As public health officials continue to investigate an E. coli outbreak linked to romaine on sandwiches from Wendy’s restaurants, there is an increasing gap between patient numbers being reported by state and federal sources.

State and federal officials all say that the outbreak and investigation are fast-moving, complicating the counting of patients.

As of Aug. 24, the federal Centers for Disease Control and Prevention (CDC) continued to report a total of 37 infected people across four states: Michigan, Ohio, Indiana, and Pennsylvania. That total has been in place since the CDC’s most recent update on Aug. 19. Overall, the CDC is reporting that ten of the 37 patients have required hospitalization.

However, officials in the affected states and some of their counties are reporting higher patient numbers.

The Michigan Department of Health and Human Services has confirmed 53 patients with infections from the outbreak strain of E. coli. Altogether the state has 115 E. coli cases under investigation, but sample testing is pending on many of the patients, according to a public information officer for the state.

“It is likely that many of the 115 cases are linked to this outbreak, but the remainder either are still undergoing sequencing or we don’t have a sample to sequence. Not all samples are sequenced,” according to the public health information officer.

In Ohio, Wood County officials are reporting at least 22 confirmed patients in the outbreak, while the CDC is reporting only 19 patients for the entire state.

Several patients in both Ohio and Michigan have been diagnosed with the hemolytic uremic syndrome (HUS), which is a type of kidney disease that often requires dialysis and sometimes results in kidney transplants and death. 

State and federal officials routinely say that the numbers from their public health departments often don’t line up because of the time it takes for doctors and hospitals to report cases to states, for states to do initial and confirmation testing, and then report results to federal officials who then add patients to the overall list.

In the meantime, the Food and Drug Administration reported it has begun on-site inspections, but did not indicate what locations are being inspected. The agency could be inspecting restaurants or entities in the growing, packing, and distribution chain.

When contacted for comments on the outbreak, Wendy’s corporate officials sent an auto-response stating:

“We are fully cooperating with public health authorities on their ongoing investigation of the regional E. coli outbreak reported in certain midwestern states. While the CDC has not yet confirmed a specific food as the source of that outbreak, we have taken the precaution of discarding and replacing the sandwich lettuce at some restaurants in that region. The lettuce that we use in our salads is different and is not affected by this action. As a company, we are committed to upholding our high standards of food safety and quality.”

About E. coli infections
Anyone who has developed symptoms of E. coli infection should seek medical attention and tell their doctor about their possible exposure to the bacteria. Specific tests are required to diagnose the infections, which can mimic other illnesses.

The symptoms of E. coli infections vary for each person but often include severe stomach cramps and diarrhea, which is often bloody. Some patients may also have a fever. Most patients recover within five to seven days. Others can develop severe or life-threatening symptoms and complications, according to the CDC.

About 5 to 10 percent of those diagnosed with E. coli infections develop the potentially life-threatening kidney failure complication, known as hemolytic uremic syndrome (HUS). Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of urination, small unexplained bruises or bleeding, and pallor. 

Many people with HUS recover within a few weeks, but some suffer permanent injuries or death. This condition can occur among people of any age but is most common in children younger than five years old because of their immature immune systems, older adults because of deteriorating immune systems, and people with compromised immune systems such as cancer patients. 

People who experience HUS symptoms should immediately seek emergency medical care. People with HUS will likely be hospitalized because the condition can cause other serious and ongoing problems such as hypertension, chronic kidney disease, brain damage, and neurologic problems.

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