1. TN Spinach Outbreak 2006 To Eat or Not to Eat? Swan Lin Baker, RN, BSN Metro Public Health Department Nashville Davidson County

2. Background E. coli 0157: H7 is a leading cause of foodborne illness 1999 estimate- 73,000 cases with 61 deaths occur in the United States per year Hundreds of strains of e. coli

3. Background E. coli is a gram negative bacteria Only some strains of e. coli are pathogenic E. coli 0157: H7 produces a powerful toxin Only takes a small amount of this organism to cause illness

4. Background Incubation period is generally 2-8 days with an average of 3-4 days after exposure Symptoms include: severe bloody diarrhea and abdominal cramps Most people recover in about 5-10 days, however, 5-10 % of people who are infected with e. coli can go on to develop a complication known as Hemolytic Uremic Syndrome (HUS)

5. MPHD hx with e. coli September 2005 –PFGE match to isolate Cases related to YMCA Most cases resided in another region 2 cases resided in Nashville

6. MPHD hx with e. coli Conclusion: possible water system leakage at YMCA No other known outbreaks in Davidson County recently

7. Outbreak Case On Thursday, September 21 st, the Metro Public Health Department (MPHD) received laboratory confirmation of an e. coli 0157:H7 from the hospital Subsequently received notification from the Tennessee Department of Health that the stool specimen was a PFGE match to the national spinach outbreak

8. History of Illness Initial contact with pt. Patients initial sx began on Sept. 9 th September 10 th -progression of illness By Monday, September 11 th - sx worsened

9. History of Illness cont. On Tuesday, September 12 th he called his doctor who advised him to come to the office to be seen

10. History of Illness cont. He finally did proceed to the ER around 8 pm where he was examined, treated and released Over the course of his illness he began to develop back pain which continued to worsen

11. History of Ilness cont. He visited his PCP on Tuesday, September 18 th due to back pain that continued to worsen. Diagnosis What the interview did/didnt reveal

12. What we didnt know… When the spinach was purchased What brand he consumed

13. Next Steps… Contacted Kroger corporate office Home visit Kroger released receipts to patient Patient sent receipts to TDH

14. In Conclusion… From receipts gathered, pt. purchased the Dole baby spinach on 8/23/06. Specimen was a confirmed PFGE match to the national outbreak pattern, thus making this the first case of this strain of e. coli 0157:H7 in Tennessee

15. QUESTIONS