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E. coli effects can last a lifetime

When she was 10 years old, Brianne Kiner became the public face of one of the country’s worst outbreaks of food poisoning.

According to the LA Times report, Brianne suffered from hemolytic uremic syndrome, or HUS, the most dreaded consequence of E. coli O157:H7 infection and the most common cause of kidney failure in children under 18. Of the 171 cases identified so far in the current spinach-related outbreak, 27 have been diagnosed with HUS. One person has died. Two other deaths are under investigation.

The death rate from HUS is 3% to 5%, doctors say. Ten percent of patients survive but have long-term kidney damage and may eventually require dialysis or a transplant. Brianne’s case was so severe that just about everyone expected her to die. She was the last to leave the hospital among those stricken in the Jack-in-the Box outbreak that sickened hundreds and killed four.

During the months she was laid up, the toxin produced by the bacteria attacked her brain, kidneys and liver, putting her in a coma for 40 days. She suffered strokes and seizures. Her infected pancreas lost the ability to produce insulin, and she developed diabetes. Doctors removed part of her inflamed intestine.

The $15.6-million settlement the Kiners won in 1995 from Jack-in-the-Box provides for Brianne’s support. She now lives on her own and takes community college classes part time – routine milestones for a 23-year-old, but they represent hard-won autonomy for someone stricken as severely as she was. Every three months, she visits her endocrinologist to check her diabetes, but she pronounces her health – and life – “Good.”

E. coli is commonly found in cow manure and passed to people though contaminated food. Most strains are ubiquitous and relatively harmless.

But somewhere along the way, E. coli O157:H7 evolved the ability to produce lethal toxins that can cross the intestinal wall and enter the bloodstream. The toxins flock to receptors in the kidneys, where they kill small blood vessels and clog waste filters. They can also harm the pancreas, liver and heart. Death is often a result of toxins infecting the brain and causing strokes or swelling. Sometimes, the damage reveals itself years later. Each kidney has about a million filters. On average, most people lose about 20% of these filters by the time they’re 80, just through wear and tear.

What saves the vast majority of children who fall ill from HUS is the resilience of the human body. Virtually nothing can be done to fight the infection once it is underway. Treatment consists of supporting the patient – from something as simple as hydration, all the way to dialysis – while the body fights off the toxins.

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