A Guide to E. Coli and Foodborne Illnesses

Meredith Porter, MD is a board certified family physician with 22 years of clinical experience and a lead physician for Inova Urgent Care. Inova Urgent Care centers are open seven days a week – including holidays, except Christmas Day – and treat walk-in patients of all ages. Select centers offer specialized pediatric care where staff is cross-trained in pediatric emergency medicine. Click here to learn more about Inova Children’s Urgent Care services.

romaine lettuce leavesThe holiday season is a time to enjoy friends, family – and lots of good food! As you plan the menu for your upcoming holiday gatherings, recipes containing romaine lettuce should not be included until further notice.

On November 20, 2018, the Centers for Disease Control and Prevention (CDC) issued a romaine lettuce advisory warning to consumers, stores, and restaurants to throw away, stop selling, and/or serving all romaine lettuce. The nationwide romaine lettuce recall includes all types of romaine lettuce:

  • Whole heads of lettuce
  • Hearts of romaine lettuce
  • Bags and boxes of precut lettuce and salad mixes such as baby romaine, spring mix, and Caesar salad
  • Any products at home – even if some of the lettuce has already been eaten and has not caused illness

If romaine lettuce is at home, the CDC also advises thorough washing and cleaning of storage areas after disposal.  Here’s what you need to know about the recall and E. Coli infections.

Why did the CDC issue a serious E. Coli warning?

Public health officials are following multiple reports of illnesses across eleven states and Canada during the month of October 2018, caused by the bacteria Shiga toxin-producing Escherichia coli O157:H7 (STEC).

According to the CDC, 32 Americans and 18 Canadians have become ill.  Nearly half of the U.S. cases required hospitalization and one person developed kidney problems.  The CDC has linked the likely infection source as romaine lettuce.

What are symptoms that occur with E. Coli infections?

 Often, people use the terms “stomach flu” or “stomach bug” to describe the symptoms related to food-borne illnesses like E. Coli.  They can include:

  • Mild to severe abdominal cramping
  • Diarrhea, with or without blood
  • Vomiting
  • Low grade fevers
  • Dehydration
  • Muscle aches

For most people, the symptoms start 3 to 4 days after eating or drinking something containing E. coli.    But for some, the illness could start as early as 1 day, or up to 10 days, after exposure. Most infected people are sick for less than 5 days and symptoms tend to be very mild. But, for others, the symptoms can be more severe – even life-threatening – and cause hospitalization.

One possible complication of this type of E. coli infection, occurring in 5-10% of cases, involves injury to the kidneys. This is referred to as Hemolytic Uremic Syndrome or HUS. As the diarrhea improves (usually around day 7 of the illness), people may notice these additional symptoms:

  • Abdominal pain
  • Nausea and Vomiting
  • Decreased urination
  • Fatigue
  • Loss of color to cheeks and lower eyelids

How is an E. coli infection diagnosed?

E. coli O157:H7 is found through a stool culture. Your doctor can order the stool test, if needed. Stool testing can help find the cause of diarrheal infections and identify outbreaks. Other common causes for foodborne illnesses include:

  • Viruses (norovirus)
  • Bacteria (Salmonella, Escherichia coli, Campylobacter and Listeria)
  • Parasites (Toxoplasma gondii, Giardia)

How is the E. coli infection treated? Can an antibiotic help me feel better?

Unfortunately, antibiotics are not recommended for treating E. coli O157 infections and they shouldn’t be started if this type of infection is suspected. Antibiotics haven’t shown to help with this particular strain of E. coli infection and may actually increase the chance of having serious kidney problems, or HUS.

Prevention is the best first step to fighting illnesses spread through food sources. Safe handling and preparing of food can help prevent infections. However, if you contract a foodborne illness like E.coli, treatment of the symptoms is most important. Here are some helpful tips to consider:

  • If E. coli O157 is suspected, over the counter antidiarrheal medications, such as Imodium and Pepto-Bismol, should be avoided – especially in children.
  • Medications can be used to treat nausea if significant vomiting is present.
  • Rehydration by oral fluids can prevent and treat dehydration in all ages. Oral rehydration solutions can be used, such as Pedialyte, Hydralyte or oral rehydration packets. Juice, sodas, and sports drinks should be avoided. Rehydration with IV fluids may be needed in people with severe dehydration.

Recommended bland foods during diarrheal illness can include:

  • “BRAT” diet:
    • Bananas
    • Rice
    • Apples
    • Toast
  • Jello, broth, crackers, cooked cereals
  • As symptoms improve, add soft cooked eggs, sherbet, cooked vegetables, white chicken or turkey meat.

Foods to avoid during diarrheal illness:

  • Milk and dairy products for 3 days
  • Fried, fatty, greasy and spicy foods
  • Raw vegetables
  • Citrus fruits
  • Alcohol
  • Coffee and caffeinated sodas

Where else can Shiga Toxin-producing E. coli be found?

E. coli O157:H7 strain does not normally live in human intestines. The bacteria can be found in about 1% of healthy beef cattle intestines and can contaminate meat during processing or other food products.  E. coli infections have also been reported from other food and environmental sources:

Food sources:

  • Raw fruits and vegetables including alfalfa sprouts and leaf lettuce
  • Undercooked meat (beef, deer’s meat)
  • Unpasteurized milk and juice

Environmental sources:

  • Fecal-contaminated lakes
  • Non-chlorinated municipal water supply
  • Petting farm animals
  • Unhygienic person-to-person contact

 Remember, prevention is the best first step to fighting illnesses spread through food sources. Click here to view safe handling and food preparation tips from the USDA to help prevent infections.


Inova Urgent Care wishes you and your family a peaceful and safe holiday season.

1 Comment

  1. Michael Dash on November 23, 2018 at 11:05 pm

    An excellent coverage of this problem.

Leave a Comment