Explainer | What to know about E coli symptoms, hygiene after Hong Kong doctor’s death

The death of a young Hong Kong doctor among a group of healthcare professionals presenting symptoms of Shiga toxin-producing E coli infection has alarmed the city and prompted an investigation by authorities. The deceased was among three doctors with Princess Margaret Hospital in Kwai Chung that formed an outbreak cluster that came to light on Tuesday. The Post looks at the deadly bacteria and what one should do to avoid infection. 1. What is Shiga toxin-producing E coli? Most strains of E coli, which are commonly found in the gut of humans and other warm-blooded animals, are harmless. But the Shiga toxin-producing E coli, among some other strains, can produce toxic substances and cause severe foodborne diseases. It is transmitted mostly through consumption of contaminated food, such as raw or undercooked ground meat products, polluted fruits, vegetables or water, and unpasteurised dairy products. The strain was named after Japanese doctor and bacteriologist Kiyoshi Shiga, who discovered the bacteria linked to the toxin in the late 19th century. It was in the late 1970s when the E coli bacteria strains that could produce the Shiga toxin were discovered by scientists. Infection of the Shiga toxin-producing E coli is a statutory notifiable disease in Hong Kong, meaning suspected or confirmed cases must be reported to the government. 2. What are the symptoms and who is likely to become severely ill? People infected with Shiga toxin-producing E coli may have symptoms such as abdominal pain, diarrhoea, fever and vomiting. Some cases can also progress into bloody diarrhoea. Yuen Kwok-yung, chair professor of infectious diseases at the University of Hong Kong’s department of microbiology, said children aged younger than five and people older than 65 were more likely to develop serious complications following infection. Some complications include haemolytic uraemic syndrome, a life-threatening condition that may involve symptoms such as bloody diarrhoea and abdominal pain. The syndrome can lead to kidney failure, high blood pressure and blood clotting. 3. Has the bacteria led to an outbreak in Hong Kong or elsewhere? So far three doctors from the department of oncology at Princess Margaret Hospital were included in the latest infection cluster, as all had developed symptoms of diarrhoea within a week and one of them tested positive for Shiga toxin-producing E coli. Such infections were rare in Hong Kong, according to Dr Albert Au Ka-wing of the Centre for Health Protection’s communicable disease branch. From 2015 to last year, the number of Shiga toxin-producing E coli infections recorded in the city ranged from zero to six annually. In the United States, bacteria linked to slivered onions in McDonald’s Quarter Pounder hamburgers caused an outbreak from September to October last year. A total of 104 cases were detected across 14 states and one person died. According to the US’ Centres for Disease Control and Prevention, the country last year also recorded outbreaks of the E coli strain linked to raw Cheddar cheese, organic walnuts and organic carrots. An outbreak linked to flour products contaminated by the bacteria was previously reported in the US in 2016, infecting 46 people. Hong Kong’s Centre for Food Safety at that time also reminded the public not to eat or taste raw flour dough or batter. In the United Kingdom, more than 270 people were confirmed to be infected with the Shiga toxin-producing E coli from May to June last year. Authorities said the cause was likely to have been lettuce in pre-packaged sandwich products eaten by many of the patients. There were also reports from the US and Austria of people being infected after visiting petting zoos, where people could touch and feed animals. 4. What are the treatments and are there over-the-counter medication options? There is no specific treatment targeting the infection. Patients with severe diarrhoea are usually given fluids and supplements for electrolyte replacement. Yuen urged the public not to take antibiotics without a prescription if they had symptoms of diarrhoea, as the medication could increase the chance of complications. Studies have shown that antibiotics could increase the chance of haemolytic uraemic syndrome among infected patients, as the medication could increase the production of the Shiga toxin. Yuen also warned against the use of medications to suppress stomach acid, as those could make one more susceptible to the infection. He said the use of nonsteroidal anti-inflammatory drugs, such as ibuprofen, could damage mucus in the intestines and lead to more serious conditions if infected with the bacteria. 5. How can one prevent infection? Proper hygiene is key to preventing infection. That includes washing hands thoroughly with soap and water before and after cooking or handling raw meat, after going to the toilet or changing diapers, or after having contact with animals. Proper food preparation methods also help. The US’ Cleveland Clinic advises using different cutting surfaces for different types of food, and avoiding wooden boards for cutting raw meat as they are harder to clean completely. Do not rinse meat before cooking as that could spread bacteria to nearby surfaces, and cook food thoroughly before consumption. The Centre for Health Protection said when cooking or reheating meals, the core temperature of the food should reach at least 70 degrees Celsius (158 Fahrenheit) for 30 seconds.

Explainer | What to know about E coli symptoms, hygiene after Hong Kong doctor’s death

The Post looks at the bacteria and what one should do to avoid infection after death of Princess Margaret Hospital doctor

1. What is Shiga toxin-producing E coli?

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