Speaker 1: By the time paramedics removed Brianne Kiner from the ambulance
Speaker 1: and wheeled her into the e ER at Children's Hospital,
Speaker 1: Suzanne Kiner was doing all she could to hold herself together.
Speaker 1: Brianne was writhing in pain, and the diarrhea just kept coming,
Speaker 1: so did the blood. Suzanne was afraid to leave Brianne's side.
Speaker 1: It looked and sounded like her little girl was dying.
Speaker 1: Her breathing was rapid, she had deep pain in her chest,
Speaker 1: her urine output had practically disappeared. Even her mental condition
Speaker 1: was deteriorating, and she was slurring her words when she
Speaker 1: tried to speak. When the hospital transferred Brianne to the
Speaker 1: ICU for round the clock observation, Suzanne wanted answers. The
Speaker 1: doctors informed her that Briann's stool culture had come back
Speaker 1: and definitely showed the presence of E. Coli O one
Speaker 1: five seven h seven, and her symptoms suggested she had
Speaker 1: hemolytic uremic syndrome. Shortly after arriving in the ICU, Brianne
Speaker 1: suffered a seizure and stopped breathing. Doctor scrambled to resuscitate her.
Speaker 1: They gave her dilantin intravenously along with phenobarbital tubes were
Speaker 1: inserted in her chest. By the time doctors emerged to
Speaker 1: give Susanne an update, Brianne was in a coma. Suzanne
Speaker 1: had trouble swallowing. She wanted to scream, but all she
Speaker 1: could do was cry, WHOA yeah?
Speaker 2: Did she survive?
Speaker 1: She didhw Yes. So that first hand account is pieced
Speaker 1: together from a book called Poisoned, The True Story of
Speaker 1: the Deadly E. Coal I Outbreak that Changed the way
Speaker 1: Americans eat by Jeff Benedict. And it's about the outbreak
Speaker 1: of E. Cole I oh one five seven that you're
Speaker 1: going to hear a lot more about in nineteen ninety three.
Speaker 1: And Brienne was one of the children who was infected
Speaker 1: with E. Coli and she did survive, but she has
Speaker 1: had a lot of lingering problems because of this infection. Hi,
Speaker 1: I'm Aaron Welsh.
Speaker 2: And I'm Erin omen Updyke.
Speaker 1: And this is this podcast Will Kill You, And.
Speaker 2: Today we're talking about E.
Speaker 1: Coli E Coli.
Speaker 2: Do you know I always raise my hands up when
Speaker 2: I say the disease that we're talking about, and no
Speaker 2: one can see except.
Speaker 1: You, But I appreciate it.
Speaker 2: Thank you, so so, today's a big one. It's a
Speaker 2: massive barin.
Speaker 1: I did not realize that when we were like, let's
Speaker 1: do we call it?
Speaker 2: Yeah, it's like it's well, yeah, we'll get into it.
Speaker 2: It's so big. It's so big. It's going to be
Speaker 2: a short episode though, don't worry.
Speaker 1: Well to help us through this episode, I think it's
Speaker 1: time for quarantinis.
Speaker 2: I think it's quarantini time. I have my first real
Speaker 2: quarantini in eleven months, yay, which feels quite exciting. What
Speaker 2: are we drinking today?
Speaker 1: We are drinking the cookie Don't so and in the
Speaker 1: Cookie don't it's actually quite delicious.
Speaker 2: It is. It's really tasty.
Speaker 1: It is dark rum and chocolate liquore, Almaretto ice cream,
Speaker 1: ice chocolate syrup. You blend it and then you pour
Speaker 1: it into a glass that is rimmed with chocolate and
Speaker 1: crushed cookies.
Speaker 2: It's so tasty.
Speaker 1: It's really good. It's so good, it's like too good.
Speaker 1: I think.
Speaker 2: Yeah. We'll post the full recipe for this quarantine as
Speaker 2: well as our non alcoholic Pussy Brita on all of
Speaker 2: our social media's and our website, so you can drink
Speaker 2: along with us.
Speaker 1: Yes and it's called the cookie don't for reasons that
Speaker 1: I'm sure you'll go into Aaron.
Speaker 2: Oh yeah, we'll talk all about it.
Speaker 1: And I'm sure that everyone here can guess.
Speaker 2: You can guess, yeah, cookie dough don't.
Speaker 1: Yeah, it works. It works better if you read it.
Speaker 1: I think it does. We didn't think this went through.
Speaker 2: It's still great. I like it.
Speaker 1: Okay, So speaking of cookie dough and don't and whatever, Aaron,
Speaker 1: should we just get started?
Speaker 2: I think so. We have merch check it out on
Speaker 2: our website, click on merch et cetera. Business. Let's do it,
Speaker 2: all right, cool, we'll take one quick break, all right.
Speaker 2: E Coli. I wrote that maybe this is the most
Speaker 2: important bacterial species we'll ever talk about, But I feel
Speaker 2: like that's overkill.
Speaker 1: Well, I feel like a lot of people might have
Speaker 1: opinions about them.
Speaker 2: They probably would, so I'm not going to make that statement,
Speaker 2: even though I just said it.
Speaker 1: But it is massively important.
Speaker 2: It is massively important. The thing about it is that E.
Speaker 2: Coli is everywhere. It's everywhere, and it's everything, and it
Speaker 2: causes almost every type of illness that you can think of.
Speaker 2: And we also use it in the lab to study
Speaker 2: every other disease pretty much. Equal is like the lab bacteria.
Speaker 1: Oh and not just every other disease, but life itself
Speaker 1: all how life works.
Speaker 2: Like literally, that's not an exaggeration.
Speaker 1: Yeah. No, I'm going to talk about it.
Speaker 2: Oh excellent. I can't wait because I'm not going to
Speaker 2: talk about it. O.
Speaker 1: Good.
Speaker 2: Oh. But we will get some of the basics out
Speaker 2: of the way first and then we'll talk about the
Speaker 2: diseases that equal I causes. Cool, perfect, Okay. So equal
Speaker 2: is a bacterium. It's a gram negative bacterium. So it's
Speaker 2: pink when we stain it on the microscope. That's what
Speaker 2: it means for the purposes of this podcast.
Speaker 1: That's really the important takeaway is that a pink.
Speaker 2: BacT pink little bacteria. If you're going to paint it color,
Speaker 2: you should choose it's rod shaped so it looks like
Speaker 2: a little tic tac. Okay, yeah, you have it in
Speaker 2: your mind now. For the most part, in our bodies, E.
Speaker 2: Coli is a normal and important component of our gut microflora.
Speaker 2: It's always there, and it's supposed to be there. It's
Speaker 2: part of a healthy microbiome. But this is this podcast
Speaker 2: will kill you. So that's not the ecoli that we're
Speaker 2: going to talk about today.
Speaker 1: Nope, although we could talk a little bit about those guys.
Speaker 2: Sure. Sure. So Aaron, when you think of the E.
Speaker 2: Coli that makes you sick, what do you think.
Speaker 1: Of you mean, like, what symptoms and signs and stuff. Oh,
Speaker 1: I would say, well, after reading that first hand account,
Speaker 1: I would say bloody diarrhea, bloody diarrhea, and then also
Speaker 1: whatever hus is. But I was hoping you were going
Speaker 1: to tell me about that.
Speaker 2: Don't worry, I'm going to Okay, Bloody diarrhea is the
Speaker 2: thing that probably comes to most people's minds when they
Speaker 2: think of E. Coli first, and that's because of just
Speaker 2: like you said, that oh one to five seven outbreak,
Speaker 2: which we'll talk about, you'll talk about, et cetera. Yeah,
Speaker 2: the diarrheagenic that's their official name. The diarrhegenic E Coli
Speaker 2: are probably the most infamous of the ecoalies that cause disease,
Speaker 2: but they're not the only ones. So here's how I'm
Speaker 2: going to structure this biology section because E. Coli is
Speaker 2: so big. First, we're going to talk really quickly about
Speaker 2: what makes the pathogenic ecoali strains different than all of
Speaker 2: the normal ecoli or all of the non pathogenic ecoal
Speaker 2: i that live in our gut happily, okay, and then
Speaker 2: we'll talk about the non diarrheagenic ecoli just briefly, and
Speaker 2: then we'll talk poop cool.
Speaker 1: Oh great, love talking poop met too.
Speaker 2: It's one of my favorite things to talk about. Okay.
Speaker 2: So the main difference between the E. Coli hanging out
Speaker 2: in our guts happily right now and the E. Coli
Speaker 2: that made that little girl in the first hand account
Speaker 2: massively sick, or what are called virulence factors. We've talked
Speaker 2: about these before, right, I think so, I think so? Sure. Well,
Speaker 2: if you don't remember what a virulence factor is, it's
Speaker 2: basically just stuff things. Yeah, that clears it up, Things
Speaker 2: that a bacteria or a virus or a parasite makes
Speaker 2: that helps it to cause disease in an organism. So
Speaker 2: let me give you some examples. Sometimes virulence factors allow
Speaker 2: for bacteria to attach to certain cells and colonize a
Speaker 2: new area in a host that they wouldn't be able
Speaker 2: to before.
Speaker 1: Oh yeah, okay, like little velcrow, little velcro strips.
Speaker 2: Sometimes it might be like a capsule kind of like
Speaker 2: an armor that allows it to evade a certain part
Speaker 2: of our immune response. That could be a virulence factor.
Speaker 2: It could be an endotoxin that the bacterium produces that
Speaker 2: also allows it to evade the immune system, or an
Speaker 2: exotoxin that it produces and sends out into our body
Speaker 2: and actually causes damage to other cells.
Speaker 1: Cool.
Speaker 2: Okay, So virulence factors are literally anything that a pathogen
Speaker 2: can make that makes it more virulent, aka makes you
Speaker 2: get sicker.
Speaker 1: Cool sounds reasonable.
Speaker 2: So these subtypes of E. Coli that are they're called
Speaker 2: different pathotypes because they are pathogenic, collectively have a couple
Speaker 2: of main virulence factors that allow them to get us sick.
Speaker 2: And those two things are different types of adhesons which
Speaker 2: allow them to adhere and colonize new areas, and toxins.
Speaker 2: Those are the two things that Ecoli tends to use
Speaker 2: to be able to invade new organs in our body
Speaker 2: and make us sick in new ways. So another important
Speaker 2: thing about the virulence factors in E. Coli is that
Speaker 2: a large number of them are on plasmids, which we've
Speaker 2: talked about before. I think, right, oh, did we talk
Speaker 2: about it with cholera Maybe, because cholera definitely has plasmids anyways.
Speaker 2: Plasmids are a little round pieces of DNA that bacteria
Speaker 2: can move from like one bacterium to another, they can
Speaker 2: like pass it off, and so basically this allows for
Speaker 2: ecoli to hand off virulence factors in like between different
Speaker 2: strains of bacteria, right, okay, Okay, that's like that's the
Speaker 2: whole pathogenesis. Like, that's how all of these ecoli have
Speaker 2: come to be, is just little changes in their toxins
Speaker 2: or their virulence factors or their adheson whatever that allows
Speaker 2: them to make us sick. Okay, So what kinds of
Speaker 2: ways can ecoli make us sick? So many different ways? Yeah,
Speaker 2: all right. The two main kinds of disease that you
Speaker 2: can get from E. Coli besides diarrhea are urinary tract infections.
Speaker 1: Oh yeah, did you try that? I think I did
Speaker 1: know that at one point. I don't know. It feels
Speaker 1: like a recovered memory. Yeah.
Speaker 2: So these strains of ecoli are called you peck. So
Speaker 2: many ridiculous acronyms.
Speaker 1: With no don't love. I don't love acronym you.
Speaker 2: Peck is europathogenic ecoal i. Okay, okay, they're all like that.
Speaker 2: They're all like blah blah. Pathogenic ecoal i, they're really
Speaker 2: so they all end in PEC. Yeah, yeah, they're all
Speaker 2: mostly sometimes they're like hex. Well you'll see.
Speaker 1: Heck and ecola, heck and e coli.
Speaker 2: That's funny.
Speaker 1: She sounds surprised.
Speaker 2: She liked it. It was good. Okay. So the upeck,
Speaker 2: the europathogenic ecoal i, are strains of ecoli that are
Speaker 2: really good at attaching to our urinary tract walls. Okay,
Speaker 2: So they have adhesions that allow them to do that,
Speaker 2: and they are the most common cause by far of UTI's.
Speaker 2: So that means like, okay, right, like eighty percent of
Speaker 2: UTI's or something like that are caused by ecole. And
Speaker 2: if you don't know what a UTI is, the symptoms
Speaker 2: generally are things like burning on urination, increase frequency meaning
Speaker 2: you have to pee way more often than normal, or
Speaker 2: urgency where you're like, if I don't pee right now,
Speaker 2: I'm on pima pants.
Speaker 1: So that sounds a lot like gonrhea, Aaron, How are
Speaker 1: people going to distinguish between the two.
Speaker 2: So another thing that upeck can cause ganeri prostatitis. No,
Speaker 2: but it is prostatitis, and gonorrhea is another common cause
Speaker 2: of prostatitis actually, so that's if it goes up the
Speaker 2: urethra far enough to invade the prostate. But then these
Speaker 2: strains of E. Coli can actually keep going up and
Speaker 2: then can also cause like pylonephritis, which is kidney infections
Speaker 2: as well, which is you can imagine more serious than
Speaker 2: only an bladder infection. Okay, so we covered three already.
Speaker 2: We've got bladder infection, kidney infection, prostate infection, all from UPEC.
Speaker 2: Then we have the m neck. I don't know if
Speaker 2: you're supposed to say it like that, but these are
Speaker 2: the meningitis associated ecoli.
Speaker 1: Ooh, that's right.
Speaker 2: Yeah, So this is one of the most common causes
Speaker 2: of meningitis in neonates, so tiny babies. It can also
Speaker 2: cause meningitis in adults, but it's much less common compared
Speaker 2: to other causes.
Speaker 1: Why.
Speaker 2: I think that just other bacteria are better at colonizing
Speaker 2: the mining geese, and so you'd have to be pretty
Speaker 2: sick already or have a root of entry. So these
Speaker 2: strains of E. Coli are associated mostly with meningitis following
Speaker 2: like a neurosurgical procedure in ADU.
Speaker 1: Oh okay, okay, yeah.
Speaker 2: But what's really scary is that in neonates, this type
Speaker 2: of E. Coli infection has a fatality rate of like
Speaker 2: fifteen to forty percent.
Speaker 1: Wow.
Speaker 2: Yeah, it's really it's really gnarly, and it's also an
Speaker 2: extremely common cause overall adults and children of bacterial sepsis.
Speaker 2: So bloodstream infections, right, and that can actually be from
Speaker 2: any strain of E. Coli, not only the UPEC or
Speaker 2: m NEX strains. You can have any any way that
Speaker 2: ecoli can gets into your blood. Once it gets there,
Speaker 2: it's pretty good at estabel and infection.
Speaker 1: Yikes.
Speaker 2: Yeah, so so those are collectively you want another academ here?
Speaker 1: Oh gosh, does end in heck er pecker?
Speaker 2: Yeah it does?
Speaker 1: What is it?
Speaker 2: Okay, they're the xpecs.
Speaker 1: I can't, I can't, I can't.
Speaker 2: These are the those are the extra intestinal pathogenic equal ie.
Speaker 1: Those we just talked about easy to remember, sure peck,
Speaker 1: XPEC eu peck. That's all we've learned so far. M
Speaker 1: neck Oh goodness, I can't.
Speaker 2: Okay, now we get into the more fun ones. Oh yikes, Okay,
Speaker 2: the EPEX people are gonna hate me. So now we're
Speaker 2: going to talk about the ones that actually colonize your
Speaker 2: gut in a way that is bad. The taro pathogenic
Speaker 2: equal ie the most famous of which we've heard a
Speaker 2: little bit about already, and that is the entaro hemorrhagic
Speaker 2: ecoal i e heck.
Speaker 1: Okay, So e hek is a form of epek. Yeah, bro, okay,
Speaker 1: it totally is. Do you want to know what gets
Speaker 1: even worse though? Aarin I even I, this is too
Speaker 1: much for even me.
Speaker 2: Ehk is also called s tech or v tech. Uh
Speaker 2: why let me tell you why? I'm so glad you asked.
Speaker 2: Oh no, The enterohemorrhagic E. Coal i are the strains
Speaker 2: that cause bloody diarrhea. Okay, Entaro heemorrhagic, like hemorrhage means
Speaker 2: bleeding out and taro means your gut. Okay. So that's
Speaker 2: like a broad umbrella term that encompasses a number of
Speaker 2: different strains of E. Coli, all of which end up
Speaker 2: with symptoms like bloody diarrhea. Some of those strains produce
Speaker 2: a toxin called shiga toxin. Oh yeah, t s tech
Speaker 2: siga toxin E. Coli. Some other strains produce a toxin
Speaker 2: that's really really similar to shiga toxin that is called
Speaker 2: suga like toxin oh, okay, or verotoxin vero toxin.
Speaker 1: Sure, so those two phrases are interchangeable, and yet they
Speaker 1: still give rise to two different acronyms. Three Oh, I'm sorry, yes,
Speaker 1: three yeah.
Speaker 2: V tech s tech EHK. I think it's annoying, So
Speaker 2: I just go with EHK because it's the broadest one
Speaker 2: and it encompasses all of them.
Speaker 1: Cool, I mean, I'm just rolling with it.
Speaker 2: Yeah, all right, So let's talk about what this actually
Speaker 2: does inside of your body. This shiga toxin or suga
Speaker 2: like toxin. It's the same toxin that's produced by another bacteria, Shigella,
Speaker 2: which arguably might actually just be a subspecies of Ecoli.
Speaker 1: Okay, yeah, so I'm glad. Yeah, I talk a little
Speaker 1: bit about it.
Speaker 2: But yeah, yeah, it's basically it. Basically they are so
Speaker 2: closely related it might as well be a subspecies. It's
Speaker 2: also possible that equoali oh one to five seven should
Speaker 2: actually be a Shagella.
Speaker 1: It's like some Ecoli strains should be Shigella and some
Speaker 1: Shagella strains should be Ecoli.
Speaker 2: Yes, is yeah what I wrote?
Speaker 1: Okay, Yeah, anyway, that blew my mind, by the way.
Speaker 2: Yeah, yeah, so they all produce this toxin that the
Speaker 2: bacteria can then release that causes damage directly to the
Speaker 2: mucosa of your intestine. These bacteria tend to colonize in
Speaker 2: your large intestine, in your colon, and when they release
Speaker 2: this toxin, they can cause perforation of your intestine. They
Speaker 2: can cause necrosis, so they can cause your your colon
Speaker 2: to actually die in places, and this is what results
Speaker 2: in the bloody stools that you see in enterohemorrhagic equali infections.
Speaker 1: Question about this unless you're going to cover this in
Speaker 1: the poop section.
Speaker 2: Oh we're in the poop section girl.
Speaker 1: Oh great, okay, okay, I thought so. I didn't want
Speaker 1: to get my hopes up in case we weren't. So
Speaker 1: bloody diarrhea doesn't mean red blood in your poop.
Speaker 2: Great, question, it can, and in this case it probably does.
Speaker 1: Okay.
Speaker 2: It all depends on where you're bleeding from. Yeah, So
Speaker 2: the higher up you bleed in your GI tract, the
Speaker 2: more black your stool is going to look when you
Speaker 2: poop it out right. The lower down you're bleeding, the
Speaker 2: more bright red this blood is going to be.
Speaker 1: But soose S tech V tech et cetera. Whatever, ones
Speaker 1: that actually cause the hemorrhage. E heck, cause the hemorrhage
Speaker 1: in your gut. That can that can produce any shade
Speaker 1: of bloody diarrhea.
Speaker 2: Yeah yeah, because they colonize your colon, and your colon
Speaker 2: is pretty big and large. So if they're colonizing closer
Speaker 2: to no erin, I'm gonna get my, oh my anatomy.
Speaker 2: If they're colonizing closer to the left side where the
Speaker 2: outlet is, then it might be more bright red blood.
Speaker 2: If they're colonizing closer to the start of your colon,
Speaker 2: it might be a darker color.
Speaker 1: Okay. In any case, seek medical attention. Yeah rah, Unless
Speaker 1: you ate beats the night before.
Speaker 2: Unless you unless it's beats. I feel like we've had
Speaker 2: so many good title possibilities already.
Speaker 1: Well, I also feel like we've mentioned beats on a
Speaker 1: couple other podcasts or a couple of other episodes before ECOLI.
Speaker 2: Unless it's beats. Unless it's beats, okay, beats by beats. Okay.
Speaker 2: So that's the damage that this toxin and that this
Speaker 2: bacteria causes in your colon where it's actually colonizing. But
Speaker 2: what's really really dangerous about these enterohemorrhagic equali is that
Speaker 2: the toxin can actually leave the intestine and get into
Speaker 2: your bloodstream. If that happens, it can make it all
Speaker 2: the way to the kidneys, where it causes inflammation in
Speaker 2: the kidneys that can end up causing kidney failure.
Speaker 1: Yikes.
Speaker 2: And then what it also does is it it causes
Speaker 2: damage in your small blood vessels that then leads to
Speaker 2: small clots forming inside of your blood vessels, like little
Speaker 2: teensy tiny clots that when your blood then passes over
Speaker 2: these clotted chunks in your blood vessels, it shears your
Speaker 2: red blood cells.
Speaker 1: Oh my goodness.
Speaker 2: Right, And so this is what's called a hemolytic anemia
Speaker 2: because your red blood cells are literally bursting open. Whoa,
Speaker 2: because they're traveling over these tiny microclots. And those clots
Speaker 2: are formed by platelets. So now all your platelets in
Speaker 2: your blood are being used up. So the three main
Speaker 2: signs that you see are renal failure, kidney failure, this
Speaker 2: hemolytic anemia, and thrombocytopenia, which means your your platelet count
Speaker 2: is low. And that collectively is what's known as hemolytic
Speaker 2: uremix syndrome. Oh wasn't that.
Speaker 1: Okay, Wow, So I have a question, Okay, how does
Speaker 1: it does it benefit ecoali to produce this toxin in
Speaker 1: terms of their replication or in terms of their ability
Speaker 1: to colonize new areas? Like why do they Why do
Speaker 1: some strains produce this toxin and some don't? Does it
Speaker 1: give them some sort of fitness advantage?
Speaker 2: That's a really really good question. I don't fully know
Speaker 2: the answer to that, but what I can tell you
Speaker 2: is that a lot of these strains of E. Coli,
Speaker 2: especially like oh one five seven, are naturally found in
Speaker 2: the guts of ruminants like cows and cheap So I
Speaker 2: wonder if it provides a fitness advantage in those environments
Speaker 2: in some way. M right, like guts, the guts of
Speaker 2: cows are bananas, They're like have five stomachs and stuff.
Speaker 1: So I know, what if the microfloor is totally different
Speaker 1: at each one of them.
Speaker 2: Oh, it probably is, I know.
Speaker 1: But like there's probably a study out there, but but
Speaker 1: we just haven't read it.
Speaker 2: Isn't that veterinarians going to be like, you guys, let
Speaker 2: me tell you tell us we want to not Yeah,
Speaker 2: we want to know. That's a really good question. Though,
Speaker 2: because yeah, the toxins are expensive for bacteria to produce,
Speaker 2: so presumably in some way it has to be. You
Speaker 2: would think, because these strains are so prevalent, you would
Speaker 2: think that, yeah, it does cause some kind of fitness advantage. Probably,
Speaker 2: great question. So yeah, that's uh. That is the enterohemorrhagic ecoalize,
Speaker 2: the most famous of which is E. Coli one five
Speaker 2: to seven H seven specific, let's just call it. That's
Speaker 2: what I do for most of it. Yeah, this is
Speaker 2: what causes outbreaks very often, but it also causes tons
Speaker 2: of infection across the globe and in the US that
Speaker 2: isn't outbreak associated, so we actually often never know what
Speaker 2: the source of infection is. But in general, you get
Speaker 2: sick between one and three days. You'll start having this
Speaker 2: diarrhea that's often bloody within one to three days after exposure,
Speaker 2: although it can be as long as ten and about
Speaker 2: five to ten percent of people that get infected with
Speaker 2: EHK will end up getting hemolytic uremic syndrome.
Speaker 1: Wow, I didn't know it was that high.
Speaker 2: The thing is that number varies a lot based on age,
Speaker 2: so in kids it's potentially even higher, especially in very
Speaker 2: young children. But in adults, that number is quite a
Speaker 2: lot less, so on balance. Yeah, so that's the entero haemorrhagic.
Speaker 2: There's one last kind of poop that I'd like to
Speaker 2: talk about before we're done here.
Speaker 1: Wonderful.
Speaker 2: So there's another strain of ecoli called e tech.
Speaker 1: Do we not talk about E tech already?
Speaker 2: No? No, we haven't. We've had EHC and now we have.
Speaker 1: E tech extraterrestrial ecola.
Speaker 2: Very very good. Guess so close. Entaro toxogenic okay, okay?
Speaker 2: And taro so toxogenic.
Speaker 1: Yeah, it has toxin and it's in your gut, and
Speaker 1: it's somehow different than shigella or than schiga toxin.
Speaker 2: Yes, exactly, that's exactly right. This is another kind of toxin,
Speaker 2: and specifically, this type of toxin is more similar to
Speaker 2: a toxin produced by Vibrio cholera.
Speaker 1: Oh yeah, so.
Speaker 2: It's not the same toxin, but it's very similar. So
Speaker 2: you can imagine that the diarrhea that you have with
Speaker 2: this type is more similar to cholera diarrhea, which is what.
Speaker 1: Aerin rice water stool.
Speaker 2: Exactly. So this is a watery diarrhea, not a bloody diarrhea. Okay,
Speaker 2: is that cool?
Speaker 1: Yes? I mean cool is maybe that's the word I
Speaker 1: would choose.
Speaker 2: I think it's pretty cool. I mean it's actually not
Speaker 2: cool because etech, as it turns out, is the cause
Speaker 2: of what's often called traveler's diarrhea. Oh, yes, that's etech.
Speaker 2: Which what that means is that etech is an extremely
Speaker 2: important cause of diarrhea in children in developing countries, so
Speaker 2: second only to like rotavirus, and probably up there in
Speaker 2: competition with rotavirus for the most important diarrheal disease. Okay,
Speaker 2: in the developing world. So it's a huge cause of
Speaker 2: morbidity immortality, and it's a watery diarrhea, so it's not bloody,
Speaker 2: but you're losing so much water that you then can
Speaker 2: end up dying from dehydration. Right, Okay, there are other
Speaker 2: enteropathogenic ecal eyes. I'm too big of a topic. I know,
Speaker 2: we're not going to talk about them. Quite honestly, we
Speaker 2: don't know as much about them, and we don't have
Speaker 2: time and etc. If you want all of the nitty
Speaker 2: gritty details of all these different pathotypes, there was a
Speaker 2: great Nature review from two thousand and four that I
Speaker 2: read that goes into way too much detail, and that
Speaker 2: will be posted on our website. So great, that's the
Speaker 2: biology of ekoli Aaron, beautiful, thank you, thank you. I
Speaker 2: made it myself. So tell me how the heck did
Speaker 2: it get here? Where did this thing come from? And
Speaker 2: why does some strains just want to kill us? Oh?
Speaker 1: Great questions. First, let's take a little break. I think
Speaker 1: that for most people the words e coli bring to
Speaker 1: mind these images that you kind of just went over
Speaker 1: and described this writhing gut, bloody diarrhea, just doubled over
Speaker 1: in the bathroom, trying to hang on. And a smaller
Speaker 1: subset may also think of ecolai's role as a model
Speaker 1: organism in the lab.
Speaker 2: That's what I think of, if we're honest.
Speaker 1: Have you worked with E coli before in the lab?
Speaker 2: Yes, I used it during my master's a lot. And
Speaker 2: also because we use it as a water quality indicator,
Speaker 2: so I've worked with ekoi a lot actually in the past.
Speaker 1: Yeah, it's a stinky colonizer. Yeah, it's not all good
Speaker 1: when you crite those big cultures smell so bad. It's
Speaker 1: really bad. But I think that those two roles you
Speaker 1: know this like super pathogenic one and also this lab
Speaker 1: model organism account for a tiny amount of the amazing
Speaker 1: diversity of E.
Speaker 2: Coli.
Speaker 1: Oh cool, because I mean A cola is found all
Speaker 1: over the earth. Oh yeah, inside people and animals and stuff,
Speaker 1: and also outside of them, which is.
Speaker 2: Why it makes for a terrible water quality indicator. Right, yeah,
Speaker 2: I was actually good point, yes, thank you.
Speaker 1: And also they're incredibly numerous. So Carl Zimmer estimated in
Speaker 1: his book about E. Cola, which was great, by the way,
Speaker 1: he estimated that there are about one hundred billion billion E.
Speaker 1: Coli on Earth, which is not a number I can comprehend,
Speaker 1: and I don't know if anyone can comprehend it. Please
Speaker 1: let us know. These bacteria are among the top, if
Speaker 1: not the very top, most studied organisms on the planet.
Speaker 1: Research on Ecoli has led to Nobel prizes, to genetic engineering,
Speaker 1: to insights into evolution and cellular biology how genes work.
Speaker 1: And there could really be an entire podcast series on
Speaker 1: the contributions of Ecoli to our understanding of how life works.
Speaker 1: So let's start at the beginning, and to do that,
Speaker 1: we have to go so far back, so so far
Speaker 1: back before humans were even humans, because E. Coli has
Speaker 1: been with us for as long as we've been a species.
Speaker 1: And way before, and probably caused occasional food borne illnesses
Speaker 1: during that long relationship. But until microscopy and microbiology emerged,
Speaker 1: it's hard to pinpoint exactly what might have caused the
Speaker 1: fatal diarrhea of this or that person and be able
Speaker 1: to conclusively say that it was ecoli. So this is more.
Speaker 1: This history is less. These are the pandemics of E.
Speaker 1: Coli and more. Yeah, more, you're about to find out.
Speaker 1: So humans first learned about the existence of E. Coli
Speaker 1: when in eighteen eighty five a German pediatrician named theatre
Speaker 1: escherish Which did we even say, Oh.
Speaker 2: My god, no, because do you know what I can't
Speaker 2: pronounce it and I didn't want another gr dam situation.
Speaker 1: Well, okay, Becauseishia Escherishia.
Speaker 2: I have never attempted to pronounce that word in my life.
Speaker 1: I don't. I mean, I've tried to do it, but
Speaker 1: I don't. I mean it's an attempt, of course. But
Speaker 1: I remember my micro tea, my micro professor in undergrad
Speaker 1: saying that one of his friends, who was also a microbiologist,
Speaker 1: gave their daughter the middle name of Escherishia because he
Speaker 1: thought it was so beautiful. Wow, weird anyway. Okay, So, anyway,
Speaker 1: Theodore Esherish was looking at baby poop under the microscope
Speaker 1: and noticed a bunch of rod shaped bacteria. And he
Speaker 1: the reason he was looking at baby poop is because
Speaker 1: he had been waging a full on war against diarrhea,
Speaker 1: believing it to be one of the biggest killers of
Speaker 1: infants under his care.
Speaker 2: And he was right, totally trite. Yeah, yeah, for sure.
Speaker 1: He was looking under the scope to try to see
Speaker 1: if he could figure out what's good bacteria and what's
Speaker 1: bad bacteria? Wow, which I think yeah, eighteen eighty five
Speaker 1: forward thinker. Yeah. And so he would look for bacteria
Speaker 1: in both healthy and unhealthy children and say, okay, what
Speaker 1: can I find in just the unhealthy ones versus what
Speaker 1: do I find him both? And he found E. Coli
Speaker 1: in both, and so he didn't really consider it to
Speaker 1: be that interesting of a finding, but he published it anyway,
Speaker 1: and absolutely no one took note of it.
Speaker 2: Shocker, right.
Speaker 1: And the original name, which was much easier to pronounce,
Speaker 1: was Bacterium coliinus, so common bacteria of the colon wow. Yeah.
Speaker 1: But seven years after his death in nineteen eighteen, scientists
Speaker 1: renamed it after him. Oh, Okay, So just a few
Speaker 1: years after that, a biochemist named Edward Tatum. I don't know,
Speaker 1: I really want to know if he's related to Channing.
Speaker 2: Mister Channing.
Speaker 1: Yeah, Edward Tatum started to culture a strain of E. Coli,
Speaker 1: the K twelve strain if you're curious in the lab
Speaker 1: and the K twelve. This K twelve strain that's so
Speaker 1: popular for lab work today was isolated from a dude
Speaker 1: who had diphtheria and was living in California in the
Speaker 1: early nineteen hundred. So what Yeah, he.
Speaker 2: Hadthera and just happened to have this strain of E.
Speaker 1: Col I. Don't really know the full story, but yeah,
Speaker 1: I assume that's because this is a harmless strain, like
Speaker 1: this is a nonpathogenic strain.
Speaker 2: Yeah.
Speaker 1: Right. So Tatum had recently gotten super interested in the
Speaker 1: very new field of genetics, because this is the early
Speaker 1: nineteen hundreds, and he had actually worked with Thomas Hunt
Speaker 1: Morgan and George Beetle, which like two of the biggest
Speaker 1: pioneers in the field, and up until this point of time,
Speaker 1: genetics had mostly been studied using things like fruit flies
Speaker 1: and bread mold, which were more complex in some ways
Speaker 1: than bacteria, particularly in that they had sex like gene
Speaker 1: exchange or were known to Tatum wanted to see whether
Speaker 1: bacteria like E. Coli also followed the one for every
Speaker 1: one gene for every enzyme rule that had been the
Speaker 1: pattern he discovered in mold. And he chose E. Cola
Speaker 1: because it has very few requirements in the lab, grows
Speaker 1: rapidly and produces visible colonies, which is useful for monitoring
Speaker 1: what exactly is going on. And he blasted E. Coli
Speaker 1: with X rays, managing to produce a few mutants, which
Speaker 1: gave this huge indication bacteria have genes. Because if you
Speaker 1: blast something with X rays and then there are mutations
Speaker 1: that happen and there are differences in the bacteria after that,
Speaker 1: then that shows that these things have changed based on
Speaker 1: how they.
Speaker 2: Write their DNA has been affected.
Speaker 1: Yeah, that was a huge finding. But did that matter
Speaker 1: that much? Did the fact that bacteria had genes matter
Speaker 1: that much if the bacteria couldn't reproduce sexually. Yeah, And
Speaker 1: so from these findings, another guy named Joshua Letterberg, who
Speaker 1: was twenty one years old, just wanted to say this, Yeah,
Speaker 1: I know that hurts.
Speaker 2: Don't tell me that He got like the Nobel Prize.
Speaker 1: Oh my, he did, okay, So Joshua Letterburg decided he
Speaker 1: would look for bacteria sex. So he was just convinced
Speaker 1: that people weren't looking hard enough, and he found it.
Speaker 1: So he found Ecola mutants could exchange genes somehow, And
Speaker 1: from this monumental discovery that led to basically the amount
Speaker 1: of research is on. You can't count the number of
Speaker 1: like findings or new laws of biology or whatever, all
Speaker 1: these discoveries. These three dudes, So Letterberg, Tatum, and Beetle
Speaker 1: were given the Nobel Prize in nineteen fifty.
Speaker 2: Eight, and he was twenty one.
Speaker 1: He was twenty one, not in nineteen fifty eight, but
Speaker 1: he was twenty one when we discovered bacteria sex.
Speaker 2: Yeah, well to I mean, he's great.
Speaker 1: Come on, come on, it's never too late. It's never
Speaker 1: too late.
Speaker 2: No, that's true, it's not.
Speaker 1: Studying E. Coli would lead to other huge advancements, such
Speaker 1: as discovering that viruses had genetic material, which was learned
Speaker 1: by looking at the bacteria phases of E.
Speaker 2: Coli.
Speaker 1: It would also help to show conclusively that genes are
Speaker 1: made of DNA, which overturned the long held hypothesis that
Speaker 1: DNA was made of proteins, and it even helped to
Speaker 1: reveal the structure of DNA in what apparently is known
Speaker 1: as the most beautiful experiment in biology. And I'm not
Speaker 1: going to get into the details of it, but it
Speaker 1: has to do with like nitrogen and different weights and
Speaker 1: lots of centrifugion. If you want to know more, read
Speaker 1: the book Microcosm by Carl Zimmer. It keeps going though.
Speaker 1: Ecol I also helped to show how DNA was made
Speaker 1: up of codons and how these codons match to certain
Speaker 1: amino acids. By studying Ecoli, scientists were learning about the
Speaker 1: rules that govern life itself and even what it means
Speaker 1: to be alive. It's amazing. It's amazing. Ecoli has thousands
Speaker 1: of genes, and scientists have a pretty good idea, if
Speaker 1: not exactly the idea, of what each of those genes do. Basically,
Speaker 1: you knock a gene out and you see what happens.
Speaker 1: And by fiddling with these mutant varieties be Coli, researchers
Speaker 1: also figured out the genes can be turned off and
Speaker 1: turned on, that they don't work in isolation, but are
Speaker 1: rather connected like a circuit board. Ecoli has been subject
Speaker 1: to the whim of so many researchers who wanted to
Speaker 1: see if it could be grown at extremely high temperatures
Speaker 1: or super low levels of food, or infected with tons
Speaker 1: of viruses. And what the scientists observed over and over
Speaker 1: again was evolution at work on a timescale that no
Speaker 1: one had thought was possible, even though now it kind
Speaker 1: of maybe seems.
Speaker 2: Obvious antibiotic resistance and all that exactly, Yeah, yeah. E.
Speaker 1: Coli was used in genetic engineering starting in the nineteen seventies,
Speaker 1: when it caused quite a stir and now no one
Speaker 1: thinks twice, but people started using it for insulin production,
Speaker 1: which led to this huge industry which was fueled initially
Speaker 1: by controversy and then by demand. Doctors sometimes would give
Speaker 1: or still give. I don't know, you tell me a
Speaker 1: strain of E. Coli called a zero thirty four slash
Speaker 1: eighty six to premature infants that don't have fully formed
Speaker 1: intestines because it helps them protect against nasty gut pathogens.
Speaker 2: I don't know if they steal do that, but that's genius.
Speaker 2: Because babies get colonized with ecolai in like minutes, like
Speaker 2: oh after bears. It's amazing.
Speaker 1: It's amazing. And so this this particular like helpful strain
Speaker 1: or whatever. Some of its genes code for things that
Speaker 1: directly fight the weapons of strains like oh, one to
Speaker 1: five seven, stop it. Yeah, this is like a total
Speaker 1: role reversal. Usually you're the one telling me about this
Speaker 1: strain differences.
Speaker 2: I love it.
Speaker 1: Okay, Okay, just a couple more cool bits about E.
Speaker 1: Coli before the history of the pathogenic one the poop.
Speaker 2: Yes.
Speaker 1: E Coli can sense each other.
Speaker 2: Oh yeah, Oh, I'm so glad you're talking about this.
Speaker 1: It's amazing. Okay. So a group of researchers least E.
Speaker 1: Coli labeled with a glowing protein into a maze and
Speaker 1: wanted to see how they would move and what would happen.
Speaker 1: And at first, so you could trace these individual cells.
Speaker 1: Right at first, everything was random, but then eventually the
Speaker 1: researchers saw a pattern emerge. The bacteria were moving towards
Speaker 1: other bacteria, and soon there was this giant cluster of E.
Speaker 1: Coli just hanging out. Okay, so it turns out you're
Speaker 1: doing a very happy dance. It turns out that Ecoli
Speaker 1: shoots out serene in its waist and other Ecoli might
Speaker 1: use that as a sensing mechanism to find other E.
Speaker 2: Coli.
Speaker 1: Once they're all together, they might even change their behavior,
Speaker 1: so instead of having their normal flagellum, they grow a
Speaker 1: giant one that gets tied up with other flagella, creating
Speaker 1: a rat king of E. Cola.
Speaker 2: Oh my gosh, ecolid like bacteria having behavior is one
Speaker 2: of the coolest things.
Speaker 1: And this whole rat king whatever like tails are flagellatide, Yeah,
Speaker 1: helps them move as a group across a petri dish
Speaker 1: or maybe even your intestinal wall.
Speaker 2: Definitely your intestinal wall.
Speaker 1: It's amazing. It's amazing, dude. Okay. Even though now I
Speaker 1: think most of us think of E. Coli as this
Speaker 1: deadly food born terror, For several decades after its description
Speaker 1: and even after its use in a lab as basically
Speaker 1: the thing that revealed all secrets of life, people weren't
Speaker 1: aware of how sick it could make you. So it
Speaker 1: wasn't until nineteen forty five that the link between E.
Speaker 1: Coli and horrific gastintestinal disease was really conclusively made. Have
Speaker 1: you ever heard of summer diarrhea?
Speaker 2: No? I know? In was it the poly episode we
Speaker 2: talked like about closing down pools and things. But summer
Speaker 2: diarrhea no.
Speaker 1: Yeah, so this was like a known phenomenon as something
Speaker 1: called summer diarrhea. So if you go to Google scholar
Speaker 1: you can find reports of now analysis of what the
Speaker 1: summer diarrhea was and writings or whatever, but also in
Speaker 1: like reports from the early nineteen hundreds. So every summer,
Speaker 1: kids and infants in industrialized countries would get super sick
Speaker 1: with diarrhea, often bad enough to kill them. So it
Speaker 1: was this very seasonal trend of diarrhea and a British
Speaker 1: pathologist named John Bray decided to hunt for whatever pathogen
Speaker 1: might be causing this using antibody tests. He found that
Speaker 1: while only four percent of the healthy kids responded to
Speaker 1: the E. Cola antibody test like they were positive, ninety
Speaker 1: five percent of sick kids did. Huh, And so then
Speaker 1: he went. He would go on to describe this strain
Speaker 1: and several more that were pathogenic to humans.
Speaker 2: Interesting.
Speaker 1: Okay, so now here's the part that you've probably been
Speaker 1: waiting for. Maybe, yes, I don't know, maybe you've enjoyed
Speaker 1: all of this.
Speaker 2: I have enjoyed all of this.
Speaker 1: Okay, good enter oh one five seven h seven, don't, don't, don't,
Speaker 1: although we can't say for sure. Oh, one five seven
Speaker 1: seems to be a pretty recent arrival. It's like nineteen
Speaker 1: seventy five to.
Speaker 2: Be that's super recent.
Speaker 1: Yeah, No, samples can be found before then.
Speaker 2: Fascinating.
Speaker 1: It first made headlines in early nineteen eighty two in Medford, Oregon,
Speaker 1: and later that same year in Traverse City, Michigan. The
Speaker 1: source was under cooked burgers at McDonald's, and then it
Speaker 1: went quiet for about ten years until the infamous nineteen
Speaker 1: ninety three Jack in the Box outbreak. JTV baby, I've
Speaker 1: never had Jack in the Box? Do they not have
Speaker 1: it out east now or like, I don't know past
Speaker 1: the Mississippi River.
Speaker 2: Oh interesting, Yeah, JTV man.
Speaker 1: There have been dozens of one to five seven outbreaks
Speaker 1: all over the world since its first appearance, and I
Speaker 1: could probably go into each one of them to talk
Speaker 1: about the source of infection and the lessons learned. But
Speaker 1: I'm just going to focus on the nineteen ninety three
Speaker 1: Jack in the Box outbreak in the western US because
Speaker 1: this is probably the most famous.
Speaker 2: Food born or E.
Speaker 1: Coli outbreak in the US. It's pretty it's massive.
Speaker 2: Everyone still talks about it.
Speaker 1: Yeah, I mean it put ekoli like in as a
Speaker 1: popular phrase or like a known phrase to people.
Speaker 2: Yeah, totally.
Speaker 1: It resulted in landmark personal injury lawsuits, increased oversight of
Speaker 1: food production, and widespread public awareness of this deadly pathogen
Speaker 1: which you know, burgers used to be safe before this,
Speaker 1: maybe some worms. It started around Christmas nineteen ninety two,
Speaker 1: when six year old Lauren Rudolph was rushed to the
Speaker 1: er in San Diego after having bloody diarrhea. After a
Speaker 1: few days of battling the illness, she passed away. And
Speaker 1: in January nineteen ninety three, doctors at Children's Hospital in
Speaker 1: Seattle started noticing an unusual number of kids with hemolytic
Speaker 1: uremix syndrome, which is that thing you described. And this
Speaker 1: set off some alarm bells because you don't really see
Speaker 1: that number of cases very often. It's not it's pretty.
Speaker 2: Rare, right, yeah.
Speaker 1: And so the high number of HUS cases, which is
Speaker 1: the hemo hemolytic urimi syndrome, I'm just gonna call it HUS,
Speaker 1: it pointed towards an E. Coli outbreak, But those usually
Speaker 1: happen in the summer, So where could these cases be
Speaker 1: coming from? These children weren't connected to one another in
Speaker 1: any way like that at daycare or something like that.
Speaker 1: But there must have been a shared source somewhere. Epidemiologists
Speaker 1: that were assigned to the case did their thing, asking
Speaker 1: parents about their lives, their movement patterns, what food they
Speaker 1: ate at home, where they ate, and eventually a likely
Speaker 1: culprit emerged, Jack in the Box the Nations. Did you
Speaker 1: know it was the nation's oldest fast food chain.
Speaker 2: No, I did not know that it beat.
Speaker 1: Out McDonald's by like a couple of months. Huh. Anyway,
Speaker 1: they so, Jack in the Box had recently been having
Speaker 1: this big promotion for their monster burger so good it's scary,
Speaker 1: just like in retrospect, not a great not glareat.
Speaker 2: They don't make that burger anymore.
Speaker 1: No, I don't think so. Yeah, the pr campaign to
Speaker 1: get Jack in the Box to not fold as a
Speaker 1: company is pretty I think also Landmark.
Speaker 2: Yeah, there's like that's a whole podcast in and of itself.
Speaker 1: I feel like, oh, for sure. So the president of
Speaker 1: Jack in the Box, Bob NuGen, when notified that the
Speaker 1: company might be the source of this horrible outbreak, he
Speaker 1: immediately stole all of the restaurants in the affected areas
Speaker 1: from serving their burgers and destroyed the possibly contaminated batches
Speaker 1: of beef.
Speaker 2: Wow.
Speaker 1: Yeah, oh was he acted as fast as he I
Speaker 1: think it seemed like as fast as you could.
Speaker 2: Yeah, that's awesome.
Speaker 1: And he did all this without being entirely convinced that
Speaker 1: it was the beef that was Jack in the Box
Speaker 1: in the first place.
Speaker 2: But I mean, but you have dead kids, so it's
Speaker 2: like exactly, yeah.
Speaker 1: Well, and everyone was very like a lot of the
Speaker 1: people who were at Jack in the Box, I think
Speaker 1: were felt awful, Like, yeah, were very very troubled by
Speaker 1: I can't even imagine by their yeah yeah, what they're
Speaker 1: inactions I think had done. And so people knew at
Speaker 1: this time. People knew that undercooked chicken could be a
Speaker 1: problem in terms of salmonella, but no one really had
Speaker 1: heard of outbreaks of food poisoning associated with beef. It
Speaker 1: was a new thing at that point, or at least
Speaker 1: it seemed to be, according to this book. And so
Speaker 1: even though there had been this Ekoli outbreak just ten
Speaker 1: years before the Jack and Box, the one that was
Speaker 1: in McDonald's, it had gotten quietly buried, and so McDonald's
Speaker 1: wasn't really named And so When Washington State epidemiologist John
Speaker 1: Kobayashi told Bob Nugent, the president of Jack in the Box,
Speaker 1: that this horrible outbreak affecting all of these kids was
Speaker 1: likely tied to E. Coli contaminated burgers, NuGen was like,
Speaker 1: what so, even though that contaminated beef had been stopped,
Speaker 1: it was too late for a lot of people, mostly children.
Speaker 1: By the end of the epidemic, seven hundred and thirty
Speaker 1: two people were infected with E. Coli.
Speaker 2: Seven hundred and thirty two confirmed.
Speaker 1: Confirmed whoa all traced back to Jack in the Box
Speaker 1: restaurants in Washington, Idaho, Nevada, Nevada. How do you say?
Speaker 1: I say Nevada, and I know that's wrong, so I
Speaker 1: need to say it properly. Nevada, Nevada and California.
Speaker 2: Yeah, please leave that in because it's the funniest thing
Speaker 2: I've ever heard people. A lot of people say Nevada, Nevada.
Speaker 2: But the way that you went Nevada, Nevada.
Speaker 1: Because I knew it was wrong as soon as it
Speaker 1: left my mouth. Embarrassing. Oh God. Avoiding these restaurants wasn't enough, though.
Speaker 1: One of the four children who died during the outbreak,
Speaker 1: was seventeen month old Riley Dettweiler, and he contracted E.
Speaker 1: Coli from a friend in daycare who had picked up
Speaker 1: the bacteria from a burger. Oh, there were two other
Speaker 1: children who died, Selina Shribbs and Michael Nole. And all
Speaker 1: of the kids who died from this outbreak were younger
Speaker 1: six years or younger.
Speaker 2: Ah, those babies, yeah, I ough. Yeah.
Speaker 1: Even if you were fortunate to survive the initial infection,
Speaker 1: many people over one hundred experience long term side effects
Speaker 1: from the infection. Viously, with so much tragedy and suffering
Speaker 1: experience as a result of this epidemic, people wanted answers
Speaker 1: to questions like how did this happen? And how can
Speaker 1: we make sure this doesn't happen again. The first question,
Speaker 1: how did this happen? Actually ended up being fairly easy
Speaker 1: to answer. So in nineteen ninety three, the federal regulations
Speaker 1: for the temperature for cooking beef were one hundred and
Speaker 1: forty degrees fahrenheit sixty degrees celsius.
Speaker 2: Oh.
Speaker 1: Okay, however, so one hundred and forty degrees keep that
Speaker 1: in your head. And Washington, the state law was actually
Speaker 1: one hundred and fifty five degrees sixty eight point three
Speaker 1: degrees celsius. This regulation was, which was different than than
Speaker 1: the federal regulation higher temperature, was put in place by
Speaker 1: the same epidemiologist John Kobyashi that I mentioned earlier, and
Speaker 1: because he was aware of the danger that E coli posed.
Speaker 2: Wow, way to go.
Speaker 1: He chose one hundred and fifty five degrees fahrenheit because
Speaker 1: that was the temperature required to kill E coli. Whoa
Speaker 1: Jack in the Box in Washington was notified of this
Speaker 1: new regulation, but for whatever reason, didn't change their practices.
Speaker 1: They followed the federal regulation of one hundred and forty degrees. So, yeah,
Speaker 1: a lot of the cases probably could have been prevented
Speaker 1: if they had followed Washington state law. But Jack in
Speaker 1: the Box argued that they weren't completely responsible for a
Speaker 1: contaminated product. The screening regulations for E coli and beef
Speaker 1: weren't what they are today, Like, people didn't really screen
Speaker 1: that much for them.
Speaker 2: They Oh, I should have had Matt kmet Co on
Speaker 2: this episode. Oh my god, you're right what he does.
Speaker 1: It's so true.
Speaker 2: Shout out Matt.
Speaker 1: And so researchers were desperately trying to figure out where
Speaker 1: the strain came from and how to prevent it from
Speaker 1: getting into the food supply. And that's something that's way
Speaker 1: easier said than done, because it was found in around
Speaker 1: twenty eight percent of cows, and probably that number has
Speaker 1: jumped since this book was written. And so basically what
Speaker 1: happens is that during the slaughtering process, if a cow's
Speaker 1: colon is cut, that E Coli that's in the gut
Speaker 1: can that escape and basically all the meat is all
Speaker 1: blended together that oh like ground together? Yeah, that one
Speaker 1: to five seven can travel through literal tons of beef.
Speaker 2: Yeah, that's so gross, horrific.
Speaker 1: Proper cooking will kill the bacteria, but if a few escape,
Speaker 1: then there you go.
Speaker 2: And do you know the infectious dose for E. Coli
Speaker 2: is like as little as ten organisms.
Speaker 1: I remember that from micro Yeah, so that's how the E.
Speaker 1: Coli got into the beef. But how do you make
Speaker 1: sure it doesn't happen again? That's a much trickier issue,
Speaker 1: and probably because we've had several outbreaks since then, it's
Speaker 1: obviously tricky. So there are several stages of food prep
Speaker 1: that could have been improved. First, there's the beef industry itself.
Speaker 1: Clean up that process, maybe don't allow dropped carcasses to
Speaker 1: be incorporated, maybe cleaning the floor on which they are dropped,
Speaker 1: maybe following a one cow, one burger practice, which isn't
Speaker 1: what happens.
Speaker 2: I need to not think about it, or I'll never
Speaker 2: eat another burger again in my life.
Speaker 1: So well, it's it's funny that you said that, because
Speaker 1: that was my exact response when I read this in
Speaker 1: Carl Zimmer's book. And then the next paragraph is, and
Speaker 1: if you're vegetarian, don't feel so smug or something like that,
Speaker 1: like you're not escaping it either, because cows poop on crops.
Speaker 2: And then the most of the outbreak, not most, but
Speaker 2: a large number of the outbreaks recently have been in
Speaker 2: lettuce and spinachar Yeah.
Speaker 1: No cookie dough. We call it cookie like the title
Speaker 1: of our quarantine Cookie don't because raw flower is how
Speaker 1: people have gotten sick for the coal. I also, yeah, okay,
Speaker 1: but then there are also these restaurant quality control improvements
Speaker 1: that could be made cooking the beef at the temperature
Speaker 1: that actually kills e coal. I. So this, this Yekuli
Speaker 1: outbreak is notable not just because of its size, but
Speaker 1: because of the changes it led to in the food
Speaker 1: industry and the government oversight of it. So it really did.
Speaker 1: It was like a huge, huge deal, and a lot
Speaker 1: of people who work in food safety are today still
Speaker 1: very unsatisfied by how it's done. And that's kind of
Speaker 1: a fair point, considering that outbreaks continued to happen, all right,
Speaker 1: so you know, back to the whole vegetables are not
Speaker 1: necessarily safe. There was a nineteen ninety seven outbreak of
Speaker 1: oh one to five seven in Japan from tainted Radish
Speaker 1: sprouts that made twelve thousand people sick.
Speaker 2: Oh my what Yeah, three.
Speaker 1: Of whom died twelve thousand. September two thousand and six.
Speaker 1: In the US, there was an oh one to five
Speaker 1: seven outbreak in Spinach that made two hundred and five
Speaker 1: people sick. That same year, let us at Taco Bell
Speaker 1: made seventy one people sick. Like you could just go
Speaker 1: on and on and on. Yeah, So I could go
Speaker 1: on and on and on and on about all these
Speaker 1: different outbreaks, but I'm not going to this. Instead, Aaron,
Speaker 1: I want you to tell me where do we stand
Speaker 1: today with E Coli?
Speaker 2: I can't wait to all right, E Coli. Today it's everywhere, yeah, yeah,
Speaker 2: it's still everywhere. It causes so many different diseases. It's
Speaker 2: really hard to do an epidemiology section on this because like,
Speaker 2: what where do you even begin? I don't know. Let's start.
Speaker 2: Let's start where you left off with the inflammatory, bloody
Speaker 2: e heck food born outbreaks. Just looking over the last
Speaker 2: ten ish years, which is basically where you left off
Speaker 2: around two thousand and six two thousand and seven, there
Speaker 2: have been pretty much between one and four multi state
Speaker 2: outbreaks of like EHK, really bad bloody diarrhea E coli
Speaker 2: every year, wow much And each of these multi state outbreaks,
Speaker 2: the multi state outbreaks are the only ones that are reported,
Speaker 2: like easily accessible on the CDC website. You can go
Speaker 2: to every state health department and probably find a handful
Speaker 2: of outbreaks that were just contained to one single state.
Speaker 2: But of these multi state outbreaks, they range in size
Speaker 2: from like eighteen or twenty cases on the low end
Speaker 2: to over two hundred cases on the high end. And
Speaker 2: every year, from each of these cases, a handful of
Speaker 2: people are hospitalized and end up getting hemolytic uremic syndrome.
Speaker 2: Most years there aren't any deaths related to this, but
Speaker 2: every other year or so there's a bad outbreak and
Speaker 2: there are some deaths associated with this, so to put
Speaker 2: some numbers on that, from the last couple of years.
Speaker 2: So far in twenty nineteen, there have been two hundred
Speaker 2: and sixty three cases in three multi state outbreaks associated
Speaker 2: with ground bison also flower oh aka cookie, dow yeap,
Speaker 2: and ground beef. Of these two hundred and sixty three cases,
Speaker 2: fifty of them were hospitalized. Nobody died so far in
Speaker 2: twenty nineteen. Twenty eighteen was a little worse, although twenty
Speaker 2: nineteen is not over yet. There were three outbreaks with
Speaker 2: two hundred and ninety cases but one hundred twenty seven hospitalizations.
Speaker 2: And that's because two of those outbreaks were actually one
Speaker 2: five to seven. Oh yeah. So these are just all
Speaker 2: of the e HEK or s tech whatever you call it, outbreaks.
Speaker 2: Not all of those are oh one five to seven.
Speaker 2: And it turns out that one five seven is more
Speaker 2: likely to cause hus than some of the other e
Speaker 2: hex strains.
Speaker 1: Just based on the amount of shiga toxin or what.
Speaker 2: Yeah, or just the specific subtype of that siga toxin okay, yeah, right,
Speaker 2: or sugar like toxin. It's just more likely to end
Speaker 2: up causing hus So the years that you have oh
Speaker 2: one to five to seven outbreaks tend to be worse
Speaker 2: in terms of the number of people hospitalized and the
Speaker 2: number of deaths. But that's just the outbreaks from The
Speaker 2: vast majority of ECK cases are actually not outbreak associated.
Speaker 2: They're just individuals who end up getting sick and maybe
Speaker 2: end up in the hospital. So in twenty sixteen there
Speaker 2: were over fifty four hundred cases of EHEK reported.
Speaker 1: Wow. Yeah, that's like twenty times higher than.
Speaker 2: The outbreak numbers. Yeah, the vast majority of people they
Speaker 2: aren't actually part of an outbreak, which means that you
Speaker 2: never actually figure out where their infection came from.
Speaker 1: Oh gotcha.
Speaker 2: And that's the other important part of it. The only
Speaker 2: time you can identify an outbreak is if you have
Speaker 2: multiple people coming to the same hospital, or at least
Speaker 2: reporting to the same health district, so that someone can
Speaker 2: pick up on the fact that there's a number of
Speaker 2: cases happening. Right, If just one person comes, or even
Speaker 2: a couple people come but to different hospitals that somehow
Speaker 2: don't end up talking to each other, there's an outbreak
Speaker 2: going on, perhaps, but you'll never know about it. You
Speaker 2: just have a handful of cases, right, that makes sense.
Speaker 2: That makes sense, okay, So yeah, and then, like you
Speaker 2: mentioned that happened in the nineteen ninety three outbreak, about
Speaker 2: ten to twenty percent of cases can actually end up
Speaker 2: in what's called like a secondary attack, where people pass
Speaker 2: on that one to five seven or that ehex strain
Speaker 2: to somebody else in a daycare facility, changing diapers, nursing homes,
Speaker 2: et cetera. So yeah, ehek is gnarley. Yeah, but again,
Speaker 2: that's not the only ecola out there.
Speaker 1: Great, there's the one that makes you have watery diarrhea
Speaker 1: instead of bloody diarrhea.
Speaker 2: So let's talk about that one real quickly, right. So,
Speaker 2: e tech is what you were mentioning. The enterotoxogenic ecoli
Speaker 2: is a hugely important cause of morbidity and mortality worldwide,
Speaker 2: especially for infants and children. So there's a lot of
Speaker 2: interest in developing a vaccine for something like ETECH because
Speaker 2: we're talking millions of children every year that are affected
Speaker 2: by this and potentially dying as a result of it.
Speaker 2: There are some candidates in trials that seem promising, but
Speaker 2: nothing so far as licensed. You're going to see that
Speaker 2: for all the different things. Okay, great, yeah, cool. The
Speaker 2: other big type of E. Coli is, of course, the
Speaker 2: europathogenic ecoli, the UPEX. There's also a lot of interest
Speaker 2: in developing a vaccine for these because eighty percent of
Speaker 2: all UTIs are caused by E. Coli, and recurrent UTIs
Speaker 2: are really really common, so getting one UTI puts you
Speaker 2: at very high risk of getting a second UTI in
Speaker 2: a short period of time. So there's a lot of
Speaker 2: people working on vaccines for the various types of UPEX. Uh,
Speaker 2: there's not really a lot promising so far.
Speaker 1: Quite honestly, they have anything promising about this section.
Speaker 2: No, it ends on the worst note possible. So great, Yeah, yeah, yeah,
Speaker 2: it's so true. Uh. But yeah, it turns out that
Speaker 2: UTIs are a massive financial burden.
Speaker 1: Oh that makes sense.
Speaker 2: Yeah, Like three and a half billion dollars a year
Speaker 2: in the US alone is spent on UTIs.
Speaker 1: Three and a half billion dollars. Yeah, dude, Well what
Speaker 1: about other countries that don't have is outrageous healthcare situation?
Speaker 2: Good, good point, good point. But still, it's like eleven
Speaker 2: million doctors' visits in the US every year and two
Speaker 2: million emergency room visits for ugs alone. Wow.
Speaker 1: Okay, So even though like those numbers sensive for understanding
Speaker 1: more than I do with money.
Speaker 2: It makes sense. So yeah, there, but there are a
Speaker 2: lot of there is a lot of work going on
Speaker 2: on etech on UPEC and even on the ex so
Speaker 2: the enterohemorrhagic ecoli. There are people trying to come up
Speaker 2: with vaccines for all of these strains, but it's proving
Speaker 2: to be pretty elusive, which isn't that surprising considering how
Speaker 2: ubiquitous equoali is and how we have co evolved with
Speaker 2: it for so like literally the entire time that we've
Speaker 2: existed as humans.
Speaker 1: I mean, because yeah, also they're it's part of our
Speaker 1: normal microflora, so you'n't have to attack it from a
Speaker 1: different angle and if you did, like the suga sugar
Speaker 1: or shiga like toxin. But because we have vaccines that
Speaker 1: are based on toxins.
Speaker 2: Yeah, and that's exactly what most of these vaccines do.
Speaker 2: They're either component vaccines or they're toxoid vaccines, which are
Speaker 2: inactivated forms of a toxin essentially, And so that's exactly
Speaker 2: what people are trying to do, is to target the
Speaker 2: things that make these pathotypes different than our normal microflora.
Speaker 2: We just haven't been able to come up with one
Speaker 2: so far that produces a good immune response in humans
Speaker 2: to actually be protective, if that makes sense. That yeah, okay, yeah.
Speaker 2: And the other thing that's really scary is that antibiotic
Speaker 2: resistance is on the rise for ecoli in general, but
Speaker 2: especially for ecoli that tend to cause sepsis, so bacteremia,
Speaker 2: blood born infections, and.
Speaker 1: Those are most common in a hospital setting.
Speaker 2: They're very for surgery. Yeah, they're very common in hospital settings.
Speaker 2: They can happen also in babies, not just the meningitis,
Speaker 2: but just blood born infections in general. And from what
Speaker 2: I saw in the paper that I will post on
Speaker 2: our website, from two thousand to two thousand and nine,
Speaker 2: the rates of antibiotic resistant ecoli have risen about three
Speaker 2: hundred percent from two thousand to two thousand and nine.
Speaker 2: What Yeah, three hundred percent rise.
Speaker 1: It's really bad.
Speaker 2: And the numbers that I saw were that ecoli sepsis.
Speaker 2: So sepsis from ecoli in two thousand and one was
Speaker 2: estimated to have caused forty thousand deaths in the US,
Speaker 2: but in twenty fourteen that number may have been as
Speaker 2: high as eighty five thousand.
Speaker 1: What?
Speaker 2: Yeah, what. Ecola is a very common cause of sepsis,
Speaker 2: and sepsis is a very high mortality rate. So these
Speaker 2: are estimate numbers.
Speaker 1: Right, But that's so many people, I know.
Speaker 2: Yeah, it's really scary.
Speaker 1: Oh my gosh.
Speaker 2: Oh no, that's the end. Oh Aaron, it's literally the end.
Speaker 2: That's where my page ends. May have been as high
Speaker 2: as eighty five thousand.
Speaker 1: Great, okay, so good night everyone sleep Well I'm sorry. Okay,
Speaker 1: so not very much good news for ecola.
Speaker 2: Yeah, I should have organized that to be a happier ending,
Speaker 2: But I mean we could end it with the happiness
Speaker 2: that there is so much cool research going on using E.
Speaker 2: Coli in a lapse setting to develop other vaccines and
Speaker 2: cool stuff, and maybe things.
Speaker 1: Will get better somehow.
Speaker 2: Yeah. I mean there's people working on it. There are
Speaker 2: people out there trying really hard to make these vaccines happen,
Speaker 2: et cetera.
Speaker 1: Maybe looking back, these will be the dark days. Well
Speaker 1: they kind of are the dark days.
Speaker 2: But right now it's pretty dark days.
Speaker 1: We're in some weird timeline. Okay.
Speaker 2: Yeah, so but yeah, that's E coli?
Speaker 1: What is This was a massive topic.
Speaker 2: Yeah, we just barely even scratched the surface of that
Speaker 2: augur plate. Let me tell you, Oh, I really like that.
Speaker 2: Thank you. I just came up with it. I didn't
Speaker 2: even plan that.
Speaker 1: Mm hmm. She checks her notes.
Speaker 2: Do I say this joke?
Speaker 1: Check?
Speaker 2: All right?
Speaker 1: Well, I guess on these really sad notes. Should we
Speaker 1: discuss sources?
Speaker 2: Yes, let's so.
Speaker 1: I read. I read a couple of books. One is
Speaker 1: called Microcosm E. Coli and the New Science of Life,
Speaker 1: and that's by Karl Zimmer. I loved it, really fascinating
Speaker 1: a lot about the lab researchedn on Equali and how
Speaker 1: it's provided answers to evolution. Then I also read a
Speaker 1: book about the nineteen ninety three Jack in the Box
Speaker 1: outbreak called Poisoned, The True Story of the deadly equal
Speaker 1: I outbreak that changed the way Americans eat. That's why
Speaker 1: Jeff Benedict I can't necessarily recommend this book.
Speaker 2: That's all I'll say about it, Okay.
Speaker 1: And then I also watched a New York Times retro
Speaker 1: report that was like a new study report on the
Speaker 1: nineteen ninety three outbreak. And I'll also post a few
Speaker 1: more articles that I read.
Speaker 2: Awesome. I will post all of the articles that I read,
Speaker 2: which included that really intense Nature Reviews microbiology paper if
Speaker 2: you want the deets on equopathotypes, and then a bunch
Speaker 2: of reviews about the current status of various vaccines and things.
Speaker 2: All of these will be on this podcast will Kill
Speaker 2: You dot com. Under the episodes tab, you can find
Speaker 2: the sources for this and all of our episodes.
Speaker 1: Thank you to Bloodmobile for providing the music for this
Speaker 1: episode and all of our episodes.
Speaker 2: Thank you to all of you for listening. This is
Speaker 2: the most fun to make this podcast, and we really
Speaker 2: love that you love it.
Speaker 1: Yes, thank you for allowing us to keep talking at you.
Speaker 2: It's so fun.
Speaker 1: And with that, please wash your hands and cook your meat.
Speaker 2: Dear God, wash your hands. You fill the animals. E