Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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More Spinach

The spinach scare continues, although I am hopeful that it will let up soon. As additional cases of infection with E. coli 0157:H7 are reported, efforts will be made to determine if they are linked with contaminated spinach.

Although I have heard comments from a few medical people regarding their belief that the advice to avoid eating raw spinach will soon change, the prudent thing now is to continue exercising caution until such time as public health officials sound the "all clear."

Here are a few more facts about E. coli 0157:H7:

1) The infection can be spread person to person. So, in the presence of someone with diarrhea, excellent hand-washing technique should be observed. Bacteria can be excreted in stool by humans for up to 2 weeks after a clinical infection.
2) The bacteria can be spread in food and water. It is possible to acquire an infection by ingesting as few as 10 bacteria.
3) After ingesting the bacteria, an infection may occur after an incubation period of 1 to 10 days, with 3 days being the average delay between exposure and illness.
4) As I mentioned in a previous post, signs and symptoms include abdominal pain, cramping, watery diarrhea (that may turn bloody), nausea, vomiting, fever or no fever, and weakness.
5) The diagnosis is made by taking a stool specimen and "culturing" it. That is, the stool is placed onto a special growth media in the laboratory and if the bacteria are present, they grow in colonies (e.g., multiply) and can be identified.
6) For treatment, antibiotics are not recommended. This is because in some cases, they may worsen the affliction. The precise reason this happens is not known, but one suggestion is that by causing rapid death of large numbers of bacteria, the result is release of large amounts of the Shiga toxin (also known as verocytotoxin), which causes the medical problems. Antidiarrheal agents, such as loperamide (Imodium) are also not recommended, because they are felt to possibly keep the bacteria in contact with the bowel for longer periods of time.
7) Most patients recover without antibiotics in approximately a week. Severely dehydrated individuals may require intravenous fluids. Children infected with E. coli 0157:H7 are at higher risk than are adults for developing hemolytic-uremic syndrome, in which they may suffer kidney failure.


1) Wash hands prior to preparing food, serving food, or eating.
2) Cook all risky food until it reaches a temperature of 160 degrees F for at least a minute.
3) Do not mix raw and cooked foods, particularly meat. After you cook meat, don't serve it on the unwashed dish that carried the raw food.
4) Since raw meat, especially beef, can be a problem, be certain to wash hands, cooking utensils, cutting boards, dishes, and counters after they have been in contact with raw meat.
5) Do not drink unpasteurized milk, cider, or fruit juices. Understand that in the absence of pasteurization, which is a heating process, no product can be guaranteed to not be contaminated with the bacteria normally killed in the pasteurization process. Many of us like to drink fresh fruit juice. When we do so, we take a risk, usually, quite minor, that it may be contaminated.
6) Wash all fruits and vegetables carefully, but understand that this is not absolutely foolproof.
7) Drink disinfected water only.
8) Try to not swallow lake or swimming pool water.
9) If a person is ill with a diarrheal illness, he or she should not prepare food for others or share common bodies of swimming or bathing water.

I understand that we cannot live in a bubble, but common sense and avoiding obvious risks can do much to prevent the spread of communicable diseases.

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photo of E. coli courtesy of
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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.