Preventing Foodborne Illness: A Closer Look at the Recent E coli Outbreak

Considering the recent E coli outbreak in organic carrots, Contagion conducted an exclusive interview with Nicole M Iovine, MD, PhD, an infectious disease physician and chief hospital epidemiologist at the University of Florida. Iovine shared her expertise on the risks of foodborne illnesses associated with organic farming practices. She discussed the safety challenges of using compost and manure in organic farming, and strategies to mitigate these risks and protect public health.

The current E coli outbreak is connected to organic carrots, specifically those from Grimmway Farms, which have been recalled due to contamination with E coli O121. This strain of E coli can cause severe foodborne illness, including stomach cramps, diarrhea (often bloody), and vomiting. Symptoms typically appear 3 to 4 days after exposure and can lead to serious complications like kidney failure (hemolytic uremic syndrome, or HUS).¹

Iovine provided additional insight into the specific strain of E coli responsible for this outbreak and its potential for severe complications, “This particular type of E coli is carrying a gene that produces a toxin, and that toxin is pretty dangerous. It can lead to kidney failure, even to the point of someone needing dialysis,” she said.

The toxin produced by this strain is especially problematic because antibiotics can worsen the infection. “If you give a person antibiotics, the bacteria can actually sense the presence of the antibiotics. It takes it as a danger signal, and the bacteria responds by revving up production of that toxin to really high levels. So, you actually make people worse when you give antibiotics for this particular strain.”

This phenomenon complicates treatment, as physicians often rely on antibiotics for gastrointestinal bacterial infections. “Most of the time, giving them an antibiotic is what you want to do, but for this particular strain, that will make the disease process worse,” Iovine explained.

As the stool culture results for identifying the specific pathogen take several days to come back, this delay can result in the patient receiving antibiotics before the correct diagnosis is made. “By the time you get those results, it’ll take a few days. So, what often happens is people do get antibiotics, and this can lead to worse outcomes, for sure,” she noted.

The Role of Organic Farming Practices in Foodborne Illnesses

While organic farming provides many benefits, such as avoiding chemical pesticides, it also introduces certain risks, especially regarding the use of manure and compost as fertilizers. Iovine emphasized that these materials must be handled properly to prevent contamination.

“There are lots of benefits to organic farming. The biggest one is that they don’t use pesticides, which is really great. But you really also honed in on a very important point: they also don’t use chemical fertilizers, and instead, they use either compost or manure to achieve that purpose. Now, that can absolutely be done safely,” she explained.

Although, she cautioned, “The post of the manure has to be properly processed such that harmful bacteria or pathogens are no longer alive in the material. If that doesn’t happen, that’s where there can be the transmission of those harmful organisms or pathogens from the manure into the produce that is being grown.”

Identifying Foodborne Illnesses: E coli and Beyond

Symptoms of foodborne illnesses can overlap, making it difficult to identify the exact pathogen based solely on clinical presentation, “You really can't tell which organism is infecting a patient based on symptoms alone, ”Iovine explained. “The symptoms are nausea, vomiting, diarrhea, abdominal pain, sometimes there's fever, and sometimes there isn't fever. More severe forms can have blood in the diarrhea as well, but that’s what pretty much all bacterial causes of gastrointestinal illness will cause.”

To differentiate between infections, Iovine stressed the importance of laboratory testing. “If someone does come to medical attention, and if they do a culture of the stool, then you can find out exactly what the organism is.”

She also offered practical advice on how individuals can protect themselves from foodborne illnesses. “Probably the most important thing you can do with your produce is to make sure you wash it, rinse it under the sink. Of course, you should wash your hands first, and you should always rinse all of your produce. Sometimes you can see in the supermarket those pre-packaged salads or even pre-packaged vegetables. And, even if they say that they've already been washed, you really need to wash them again yourself.”

Iovine further advised peeling produce when possible. “Another layer of protection that you can add is, if the produce is something that can be peeled, like a carrot, for example, remove that outer skin, with a potato peeler. You can do the same thing with potatoes as well. You can remove the outer part, but then you have to rinse it again so you don't cross-contaminate.”

Vulnerable Populations: Extra Precaution Needed

Iovine also discussed the heightened risks for certain vulnerable populations, who are more likely to experience severe outcomes from foodborne illnesses, “These individuals need to be especially vigilant and take extra care to practice all possible measures to ensure their food is safe,” she advised. “If they get infected with any kind of foodborne illness, the outcomes can be more severe. This applies particularly to individuals who are under the age of five, those over the age of 65, and people whose immune systems are suppressed—either because they are on medications or undergoing treatments like chemotherapy for cancer.”

As Iovine emphasized, “These are really basic food safety tips that are important for everyone to follow.” For vulnerable populations, these practices are even more crucial. For vulnerable populations, these practices are even more crucial. By following these guidelines, individuals can better protect themselves from potentially dangerous pathogens like E coli, reducing the impact of foodborne illness outbreaks.

Reference

CDC. E. coli Outbreak Linked to Organic Carrots. November 17, 2024. Accessed November 21, 2024. https://www.cdc.gov/ecoli/outbreaks/e-coli-o121.html