result. In this stool
culture, the E. coli O157:H7 bacteria are grown and identified.
Testing
for the toxin alone will not enable you to directly connect
your case with that of a larger outbreak. In order to create
a direct link between your case and that of an identified
outbreak, epidemiological authorities will want to have the
actual bacteria to examine its DNA and compare it with that
of other cases. S.T.O.P. therefore recommends that the labs
perform both the MacConkey-sorbitol and verotoxin tests. If
your insurance will only allow for one test, we recommend
you use a verotoxin test. Ask that the isolates, the organisms
found, be stored in the event you or your health department
ultimately wants to perform DNA fingerprinting on them.
Should
your child's stool sample come back negative for all four
diseases and the symptoms persist, you should insist on seeing
your pediatrician again. E. coli O157:H7 is not always cultured
out of a stool, although it may be there. If your child is
still showing the symptoms, you should insist on two blood
test sets:
1)
a "CBC", and
2)
those that check electrolytes and kidney function. Because
a young child could have had frequent diarrhea for four days
at this point, he/she will be nearing a point where he/she
might need intravenous fluids. If only the MacConkey-sorbitol
stool test was performed, you should have the verotoxin test
done.
If,
as determined by the blood test results, your child is developing
Hemolytic Uremic Syndrome (HUS) complications, INSIST on a
transfer to the best children's hospital in your vicinity,
specifically one with a pediatric nephrologist, a children's
kidney expert. Very few hospitals are equipped to deal with
the full range of supportive treatment required for HUS complications.
Also, very few pediatricians have the "hands-on"
experience to understand appropriate treatments. Therefore,
being at an inexperienced medical center could put your child
in the very real danger of being undertreated or overtreated.
Please do not be put off by a doctor or hospital that suggests
they can handle it without a pediatric nephrologist.
Note
that as of February, 1998, there is no cure for this illness,
and no child is "immune." Treatment at present is
"supportive"; in other words, doctors overseeing
your child's case will support the body's systems as the toxins
pass through and try to tip the odds back in favor of your
child's healing. A very high percentage of these children
seen at major medical centers recover to reasonable initial
health with supportive treatment, though life threatening
complications can ensue years later.
Should
the stool tests fail to identify the culprit, there is a blood
test available at "reference laboratories," such
as the Centers for Disease Control in Atlanta, that can be
run to determine whether your child has ever been exposed
to E. coli O157:H7. Few physicians know of its availability
and due to the two weeks it takes to get results, the test
presently will have little impact on your child's treatment
but it can again assist in creating an affiliation between
your case and an identified outbreak. Unlike a stool culture
which attempts to grow the actual bacterial organism, this
test checks to see whether your child's body has tried to
fight off an E. coli O157:H7 infection. Thus, while the organism
may already have left your child's body like a thief in the
night, its footprints may still be found. This is known as
the test for Antibodies to O157 Lipopolysaccharide. A stool
culture is superior to this blood test in cost, time-to-results
(2 to 4 days) and determining the genetic fingerprint of the
infectious agent. However, if the organism has already been
shed, this can help identify the agent.
If
your child has been affected by E. coli O157:H7, he or she
can develop an infection again if re-exposed. E. coli O157:H7
can be contracted from food, water or via person-to-person
contact with an infected person. Statistics from Canada indicate
that while the incidence rate of HUS in the population is
1.4 per 100,000 children, recurrence is considered to be possible
at a rate of 1.4 per 1000 children with a past history of
HUS.(1)
(1)
Dr. Gerald Arbus, University of Toronto, Hospital for Sick
Children, Toronto, Canada; at "HUS: The Past, Present
and Future," 8/1/99.
--Reviewed
by Dr. Steven Harris, Dept. of Pediatrics, Valley Medical
Center, San Jose, CA
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