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Escherichia coli | e-coli o157

The Sunday Times

Matthew and the burger bug

The Sunday Times Magazine, May 17 1998.

By Brian Deer

Matthew Bell lay on the sofa in the front room of his home and snuggled against a cushion half as big as himself as he gazed at Batman Forever on video. He was crazy about superheroes in serious outfits - Batman, Spiderman, Fireman Sam - and cut quite a figure himself as a blond-haired Superman at his local toddlers' group in Torrisholme, Morecambe. But on this Monday afternoon - it was nearly 4pm - his attention to the movie faltered. He had started to feel odd sometime earlier in the day, and now he had a pain in his tummy. Matthew grasped the cushion in a vain search for comfort, and wished the hurting would go away.

His mother, Rachael, was in the kitchen next door, grilling fish fingers for tea. As she laid out three plates, her youngest son, Tom, trotted between the rooms. It had been an exhausting day, like every day for this lone mother with two small children. On Friday, they had been for milkshakes at Brucciani ice cream parlour on the Morecambe promenade. On Saturday, Stuart, the boys' father, a painter and decorator, had come over and taken them all to McDonald's. Yesterday, they had played at a sea-front sandpit. And today they picked apples at an allotment. When Matthew complained, "Mam, my belly hurts," it seemed like just another routine stress.

Had Rachael known then what she found out later, she would have been terrified. Matthew, three years and nine months old, was showing the first symptoms of infection with the same kind of E-coli organism that is currently the subject of an inquiry in Scotland, after an outbreak in November 1996 traced to a Lanarkshire butcher's shop killed 21 people. As that Monday afternoon turned to evening, vicious toxins produced by the bug stuck to and attacked her child's gut. He started to suffer from diarrhoea and agonising stomach cramps. And he would soon become seriously ill.

A full explanation of what was happening to Matthew is still beyond medical science. The particular variety of the Escherichia coli bug that he had picked up - called O157:H7 - is a freak mutation of a normally harmless germ, and only surfaced in the 1980s. Despite a string of devastating outbreaks around the world, it never used to be thought to be a big enough threat to be worthy of major research. But last year the number of laboratory-confirmed infections in Britain suddenly jumped by 80%, to more than 1,500 cases, and experts are now alarmed. "It may have peaked," says Hugh Pennington, professor of bacteriology at Aberdeen University and the government's chief adviser on the subject. "But it may get 10 times worse."

No parent thinks of killer epidemics when their child has a stomach upset. On that afternoon, last September, Rachael, 32, thought that Matthew just needed a rest and would soon be up and about. She was not, in any case, the type to bother doctors or elbow her way to the front of hospital queues. Until she stopped work to look after the boys she had been a quality checker in a local factory which made toilet seats, cooker handles and switches. Her response was the same as that of young mothers' everywhere: she gave Matthew Calpol, a junior paracetamol, and waited for his tummy ache to pass.

Her son, too, was not a complainer. Despite being less than four years old, he had somehow assumed a prematurely adult role in their two-storey end-of-terrace house, opposite the post office on Lancaster Road. He had even been in on the birth of his brother, Tom, who was 19 months his junior. At night the boys shared an attic room and they played together every day. But he barely slept on that Monday night and on Tuesday he was again on the sofa. His mother was watchful and his brother was confused. But Matthew was hero-brave.

By Wednesday, it seemed to Rachael that he had more than a stomach upset. Matthew's diarrhoea now contained traces of blood, which was being shed from his gut as the poison from the bug caused the lining to ulcerate and swell. She called the night doctor, who came at 3am. He was a young, dark-haired Lancashire man. He examined the child and ruled out appendicitis. Without tests he could not tell her more.

"If it gets any worse, you should phone me," he advised her. Then he left on his out-of-hours round.

When she looked back later, Rachael felt that he had failed her. But most doctors would have acted no differently. Despite the growing number of high-profile food-poisoning reports - especially the Lanarkshire outbreak, which affected 400 people - and sporadic cases of sickness, brain damage and even death, few general practitioners have ever seen a case or learnt to spot the danger signs. There are plenty of other causes of diarrhoea, moreover, such as salmonella and campylobacter, which (at 6500 and 56,000 reported cases last year) swamp infections by the new E-coli.

North Lancashire's doctors were especially backward in their readiness to deal with the problem. Because the organism is still only gaining a foothold, it has a remarkably patchy distribution of infection - many some places, few in others. Scotland, for instance, has more cases than England, with the east more affected than the west. Canada is worse hit than the United States, with its west suffering more than its east. There had recently been a small outbreak 20 miles south of Morecambe in Garstang, traced to unpasteurised cheese, and another during 1991, linked to a McDonald's restaurant in Preston, but there was no sense of any local alert.

By Thursday, however, Rachael had seen enough and Stuart drove them over to the Royal Lancaster Infirmary, where they went to the emergency department. The blood in Matthew's diarrhoea was worse than before and now he was now vomiting up anything he ate or drank. He looked pale and tired from lack of sleep and nutrition, but still he made little fuss. He was taken to the paediatric ward, ward 34, on the ground floor of the main hospital building. A consultant examined him and nurse took a stool sample to be tested in the hospital laboratory.

Rachael was told that the test would take days. At 5pm that Thursday, it was judged that nothing more could be done at the hospital, and Matthew was discharged. Rachael was told the problem was gastro-enteritis, and given a patient information leaflet. "This is a common infection in childhood which causes diarrhoea," it explained. "There is often some vomiting as well. Most children will recover by 4-5 days, but sometimes it takes two weeks until everything is back to normal."

She was reassured, as any mother would be. But on Saturday morning - day 6 of Matthew's illness - she took him to see her GP. The boy now had a yellow tinge in his eyes, said that his back hurt and that his "wee won't come down". Also by now he was beginning to complain that he was feeling very sick. "Why can't the doctor make me better," he kept saying, when again they were told that there was no treatment for his condition, and he had returned to the sofa at home.

The following day, Sunday, Rachael phoned the hospital for the findings of the laboratory test. "We've had the result back this morning," a nurse told her. "It is E-coli O157."

Rachael was shocked. She had heard of E-coli. She had seen it on television. "That was what they had in Scotland," she said, now alarmed. "What should I do?"

But although young children with E-coli are at the greatest risk of complications from the infection, the nurse had been given no guidance on any action and couldn't offer any advice. "It doesn't mean a lot to me," is how Rachael recalls the nurse's response.

*****

Escherichia coli | e-coli o157
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