New strain of Escherichia coli: Threat looms large over India

Syed Akbar
Hyderabad, June 3: The threat of new strain of Escherichia coli superbug, which is resistant to antibiotics and more aggressive than the normal strains, looms large over India as thousands of people travel daily between India and European countries.
The new strain could be imported to the country via Indians visiting Europe or European tourists visiting India. Doctors here fear that given the aggressive virulence of the new strain of E coli bacterium and high mortality rate it causes in humans, its spread in the country may trigger a health emergency.
"There are high chances of the new strain of E coli being spread in the country from Europe. If some person infected by E coli strain visits India during the incubation period and develops the disease here, he or she will release the new strain through stools and in bad sanitary conditions the disease could spread locally," points out senior physician Dr Aftab Ahmed of Apollo Hospitals.
The E coli outbreak that started in Germany has already spread to 10 other European countries and crossed the continent to the USA within a span of just 10 days. Given the highly compromised sanitation in India
and the daily movement of a large number of people between India and Europe, the spread of the new strain in India is just a matter of time, doctors fear. Incidentally, three Americans, who visited Germany, developed the disease after they returned home.
Ironically, most of the laboratories in the country are not equipped to identify the new serotype (strain) of E coli. The treatment could be mainly based on symptoms. But since diarrhoeal cases are not referred for stool tests, unless the problem is severe, it will be difficult for doctors to treat the health problems thrown up by the
new strain.
"Though there's a high possibility of the new strain being imported to India, the problem may not be as severe as in Europe, as people here do not prefer processed foods including meat. In case of processed foods, the outbreak can be severe as a large section of people who consume it will get the disease. But, many doctors in the country may not be able to identify the new strain," says infectious diseases expert Dr Suneetha Narreddy.
India has one of the highest number of deaths in the world due to diarrhoea and E coli is one of the main culprits, besides Vibrio cholerae, rotavirus, Shigella species and Salmonella species. According to National Institute of Cholera and Enteric Diseases, India alone contributes about 20 per cent of all global under-5 diarrhoeal deaths. In this scenario, the new strain, if it enters India, may create severe health problems.
The new strain (0104:H4)is a combination of Shiga-like toxin-producing E coli (STEC), which secrete toxins leading to bloody diarrhoea and often haemolytic-uraemic syndrome damaging kidneys, and entero-aggregative E coli. While STEC lives mainly in the guts of cattle, entero-aggregative E coli is known to live only in human beings.
Doctors advise that anyone who develops bloody diarrhoea and abdominal pain, and who has had contact recently with Europe, should seek medical advice urgently. They should indicate their visit to Germany
or other European countries to help doctors identify the serotype.