Dallas County Health and Human Services (DCHHS) is now investigating nine confirmed cases of Shiga toxin-producing E. coli (STEC), up from seven on Tuesday. The one common thread: every patient visited the State Fair of Texas before falling ill. Investigators are focused on the fair’s petting zoo.
The patients range in age, several are hospitalized in Dallas, and some children have required intensive care. Children’s Medical Center Dallas has reported an uptick in E. coli cases. DCHHS Director Dr. Philip Huang is urging anyone who may be sick to contact their doctor or the county health department.
The State Fair says there is no verified information tying the illnesses to its petting zoo. DCHHS has so far called this a “cluster” rather than an outbreak, and no serotype or whole genome sequencing results have been made public. Parker’s Promise, the nonprofit that supports families hit by zoonotic and environmental pathogens, is helping three families whose children are hospitalized and has reached out to a fourth – all four attended the fair. Parker’s Promise’s Mary McGonigle-Martin says the families she is assisting visited the petting zoo.
This should not surprise anyone. Petting zoos and animal exhibits have been the source of E. coli outbreaks for decades – the North Carolina State Fair/Crossroads Farm outbreak in 2004 sickened 108 and left 15 with HUS, and the 2005 Florida fairs/AgVenture Farms outbreak sickened 63 with 22 HUS cases. I have written about this for years. And the State Fair of Texas knows the risk – it once scrapped its petting zoo because its insurer would not take the gamble. Yet petting zoos remain largely unregulated when it comes to protecting children from E. coli and HUS.
What a child in the ICU with E. coli tells you
Health officials have not said how many of these children have hemolytic uremic syndrome (HUS). But in my experience, when a child with STEC lands in a pediatric ICU, HUS is usually the reason – or the doctors are watching closely for it. Severe dehydration and bloody diarrhea can send a child to the hospital; kidney failure, plummeting platelets and the need for dialysis are what put them in intensive care.
HUS – a primer
HUS is the most serious complication of an E. coli O157:H7 or other STEC infection. The bacteria produce Shiga toxin, which is absorbed from the gut into the bloodstream and attacks the lining of small blood vessels – particularly in the kidneys, but also the brain, pancreas and heart. The damage produces a classic triad: hemolytic anemia (red blood cells destroyed as they pass through damaged vessels), thrombocytopenia (a drop in platelets as they are used up forming tiny clots), and acute kidney injury.
Who gets it and when. Roughly 5 to 15 percent of people with STEC develop HUS, and the risk is highest in children under five and the elderly. HUS typically develops about a week after diarrhea begins – often just as the diarrhea is improving and parents think the worst is over.
Warning signs. Decreased urination, unusual paleness, extreme fatigue and irritability, unexplained bruising or tiny red spots on the skin, and swelling of the face, hands or feet. Any child with recent bloody diarrhea who shows these signs needs medical attention immediately.
Treatment. There is no cure – care is supportive. Many children need blood and platelet transfusions, and about half need dialysis while their kidneys recover. Some suffer seizures, strokes, pancreatitis or heart involvement. Antibiotics and anti-diarrheal medications are generally avoided in STEC infections because they may increase the risk of HUS.
The long tail. HUS is the leading cause of acute kidney failure in children in the United States. Most children survive, but a few percent die, and a significant share are left with long-term kidney damage, high blood pressure or other complications that can surface years later – some eventually needing a transplant. That is why children who had HUS need lifelong kidney monitoring. Last year in North Texas, 7-year-old Lily Rogers was hospitalized for 45 days after contracting STEC from a petting zoo and still has kidney issues.
Bottom line
If your child visited the State Fair of Texas and develops diarrhea – especially bloody diarrhea – call your doctor, ask for a stool test for E. coli, and report it to DCHHS. And keep watching for the signs of HUS for up to two weeks after symptoms start. Petting zoos are a known, high-risk exposure for young children. The fair and its exhibitors need to explain what handwashing, barrier and animal-health measures were in place – and why they were not enough.
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