Back in 2016, when I went to Peru for the first time to visit my girlfriend who would later become my cherished wife, I learned the hard way just how poorly treated the water can be there. Most people know not to drink unfiltered tap water, especially in Latin America, but has anyone thought that shower water can be equally dangerous even if ingested in tiny amounts? I never thought about the imminent danger in such a context. I simply went about showering how I normally do, which included getting some of that water inside my mouth, rinsing it, and spitting the contents out (maybe it sounds gross to some of you, I don't blame you!). Well, that was the last time I did that because a day later I soon began to feel the symptoms. I had abhorrent diarrhea every 10 to 15 minutes, abdominal cramping, and pain. I felt utterly bad, like never before in my life. My wife's family knew right away what was going on inside of me, I was told I had been infected with E. coli and at my wife's instance we went to the ER without further hesitation. When I got there I was immediately put on a hospital bed and hooked up to an intravenous saline solution to quickly help rehydrate my body. I was already in a too weakened state to notice what exactly was happening around me, but I remember the nurse administering what was most likely an intravenous antibiotic to combat the E. coli. I recovered fairly quickly and I could already feel my strength back. My girlfriend who is now my wife, stayed with me the entire time. What she and her family told me after my recovery is that they never open their mouth when showering and that I should do the same, at least while in Peru. After that experience I learned not to repeat my habit of rinsing my mouth while showering. E. coli can be found in the feces of healthy cattle, and is transmittable to humans by contaminated food, water, or by having direct contact with people or animals (Mead, 1998). In my case, I was infected with E. coli via the contaminated water. Let me now tell you that the E. coli I was infected with was not the normal one, this was the kind that can kill you if not seeking treatment! The strain of E. coli I was infected with belongs to a group that triggers diarrhea, which is called Shiga toxin-producing E. coli or STEC for short (Centers for Disease Control [CDC], 2014). The kind of STEC strain that I was infected with was most likely the O157 serotype since the non-O157 are less likely to cause severe disease and are more complicated to diagnose (Centers for Disease Control [CDC], 2014). The incubation period of E. coli 0157 is on average 3 days, but can be as short as 1 day, which was my case. The symptoms of E. coli 0157 can range from "symptom-free to non-bloody diarrhea, hemorrhagic colitis, hemolytic uremic syndrome, and death" (Mead 1998). Usually stool samples are taken to detect the Shiga toxin and narrow down the strain of E. coli infection, but in my case, I don't remember having my stool sample taken. I was immediately placed on a bed and the saline solution prevented any further dehydration. Rest assured that after this experience, I never got sick with E. coli again, even during subsequent visits to Peru.
Sources:
E. coli (Escherichia coli). Centers for Disease Control and Prevention. http://www.cdc.gov/ecoli/general/index.html. Accessed October 04, 2020.
Mead, P. S., & Griffin, P. M. (1998). Escherichia coli O157:H7. The Lancet, 352(9135), 1207-12. doi:http://dx.doi.org.aurarialibrary.idm.oclc.org/10.1016/S0140-6736(98)01267-7
Hello Adrian,
ReplyDeleteThis is a very interesting story and I am sorry that this happened to you but happy that you made a full recovery. I am familiar with E. Coli and the infections that these bacteria can cause, but I was not aware of the diversity of E. Coli strains. This was also the first time I had learned about Shiga toxin and STEC. I was not aware that it was this specific strain of E. Coli that produces the symptoms of diarrhea. I think it is very interesting that such a small amount of ingested water (even though you did not even perceive the ingestion of the water) was able to cause the infection.
I wanted to do a little more research in to the E. Coli 0157 serotype that is suspect in infecting you. I read an article by Sewlikar and D’Souza (2017) that I found interesting. In this article, the researchers were examining the antimicrobial effects of bark extracts from the a tree called Quillaja Saponaria. The extracts from this tree were recently cleared by the FDA to be used as a natural flavorant in foods. Results from this article suggest that this extract damaged cell membranes of bacteria that were treated with it. Among the bacteria that the extract was able to successfully damage was the E. Coli 0157 serotype. The researchers suggest that this tree extract could be used in foods to control the spread of various STECs. I just thought this was an interesting side note.
Sewlikar, S., & D'souza, D. H. (2017). Antimicrobial Effects of Quillaja saponaria Extract Against Escherichia coli O157:H7 and the Emerging Non-O157 Shiga Toxin-Producing E. coli. Journal of Food Science, 82(5), 1171-1177. doi:10.1111/1750-3841.13697
Hello Adrian,
ReplyDeleteThis is a very interesting story and I am sorry that this happened to you but happy that you made a full recovery. I am familiar with E. Coli and the infections that these bacteria can cause, but I was not aware of the diversity of E. Coli strains. This was also the first time I had learned about Shiga toxin and STEC. I was not aware that it was this specific strain of E. Coli that produces the symptoms of diarrhea. I think it is very interesting that such a small amount of ingested water (even though you did not even perceive the ingestion of the water) was able to cause the infection.
I wanted to do a little more research in to the E. Coli 0157 serotype that is suspect in infecting you. I read an article by Sewlikar and D’Souza (2017) that I found interesting. In this article, the researchers were examining the antimicrobial effects of bark extracts from the a tree called Quillaja Saponaria. The extracts from this tree were recently cleared by the FDA to be used as a natural flavorant in foods. Results from this article suggest that this extract damaged cell membranes of bacteria that were treated with it. Among the bacteria that the extract was able to successfully damage was the E. Coli 0157 serotype. The researchers suggest that this tree extract could be used in foods to control the spread of various STECs. I just thought this was an interesting side note.
Sewlikar, S., & D'souza, D. H. (2017). Antimicrobial Effects of Quillaja saponaria Extract Against Escherichia coli O157:H7 and the Emerging Non-O157 Shiga Toxin-Producing E. coli. Journal of Food Science, 82(5), 1171-1177. doi:10.1111/1750-3841.13697
Adrian - sounds like a terrible experience! Hope you were able to enjoy the rest of your trip to Peru. My sister and mom unfortunately had to learn the hard way as well. We went on a trip to Mexico, and although we were careful about not drinking tap water, they both got soda at a restaurant. They did not think about the melting ice in their drinks that, a day or two later, led them to the same fate.
ReplyDeleteCrazy that just a rinse of contaminated water in the mouth could cause such severe symptoms! In my brief research, I found a study that showed as few as ten viable E. Coli 0157 bacteria can cause disease in humans (Ameer et.al., 2020). Because of our anatomy lectures on histology, I was curious about how this specific strain works. E. coli O157 attaches to microvilli of intestinal epithelial cells using intestinal fimbriae (Ameer et.al., 2020). This causes lesions of the microvilli that eventually flatten them. The Shiga toxins cause intestinal mucosa cells to slough off, manifesting as hemorrhagic diarrhea and abdominal pain (Ameer et.al., 2020). The toxin results in an inflammatory cascade causing “leukocyte aggregation, apoptosis of the affected cells, platelet aggregation, microthrombi formation, hemolysis, and renal dysfunction” (Ameer et.al., 2020). Histologically, the effects of E. coli O157 appear similar to that of ischemic colitis and C. difficile (Ameer et.al., 2020).
I will be sure to keep this in mind during future trips abroad!
References:
Ameer MA, Wasey A, Salen P. Escherichia Coli (E Coli 0157 H7) [Updated 2020 Oct 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507845/