Bulletin

BULLETIN N°5 - November 2001

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E. coli infection sickens children, one critically
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Health Department officials seek source of potentially deadly bacteria By Tom Held and Kawanza L. Griffin of the Journal Sentinel staff
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Last Updated: July 26, 2000		Brianna Kriefall, 3, was in critical condition at Children's Hospital of Wisconsin.
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City health officials are searching for the source of E. coli bacteria that appear to have sickened at least six children, including one now in critical condition at Children's Hospital of Wisconsin.
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Reports from Children's Hospital prompted the investigation by the Milwaukee Health Department, which also noticed an unusual number of specimens entering its lab to be tested for the potentially deadly bacterium, Health Commissioner Seth Foldy said Tuesday.
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The number of children apparently sickened by the bacterium, tentatively identified as E. coli O157:H7, is between six and 12, Foldy said. Two were treated at Children's Hospital and released, while four remain hospitalized, a hospital spokeswoman said.
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Doug and Connie Kriefall of South Milwaukee, who have been passing long hours with their gravely ill three-year-old daughter Brianna in the intensive care unit of Children's Hospital, said a health care worker there suggested to them that a south side restaurant appeared to be the source of the bacterium. The family ate at the restaurant early last week.
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The area manager for the restaurant chain, reached at the restaurant Tuesday evening, said he was unaware of any outbreak and had not received any complaints. The Journal Sentinel is not naming the restaurant because it has not been verified to be the source of the outbreak.
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Foldy declined to confirm or deny that the restaurant was the source, but said: "We will be comparing, assembling information about what people ate, where they ate, what they ate and when they ate it for the past several days preceding the onset of symptoms."
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Foldy also hesitated to conclude that all of the cases originated at the same source, but he did say they appear to be E. coli-related.
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"It's a possible cluster," he said. "That means we don't have anything we would point to as proof positive that they are connected."
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The Kriefalls' daughter, just two months past her third birthday, became sick with flu-like symptoms Wednesday that worsened into the weekend. Brianna was taken to Children's Hospital on Saturday and has been showing few signs of improvement, Connie Kriefall said.
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"For the most part, at this point, she's worse," Connie Kriefall said. "It's hard to talk about your child that way, but to be honest, that's what it is.
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"Sometimes you just look at her and get all upset to see a perfectly healthy little girl turned so sick," she said. "I can picture her singing her ABCs the other day, and now she can hardly talk."
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Doctors told the Kriefalls that Brianna was suffering from "HUS," or hemolytic uremic syndrome.
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According to U.S. Centers for Disease Control, HUS is the leading cause of acute kidney failure in infants and young children. It is sometimes characterized by severe stomach cramps, vomiting and bloody diarrhea, symptoms Brianna showed initially, and it is caused primarily by E. coli O157:H7.
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The microbe was first identified in cattle in the late 1970s and was first recognized as a cause of illness in 1982 during an outbreak of severe bloody diarrhea that was traced to uncooked hamburgers. It has since been found in sprouts, lettuce, salami, unpasteurized milk and juice, and in contaminated water.
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Although most strains of E. coli are harmless and live naturally in the intestines of healthy humans and animals, the E. coli O157:H7 bacterium releases a toxin that's absorbed by the intestine and enters the bloodstream.
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Foldy said people infected with the bacteria show symptoms in a range of two to eight days. In many cases there are no symptoms, but 8% of cases can result in severe symptoms such as kidney failure, seizures, blindness, paralysis or even death.
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Brianna's younger brother, Chad, also showed flu-like symptoms late last week, but has not required a trip to the hospital, Kriefall said. He was tested for the bacterium, but results were not available.
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According to the CDC, an estimated 73,000 cases of infection and 61 deaths occur in the United States each year, primarily in younger children and older adults as a result of E. coli infections.
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"Most people do recover without any problems," said Benson Massey, associate professor of medicine in the division of gastroenterology and hepatology at the Medical College of Wisconsin. "But illnesses do affect children and adults differently, and (HUS) seems to be more overwhelming in children . . . but we really don't know why."
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Connie Kriefall said Brianna's illness progressed from vomiting and severe diarrhea late last week to her current, almost-unresponsive condition. She has undergone blood transfusions and started dialysis on Tuesday to help eliminate the toxins from her body.
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"She's awake, but not coherent," Doug Kriefall said. "She opens her eyes, but she doesn't really recognize us.
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"That's why I say she's probably getting worse," he said. "When we first came in she knew us, but now she just looks around."
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The Kriefalls spent eight years going through tests and treatments in order to conceive their first child.
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Their ordeal included four miscarriages, and, after the births of Brianna and Chad, a stillbirth.
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"It just makes it that much more difficult to accept," Connie Kriefall said.
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"She's so small and so tiny, and to see her go through all this, and she doesn't even know what's going on."
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Appeared in the Milwaukee Journal Sentinel on July 26, 2000.
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	Ladies! Gentlemen! Let Us Wake Up ! We Have Been Sleeping Too Long ! "Never believe that a few caring people can't change the world. For indeed, that's all who ever have." Margaret Mead
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