E. COLI CASES UNRELATED, OFFICIALS SAY

Words like isolated and unrelated were being used by health officials to describe two E. coli-related illnesses in Southeast Missouri, one of which resulted in a woman's death.

On Nov. 28, Muriel Frueh, 76, of Rolla went out for lunch with her daughter. Frueh, who was staying with her daughter in Cape Girardeau while she recovered from hip replacement surgery, began complaining of stomach cramps the next day. She was admitted to St. Francis Medical Center Nov. 30.

On Jan. 1, she died. Her death certificate lists kidney failure caused by infection with E. coli 0157:H7, a toxic strain of bacteria.

Until Frueh's death, family members say, they had never heard of the disease, usually associated with sometimes fatal food poisoning from undercooked beef. The best-known outbreak occurred at Jack in the Box restaurants in Washington state in 1993, when several children died. The infection can be contracted from several sources besides food, including unchlorinated drinking or recreational water.

Now Frueh's granddaughter, Kathy Bess Holloway, and daughter Charlotte Bess want to make the public aware of the potential risk of infection.

Holloway began researching the infection after her grandmother's diagnosis. She thinks it is underreported, and wonders how many others may have gotten sick or died from it.

"When you talk to the CDC (Centers for Disease Control), they make it sound like it's easier to get hit by lightning than to die from this," she said.

But, she said, after learning about the symptoms and how the disease is spread, "Now I'm convinced that this happens quite frequently but it's not being accounted for properly."

Watching her grandmother during her illness wasn't easy, Holloway said. The disease left her "racked with pain," she said.

"It's a rotten way to die," she said. "I need to talk about it and help other people not to get it."

Sue Tippen, communicable disease coordinator for the Missouri Health Department's regional office in Poplar Bluff, said one reported case of E. coli affecting a 3-year-old girl is currently under investigation in Mississippi County.

The father of the 3-year-old, Ricky Penrod of East Prairie, said his daughter's illness was caused by a different strain of the E. coli bacteria than the strain that killed Frueh. He said his daughter was very sick with flu-like symptoms when she was diagnosed with the illness Jan. 15.

"She's doing fine now," he said.

An official with the Cape Girardeau County Health Department, Jane Wernsman, said Frueh's infection was the only county case they confirmed in 1995. Her case is isolated, she said.

"I had six reports all of last year," Tippen said. "There could have been more. It's not always the serious disease; it can be self-limiting and not a real big problem."

Young children and the elderly are at the most risk with E. coli infection, she said. Others may just think they have a bad case of the flu. Symptoms include diarrhea, severe stomach cramps, vomiting, nausea and a low-grade fever. In severe cases, seizures, coma and blood clots in the brain may lead to death.

Irene Donelon, assistant bureau chief for the Missouri Department of Health's Bureau of Communicable Diseases, said E. coli 0157:H7 has only been reported in Missouri since June of 1992. For that reason, she said, it's difficult to track infections because there's little baseline data.

In 1992, 12 cases were reported in Missouri from June through December, including one death. Of the 12 cases, seven were confirmed not to have resulted in death, and no information regarding victims' death or survival was recorded in the remaining four cases.

In 1993, 35 cases were reported, including 28 not resulting in death and seven with no information recorded. In 1994, 40 cases were reported, including 36 not resulting in death, and four with no information.

Medical experts are concerned that infectious diseases will be on the increase, but Donelon said she's reluctant to try to predict whether E. coli 0157:H7 will become more prevalent.

Because it's now a reportable disease, she said, local health officials "are looking for it. We've known it was out there since 1982, but know we're looking for it. To say it's going up because there's more of it or because of better reporting, I can't do that."

In isolated cases like Frueh's infection, Tippen said, tracking down the source of the infection is virtually impossible.

"She consumed a product that could have been a possible contaminant but she did not get ill or get a diagnosis confirmed for several days," she said. Symptoms begin anywhere from one to seven days after infection with the bacteria, she said.

The dangers of infection by E. coli 0157:H7 from undercooked beef are well-known, Tippen said.

"What maybe the general public is not understanding is if you handle raw meat, and then you handle something that's going into somebody's mouth, there's a possibility of cross-contamination," she said.

For instance, if raw meat is placed on a plate, that plate should be washed before the cooked meat or other food is placed on it, Tippen said. It's also important that people who handle food wash their hands frequently to prevent spreading the E. coli bacteria or other sources of disease, she said.

Holloway said she and her family have no way of knowing how Frueh contracted the infection, and they are not interested in trying to lay blame.

"My motivation is to tell people that when they eat hamburgers look in the middle of them, and, if they're pink, send them back. Don't eat them," she said.

With proper sanitation, the infection is "completely preventable," Holloway said.

There are thousands of strains of the E. coli bacteria, most of them harmless to humans. E. coli 0157:H7 was identified in 1982. Outbreaks of the illness have been reported in Washington, Idaho, Nevada and California.