- Associated Press - Sunday, June 5, 2011

BERLIN (AP) - When Nicoletta Pabst woke up last week with stomach cramps and diarrhea at her Hamburg home, it didn’t really bother her too much. But when she discovered blood in her stool a few hours later, she got worried.

Hamburg is at the epicenter of an E. coli outbreak, which has killed at least 18 people since May 2.

“We’d all been reading the scary news about the E. coli outbreak in our region for days,” the 41-year-old homemaker said in an interview with The Associated Press on Saturday. “So I talked with my husband about it and he took me to the university hospital right away.”

The epidemic is considered the deadliest E. coli outbreak in modern history. More than 1,700 people in Germany have been sickened, including 520 with a life-threatening complication that can cause kidney failure. Ten other European nations and the U.S. have reported 90 additional cases, all but two related to visits in northern Germany.

While suspicion has fallen on raw tomatoes, cucumbers and lettuce as the source of the bacteria, researchers have been unable to pinpoint the food responsible for the outbreak.

When Pabst and her husband arrived at the emergency room of the University Medical Center in Hamburg-Eppendorf, they were shocked by the chaotic scenes there.

“All patients suspected of E. coli were led to a separate location for examination,” remembered Pabst. “When I arrived, there were at least 20 other people and more and more kept coming in, many of them by ambulance.”

She said sanitary conditions in the emergency room were abhorrent.

“All of us had diarrhea and there was only one bathroom each for men and women _ it was a complete mess,” she said. “If I hadn’t been sick with E. coli by then, I probably would have picked it up over there.”

After waiting three hours to be seen, Pabst was told to go home because her blood levels did not indicate that she had kidney failure.

Hospitals in Hamburg have been struggling to provide enough beds for all the infected patients in recent weeks, and several people have said they were initially turned down, only to return days later with much more severe symptoms.

Pabst’s stomach cramps and bloody stools also got worse during the night. The next morning she was so weak that she couldn’t get up from bed, and her husband called an ambulance.

She was hospitalized at Asklepios Hospital in Hamburg-Altona and taken to an isolation room that doctors and nurses were only allowed to enter when covered from head to toe in protective gowns, gloves and mask.

Health officials questioned her about the food she’d been eating, and as a precaution her children were no longer allowed to go to school.

Nobody else in Pabst’s family got sick “even though we all ate the same tomatoes, cucumbers and salads,” she remembered.

The cause of her infection seemed to point to home cooking at her house or a friend’s, unlike suggestions Saturday that many people may have been infected while visiting a port festival in Hamburg last month or a restaurant in the northern German city of Luebeck, where health officials were investigating whether 17 persons might have been infected there.

Mostly women have been infected by the mysterious bacterial outbreak, but again, experts have not been able to find the reason for that either.

Pabst had to stay at the hospital for one week.

“For the first two days, I was completely exhausted, nodding off, not aware at all of what was happening around me,” Pabst remembered. She was put on an intravenous drip and her doctor decided to treat her with antibiotics despite official recommendations by the World Heath Organization and the German health ministry not to do so.

German Health Minister Daniel Bahr specifically warned Saturday against using antibiotics to quell the disease.

“It is not reasonable to use antibiotics because E. coli infections produce toxins which can be increasingly released by antibiotics and harm the organism badly,” Bahr told daily newspaper Ruhr Nachrichten.

Nonetheless, there have been more and more reports about doctors treating their patients with unconventional, non-approved therapies like antibody treatment or antibiotics, often simply because traditional treatment does not improve the patients’ health.

Friedrich Hagenmueller, the medical director of Asklepios Hospital, treated Pabst with antibiotics early on “because what we had been doing so far in this outbreak hasn’t been very successful.”

“Her quick recovery has encouraged me to try out antibiotics on other incoming patients as well,” Hagenmueller told the AP.

Hans-Joerg Epple, a gastroenterologist and infectologist at Berlin’s Benjamin-Franklin-Hospital, said that while antibiotics were normally not given to E. coli patients, some experts were looking into treating the current E. coli strain with specific kinds of antibiotics.

“It is quite unusual and we don’t have a lot of data on this, but there are indications that some kinds of antibiotics may be helpful here,” Epple said.

Pabst’s recovery started 48 hours after she’d received her first dose of antibiotics and on Wednesday she was discharged from the hospital.

Her children will be allowed to go back to school next week and Pabst said she’s feeling strong and healthy again herself _ she even took her kids to the market on Saturday, but only to look at the fresh produce there.

“One thing’s for sure: as long as the cause of the E. coli outbreak has not been found, there’ll be no more vegetables or fruit in our house,” Pabst said. “We’re only eating deep-frozen meals and spaghetti these days.”

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