CNN Botulism Story

[stauffenberg]

Did anyone here see Dr. Sanjay Gupta's recent report on CNN concerning the toxic effects of e coli found in spinach?  A focus of the story was a two-year-old girl who suffered acute renal failure as a result of e coli, but then partially recovered.  Her doctor glibly announced that the girl "will need a kidney transplant" in four or five years, as though getting a small kidney from a child cadaver source is as simple as buying beef kidney at the grocery store.  The parents of the child seem to have been left totally uninformed of what they have to expect for the child's future, since they kept focusing on the fact that their daughter will not be able ever to become pregnant because of the toxic effects of immunosuppressive drugs, as though that were the biggest problem she would face!

In fact, the child may have to spend several years on dialysis before getting a kidney, even with the priority given to growing children on the waiting list.  During this time she will be developmentally delayed, her growth will be stunted, she will be too tired to function normally, and her brain and nervous system will not develop normally.  She will have to have a cadaver kidney, given the policy against allowing young children to donate a kidney, so she can expect it only to last about 13 years.  So she will then be in her early twenties when she has to go back on dialysis, this time without enjoying the waiting list priority of a young child.  Given the growing ratio between the number of people needing a kidney and the stagnant number of kidneys becoming available for transplant, she will probably have to wait for eight to ten years for her second kidney, during which time she will further deteriorate.  Considering all these factors, she would be lucky to live past 30.

So once again we have a news report which makes the whole problem of endstage renal failure seem to the general public to be much less serious than it is, which can only further encourage society's disinterest in doing anything to improve the situation of kidney patients.

[okarol]

The video you mentioned is available online. I am looking for a direct link.

Here's a link to the a related CNN story:

Still no answers in '06 lettuce E. coli outbreak

Story Highlights
• E. coli on lettuce at Taco John's restaurants sickened at least 81 people last year
• Investigation continuing, has not determined how lettuce became contaminated
• FDA: 20 outbreaks of E. coli linked to California lettuce since 1995

From Stephanie Smith
CNN May 18, 2007

ALBERT LEA, Minnesota (CNN) -- Thursday after work was Terri Kaiser's favorite night: It was bowling night with her three sisters.

But last November, one of those nights turned horrible.

Before hitting the lanes, the four sisters stopped at Taco John's for a quick bite. Kaiser ordered a meat and potatoes burrito with lettuce.

Afterward, the sisters bowled as usual, with no problems. But as one day turned to two, and two days into a week, Kaiser became bedridden.

"I started feeling like I was getting the flu," said Kaiser, 57. "[Then] I started having severe cramps and black, bloody stools. I was feeling like 'Wow what's going on here? This isn't your typical flu.' "

Two weeks later, she was on dialysis.

"It was a shock," said Kaiser. "How can being ill make your kidneys stop working?"

Kaiser and her doctors did not know it yet, but something on those few shreds of lettuce was wreaking havoc on her body. It was E. coli bacteria. The lettuce used by Taco John's restaurants eventually sickened 81 people in three states. Those are the reported cases. Many suspect the numbers are higher. And nobody has gotten answers about how this outbreak happened. (Interactive: Food safety tips)

Officials from the Food and Drug Administration and the Centers for Disease Control & Prevention have confirmed that the lettuce most likely came from a farm in Central California. What they don't know is how the lettuce came to be tainted with E. coli 057:H7.

CNN requested information related to the investigation of the Central California farm from the FDA and the California Department of Health Services. The answer on both fronts was that the investigation is "continuing."
E. coli a recurring problem in produce

California produce, it seems, has a problem with E. coli 0157:H7, which is most commonly found in cattle feces. Since 1995 there have been more than 20 outbreaks of E. coli in lettuce and leafy greens traced back to farms in that state. (Map: Tracking outbreaks)

"You'd think that after so many outbreaks, the government and the leafy green industry would do something about this," said Bill Marler, a Seattle, Washington, attorney specializing in food-poisoning cases.

Marler has been at the helm of several lawsuits against the leafy green industry. He says investigations are traditionally slow, and he still does not have a report from a 2005 outbreak in Dole lettuce.

The FDA told CNN that the investigation into lettuce is on hold. It was derailed in part by recent investigations into melamine contamination in pet food, fish, swine and other foods.

"The FDA has to do what it can with the resources that it has," said David Acheson, assistant commissioner at the FDA Office of Food Defense, Communication and Emergency Response. "When there is an outbreak, investigators drop what they're doing and respond."
Clinging to life

Nine days after that bowling night, Terri Kaiser lay motionless in a hospital bed, cocooned by tubes, IV bags and the persistent beeps of monitors.

"I kind of shut down with the whole thing," said Loren Kaiser, Terri Kaiser's husband. "That first day the doctor had commented that she may not make it through this ... that it could be fatal."

Her kidneys had stopped functioning and Kaiser could not produce urine. The E. coli cells were hijacking her body's ability to function.

"E. coli 157 produces a very potent toxin that kills human cells," said Mansour Samadpour, a microbiologist at IEH Laboratories in Seattle. "A toxin is released, it's absorbed and then starts killing intestinal cells and makes its way throughout the body."

No one can say for sure how the E. coli got on Kaiser's lettuce, but with cows in California residing dangerously close to lettuce crops, most investigations into outbreaks begin at the cow pasture. (How science can help keep our food safe )

E. coli 0157:H7 proliferates in the intestines of a cow. But the pathogen also is carried by other animals, including birds, rodents, deer and elk. The trouble begins when those animals traipse through lettuce fields.

"It's nature," said Samadpour. "You have absolutely zero control, because if the organism is there, wildlife is going to pick it up."

"Some people are just angry and I think some people feel violated," said Marler. "When you think about it, it's not a really pleasant thought that you're eating someone or something's feces. That's just not a very pleasant concept." (Watch: How to wash lettuce )

Kaiser may be getting over the feeling of violation, but she still wants to know how E. coli got in her lettuce in the first place. Her kidneys are functioning at about 44 percent, and she says she's steadily improving, even while contending with an extreme case of hypertension.

"Young children and people older than myself...are going to have a long, long line of problems because of eating poisonous food," said Kaiser. "It shouldn't happen." (Meet a young survivor of spinach-borne E. coliVideo - (go to link below then see link in text.)

As she heals, Kaiser waits for the government to explain why she and others like her went through this pain.

Stephanie Smith is a producer with CNN Medical News. Producer Kelley Colihan and senior producer Caleb Hellerman contributed to this report.
 
 
 
Find this article at:
http://www.cnn.com/2007/HEALTH/05/18/food.safety.lettuce/index.html

[lola]

Why will she be developmentally delayed and her nervous system not develop normally? My daughter has shown slow signs of kidney failure for 2 years now and is fine, along with her father and uncles they are all fine, and why does she have to have a cadaver kidney? Maybe she'll get a living donor, And "lucky to live past 30" ? my brother in laws are all in there 40's on there 2nd transplants and doing great!!! I understand your frustration I KNOW i get upset too but to post so many of your -'s when there are some parents on here can kinda be upsetting specially when i personally know some amazing kids who have had transplant's and are at there age level mentally.

[stauffenberg]

The data I was referring to all concern pediatric patients with established endstage renal failure, not just subnormal renal function.  Those in the latter group should be spared developmental abormalities prior to endstage renal failure.  In children on dialysis, however, IQ, memory function, and the executive function of the brain are all significantly reduced, and achievement test scores are low.  This is because dialysis and immunosuppressive drugs are neurotoxic, so the brain and nervous system do not develop normally, though the longer endstage renal failure can be postponed, the better for the child.  Exact statistics are available in B. H. Brouhard, et al, "Cognitive Function in Children on Dialysis and Post-Transplantation," Pediatric Transplantation, vol. 4, no. 4 (2000) 261-267, and in D. Gipson, "Memory and Executive Functions in Pediatric Chronic Kidney Disease," vol. 12, no. 6 (2006) 391-405.

Children with endstage renal failure have an age-specific death rate 30 times higher than that found in normal children.  After 10 years of treatment for endstage renal disease, only 79% are still alive, and after 20 years of treatment, only 66% are still alive.  These data are taken from S. P. McDonald, et al, "Long-Term Survival of Children with Endstage Renal Disease," New England Journal of Medicine, vol. 350, no. 26 (2004) 2654-2662. 

Children can only get cadaver transplants because transplanted kidneys have to be matched for size to the transplant recipient, and since children are small, they need small kidneys, which comes only from other children.  However, since the law as well as principles of medical ethics forbid children being live organ donors, kidneys for children can only come from child cadaver sources.

[jbeany]

Children can only get cadaver transplants because transplanted kidneys have to be matched for size to the transplant recipient, and since children are small, they need small kidneys, which comes only from other children. However, since the law as well as principles of medical ethics forbid children being live organ donors, kidneys for children can only come from child cadaver sources.

That makes sense logically, stauffenberg.  But it's contradicted by the experience of one of our own - Gavin - the two year old who received a transplant from his father when he was only 11 months old. 

[lola]

We have members at church there 1 yr old got his kidny from his dad!! And when my hubbie got his transplant i met a women who was a match for her son they just had to wait for his weight to reach 17lbs.

[stauffenberg]

Size matching is preferred, though you might find an adult with vestigial kidneys who would fit.  The surgical problems in connecting the oversized kidney of an adult to the tiny vasculature of a child are a nightmare.

[pierrat]

Well I agree, Of course there are alot of variables in Staufs story but that doesnt make his point any less valid. It seems in general people take CKD patients lightly, I mean we all hear of aids, cancer, heart disease, diabetes, etc constantly in the news but how often do you hear the general media talk about KD? People can look normal with the disease but underneath there bodies are a battlefield. Not to mention how almost everyone with KD has another big disease, the one that caused the KD. Like diabetes, hypertension/stroke heart attack waiting to happen, or an autoimmune disease.