No one knows when or where E Coli may appear next. Precautions in eating, cooking and hygiene are never too early. Click button to listen to E Coli Part 1 and rightclick to download Click button to listen to E Coli Part 2 and rightclick to download Health: Keeping a close eye on E coli, The nasty O104: H4 strain of the bacteria hasn't yet made an appearance in Thailand, but that doesn't mean we should drop our guard by Arusa Pisuthipan If we were to draw up a list of places where Escherichia coli, the bacteria that's better known as E coli, can thrive, Thailand would certainly be on it. Cucumbers, tomatoes and beansprouts have all been suspected of carrying this deadly new strain of E coli, which has caused some countries to impose blanket bans or restrictions on the import of fresh vegetables from Europe. "E coli can grow in temperatures ranging from seven to 50 degrees Celsius. But its optimum growth temperature is 37C, which is pretty much equal to the average temperature in Thailand and in many other tropical countries," said Dr On-Umar Banpamai, a specialist on infectious diseases. The outbreak of the virulent O104: H4 strain of E coli that is thought to have originated in Germany last month has so far been responsible for more than 20 deaths, with almost 2,500 people falling ill in 14 European countries, the bulk of the cases being in Germany. Even though no instances of E coli O104: H4 infection have yet been reported in Thailand, that doesn't rule out the possibility of the life-threatening bacteria making its way here; which is why, Dr On-Umar said, the Health Ministry has made close monitoring and surveillance by both public and private healthcare providers mandatory. KNOWLEDGE IS PREVENTION E coli is commonly found in the environment as well as in humans and other warm-blooded animals where it usually lives in the gastrointestinal and urinary tracts. And, like other types of bacteria, there are several strains of E coli in existence. Most of these strains are harmless, especially those found within the human body where they serve a useful function by suppressing the growth of harmful bacteria and by synthesising significant amounts of vitamins. Some strains of E coli can make people ill, however. We usually come in contact with these nasty strains by consuming raw or undercooked food or food that has not been processed in a hygienic fashion. Human-to-human transmission is also possible. A person who is infected with E coli has the potential to spread the bacteria to others through shared food or liquids. "E coli normally causes only mild symptoms such as common diarrhoea which the patient will usually recover from within three or four days," said Dr On-Umar. "Other symptoms include urinary-tract infection, pyelonephritis [an ascending urinary-tract infection that has reached the pyelum or pelvis of the kidney], lung and respiratory-tract infections. Death caused by common E coli is very rare. IS THIS A NEW STRAIN OF E COLI The culprit responsible for sickening so many Europeans of late is not any of the aforementioned common strains of E coli but a mutated strain called O104: H4. A new bacterial mutation can cause severe or even fatal symptoms, explained Dr On-Umar, because our bodies have never encountered it before and thus have no in-built resistance to it whatsoever. There are a few factors that could explain the mutation of E coli. First, adaptive mutation is actually very common not only in E coli but also in other types of bacteria: They mutate their genes in order to survive. E coli that have been exposed to improper doses of antibiotics, for instance, will mutate in order to beat the drugs. And different strains of E coli can exchange genes among themselves and in so doing become a mutant species. Laboratory tests are still being carried out on O104: H4 and the investigation into its ancestry is by no means complete, but a number of scientists have already gone public to suggest it might be a mutation containing genes from two particularly aggressive types of E coli: Entero-aggregative E coli (EAEC) and Entero-haemorrhagic E coli (EHEC). All we know for sure so far is that this unwelcome arrival can cause a range of severe symptoms including abdominal cramps, vomiting, low fever and watery diarrhoea followed by bloody diarrhoea. It has an average incubation period of two to three days. In other words, symptoms can appear only a few days after the consumption of contaminated food. In some patients it has only taken a day for the bacteria to make its presence felt while in others the delay has been as much as 10 days. Five to seven days after the first symptoms occur, the diarrhoea usually subsides. But this is often the beginning of something far worse: haemolytic uremic syndrome (HUS), a disorder caused by a toxin called Shiga which is released by this mutant strain of E coli. Shiga triggers a serious inflammation of blood vessels. And when a blood vessel ruptures, there is a large build-up of platelets at the point of rupture. The resultant clotting disrupts the flow of blood through the vessel and when red blood cells collide with the clot they break. Dr On-Umar said the clot tears red blood cells open rather like a thorn on a rose might rip into one's finger. "Patients get progressively more anaemic and then develop acute kidney failure," the doctor explained, adding that HUS is fatal in five to 10% of cases. A mutant strain of E coli bacteria has so far been responsible for more than 20 deaths and the hospitalisation of almost 2,500 people in Europe. UNUSUAL BEHAVIOUR Those who are most prone to becoming ill when exposed to common strains of E coli are children, the elderly and people with weakened immune systems, the same risk groups who are vulnerable to infectious diseases in general. But this, said the specialist, is not the case for O104: H4. Strangely, the mutant E coli has been reported to cause sickness in adults of reproductive age more often than in children or the elderly. CAUTION IS KEY There is a high probability that this bacteria will mutate further given its adaptive nature so preventive measures must be taken by medical practitioners, food manufacturers, restaurateurs and the general population. Workers in the food-processing and catering industries should maintain the strictest standards of hygiene when handling food in order to ensure that it does not become contaminated and physicians will need to be alert for the symptoms of O104: H4 infection, especially in patients who have recently arrived here from European countries. "As for the increasing number of bacteria which are resistant to antibiotics, we can see that the overuse of antibiotic medication has almost become a cliche these days," Dr On-Umar noted wryly. "Physicians should prescribe antibiotics only when they are absolutely necessary. And patients should strictly follow their doctor's instructions and only take antibiotics as recommended. They shouldn't buy this type of medicine over the counter. And if they are prescribed antibiotics, it is crucial that they finish the entire course of tablets. Inappropriate use of antibiotics can give rise to resistant genes in bacteria. It was recently reported that O104: H4 E coli is already displaying resistance to a number of antibiotic drugs. 5 KEYS TO SAFER FOOD The World Health Organization (WHO) has published the ''Five Keys to Safer Food'' manual to raise public awareness on how to prevent foodborne illnesses, including the recent outbreak of E coli. The manual is available in 63 languages. KEEP CLEAN 1. Wash your hands before handling food and often during food preparation. 2. Wash your hands after going to the toilet. 2. Wash and sanitise all surfaces and equipment used for food preparation. 3. Protect kitchen areas and food from insects, pests and other animals. SEPARATE RAW AND COOKED 1. Separate raw meat, poultry and seafood from other foods. 2. Use separate equipment and utensils such as knives and cutting boards for handling raw foods. 3. Store food in containers to avoid contact between raw and prepared foods. COOK THOROUGHLY 1. Cook food thoroughly, especially meat, poultry, eggs and seafood. 2. Bring foods like soups and stews to boiling to make sure that they have reached 70C. For meat and poultry, make sure that juices are clear, not pink. Ideally, use a thermometer. 3. Reheat cooked food thoroughly. KEEP FOOD AT SAFE TEMPERATURES 1. Do not leave cooked food at room temperature for more than two hours. 2. Refrigerate promptly all cooked and perishable food (preferably below 5C).  3. Keep cooked food piping hot (more than 60C) prior to serving. 4. Do not store food too long even in the refrigerator. 5. Do not thaw frozen food at room temperature. USE SAFE WATER AND RAW MATERIALS 1. Use safe water or treat it to make it safe 2. Select fresh and wholesome foods. 3. Choose foods processed for safety, such as pasteurised milk. 4. Wash fruits and vegetables, especially if eaten raw. 5. Do not use food beyond its expiry date. Visit www.who.int (Source: Bangkok Post, Health: Keeping a close eye on E coli, The nasty O104: H4 strain of the bacteria hasn't yet made an appearance in Thailand, but that doesn't mean we should drop our guard, 14/06/2011, Arusa Pisuthipan, link) Health Vocabulary bacteria - a very small single cell living thing with no nucleus (prokaryote), reproduces by cell division (meitosis), along with viruses the cause of many diseases, typically a few micrometres in length, have a wide range of shapes, ranging from spheres to rods and spirals, the oldest and most numerous living thing on earth (See Wikipedia) E coli - a species of rod-shaped bacteria with many varieties commonly found in the lower intestine of warm-blooded organisms such as humans, most E. coli strains are harmless, but some types can cause serious food poisoning in humans, one the the harmless kinds of bacteria typically found in the human gut (See Wikipedia) Escherichia coli - long form of "E Coli" E coli O104: H4 - the variety of E Coli that caused the recent disease outbreak in Europe: "A currently ongoing Escherichia coli O104:H4 bacterial outbreak began in Germany in May 2011. Certain strains of E. coli are a major cause of foodborne illness. The outbreak started after several people in Germany were infected with bacteria leading to hemolytic-uremic syndrome (HUS), a medical emergency that requires urgent treatment. The agriculture minister of Lower Saxony has identified an organic farm in Bienenbüttel, Lower Saxony, Germany, which produces a variety of sprouted foods, as the likely source of the E. coli outbreak. The farm has since been shut down. Although the laboratories in Lower Saxony did not detect the bacterium in produce from the farm, it was later announced that a laboratory in North Rhine-Westphalia had found the deadly strain in a discarded package of sprouts from the suspected farm. A control investigation confirmed the farm as the source of the outbreak. While the threat of EHEC still exists, the number of new cases has been plunging. In addition to Germany, where 3,228 cases and 35 deaths had been reported as of 13 June, a handful of cases have been reported in several countries including Switzerland, Poland, the Netherlands, Sweden, Denmark, the UK, Canada and the USA. Essentially all affected people had been in Germany shortly before becoming ill" (See Wikipedia) haemolytic uremic syndrome (HUS) - "a disease with hemolytic anemia, acute renal failure (uremia) and a low platelet count (thrombocytopenia). It predominantly but not exclusively affects children. Most cases are preceded by an episode of diarrhea caused by E. coli O157:H7, which is acquired as a foodborne illness. It is a medical emergency and carries a 5–10% mortality; of the remainder, the majority recover without major consequences but a small proportion develop chronic kidney disease" (See Wikipedia) uremia (noun) - uremic (adjective)  outbreak - the sudden start of a disease, a war, violence, etc. การระบาดของโรค virulence (noun) - the ability of a disease to harm and kill people (See Wikipedia) virulent (adjective) - how harmful a disease for humans blood vessels - the tubes that carry the chemicals necessary for life around the body (oxygen, carbohydrates, lipids (fats), proteins, nucleic acids, vitamins and minerals, electrolytes, hormones, white and red blood cells), arteries carry blood away from the heart and veins carry blood back to the heart (See Wikipedia) red blood cells - erythrocyte, the cells that transport oxygen from the lungs to the tissues of the body where it used to produce energy (ATP) and transports carbon dioxide (the waste product produced) (See Wikipedia) clot - blood clotting or coagulation, part of the process of  "hemostasis" the complex process that the body follows to stop blood flow when the there is a break in a blood vessel, consisting of: 1. damaged blood vessels constricting (vasoconstriction), 2. platelets adhere to damaged endothelium to form platelet plug, 3. then finally the blood coagulates to form a blood clot when fibrinogen turns into fibrin (See Wikipedia) anaemia (noun) - the most common disorder of the blood, a decrease in number of red blood cells (RBCs) or less than the normal quantity of hemoglobin in the blood, it can include decreased oxygen-binding ability of each hemoglobin inside RBCs which carries oxygen from the lungs to the tissues, anemia leads to hypoxia (lack of oxygen) in organs (See Wikipedia) anaemic (adjective)  get progressively more anaemic - have decreasing blood cells over time (increasing anaemia) immune system - the system in the human body that protects the body against diseases (See Wikipedia) weakened immune system - a condition when the body is less able to protect itself from diseases inflammation - a red, painful and often swollen area in or on a part of your body การอักเสบ, การติดเชื้อ monitor - watch an activity closely and checking for problems จับตาดู keep an eye on - watch closely or monitor an activity (to see if problems arise) surveillance - the process of carefully watching a person or place การเฝ้าตรวจตราอย่างเข้มงวด drop our guard - to not defend yourself, stop taking precautions (against dangers and risks) keep up our guard - continue to take precautions and protect ourselves tropical - relating to the hottest area of the Earth, between the Tropic of Cancer and the Tropic of Capricorn ในเขตร้อน environment - the surroundings in which people live, work and exist (example: noice in the workplace environment can lower productivity) warm-blooded animals - a kind of animal (such as a bird or a mammal) with a fairly high body temperature (hot body) that does not change a lot and is not affected much by the temperature outside the body (humans are warm-blooded) (See Wikipedia) gastrointestinal tract - the "GI tract" or "gut tube", the path that the food you eat follows from mouth to stomach to intestine to anus and out of body (See Wikipedia) abdominal - involving the front part of your body below your waist ช่องท้อง (ช่องพระนาภี) cramp - muscle cramp, sudden strong pain in a muscle (when the muscle contracts) (See Wikipedia) abdominal cramps - pains in the stomach area (abdomen) (See Wikipedia) vomit - when food or drink comes up out of your stomach and through your mouth (See Wikipedia) fever - an abnormally high body temperature ไข้ (See Wikipedia) common - happens often, happens to many people diarrhoea - when a lot of watery waste (stool, faeces) comes out of the body when you go to the bathroom because you are sick (See Wikipedia) common diarrhoea - the kind of mild diarrhoea that people often get from time to time subside - goes down, becomes less diarrhoea subsides - diarrhoea becomes less or stops kidney - one of the two organs in your body that clean your blood and remove waste ไต (See Wikipedia) urine - the liquid that passes from your body when you go to the bathroom (created when the kidney filters the blood and creates waste products and excess water) (See Wikipedia) urinary-tract - the tubes that carry urine from the kidneys to outside the body for disposal urinary-tract infection - pyelonephritis - a urinary tract infection that has worked its way up the urinary tract all the way to the pelvis of the kidney (See Wikipedia) -itis - word suffix meaning: inflamation pelvis of the kidney - a funnel shaped part inside the kidney that collects together urine before it is sent down the ureter to the bladder and then through the urethra and out of the body (See Wikipedia) pyelum - another word for "pelvis of the kidney" acute - very sudden and serious เฉียบพลันและรุนแรง kidney failure  - when kidneys fail to remove waste products from the blood and keep the blood in the correct chemical condition (homeostasis), abnormal levels of potassium, calcium, phosphate and abnormal acid-base balance make regular hemodialysis with a dialysis machine kidney replacement to remove wastge products from the blood necessary until a kidney transplant can be found (See Wikipedia) respiratory - relating to the process of breathing air in and out of the lungs (where oxygen is absorbed into the blood and carbon dioxide waste is released to the blod) ระบบทางเดินหายใจ, เกี่ยวกับการหายใจ respiratory tract - the part of the body that brings air through the mouth down into the lungs where the blood takes up oxygen and releases carbon oxide waste products (See Wikipedia) lung - one of the two organs in your chest that fill with air when you breathe ปอด hygienic - clean and not likely to cause illness or disease ถูกสุขอนามัย sanitise - clean completely (to remove germs and bacteria) maintain - to keep รักษา standards - an acceptable level of quality or achievement มาตรฐาน hygiene - the degree to which people keep themselves or their environment clean, especially to prevent disease สุขลักษณะ maintain the strictest standards of hygiene - continue to be perfectly clean all the time perishable - food that can go bad (rot) if not refrigerated, so it cannot be eaten contaminated - made dirty, polluted or poisonous by the addition of a chemical, waste or infection raw food - food that has not been cooked processed - treated in some way, e.g., pre-cooked, treated with chemicals, cut, etc. food-processing - the processes inside factories of turning meat and plant crops into food products that can be sold in stores catering - the business of providing food service at a remote site (See Wikipedia) การจัดเลี้ยง expiry date - the date for throwing away food (after this date there is a risk of the food going bad or rotting and people getting sick if they eat the food) pasteurised milk - milk that has been heated and processed to make it clean without germs (See Wikipedia) piping hot food - very hot food frozen - when water turns to ice, when something stops moving thaw frozen food - unfreezing food (taking food out of the freezer and letting it sit until all the ice has melted) patient - someone who is receiving medical treatment คนป่วย, คนไข้ medical practitioners - doctors, physicians healthcare - the treatment and prevention of diseases and other medical problems infect - when a disease is transmitted or passes from one person to another person ซึ่งติดเชื้อ (See Wikipedia) infectious diseases - a disease resulting from an infection, the entering into the body and growth of disease-causing "pathogens" such as  viruses, bacteria, fungi, protozoa, parasites, and protein prions, transmission of pathogen from person to person can occur in various ways including physical contact, contaminated food, body fluids, objects, airborne inhalation, or through vector organisms, also called communicable diseases, contagious diseases or transmissible diseases (See Wikipedia) in general - considering all of them, holding true for all of them infectious diseases in general pests - small living things that cause disease สัตว์ที่ทำลาย, สัตว์ที่รบกวน disorder - a situation in which people behave in a noisy or violent way in public, often as a protest against something ความวุ่นวาย exposed - exposed to a disease, not protected from something, openly affected by itได้รับ ได้สัมผัส (แดด หรือสารพิษ เป็นต้น) transmission - transmission of disease, the spread of a disease from one person or animal to another การแพร่เชื้อ spread - spread disease, to (cause to) cover, reach or have an effect on a wider or increasing area or number of people กระจายไปทั่ว risk - a danger, the possibility that some bad event might happen ความเสี่ยง vulnerable - easily damaged or harmed ซึ่งถูกทำลายได้ง่าย ที่เปราะบาง ที่ล่อแหลมต่อการเกิดภัยภิบัติ recover - recover from disease, to become healthy and fit again after an illness or injury การฟื้นไข้ survive - survive a serious disease, still alive, not dead; to continue to live and exist after experiencing a dangerous or difficult situation รอดพ้นอยู่รอด สืบต่อไปได้  มีชีวิตรอด severe - very serious and worrying ที่รุนแรง ที่น่าเป็นห่วง fatal - causing someone to die ถึงตาย symptom - symptom of a disease, something that is wrong with your body that shows that you have a disease mild symptoms - weak signs of a disease (when something bad happens just a little to part of your body, not very dangerous) severe symptoms - strong signs of a disease (when something bad happens a lot in your body, very dangerous) strictly - completely อย่างเข้มงวด strictly follow instructions - do exactly what they are told to do (without exception or relaxing the rules) over-the-counter - medicine that you can buy without a doctor's permission entire course of tablets - taking all the tablets that the doctor ordered you to take over a period of time crucial - very important (because it effects the result of something) สำคัญยิ่ง medication - a medicine, or a set of medicines or drugs used to improve a particular condition or illness prescribe medication - when a doctor writes out the name of medicine for you to take, on an official piece of paper, when presented a pharmacy supplies you with the medicine สั่งยา antibiotics - a drug that kills or inhibits the growth of bacteria (See Wikipedia) resistant - not harmed or affected by something resistant to antibiotics - resistant genes in bacteria - no in-built resistance whatsoever - resistance - การต่อต้าน, การขัดขืน mutate - to become physically different from other viruses, plants or animals as a result of a genetic change กลายพันธุ์, เปลี่ยนแปลง, เปลี่ยนรูป mutant (adjective) mutation (noun) species - a set of animals or plants in which the members have similar characteristics to each other and can breed with each other...