University of Calgary doctor shines light on severe E. coli infections in children

Dr. Stephen Freedman, a professor of pediatrics and emergency medicine in the University of Calgary's Cumming School of Medicine, is the lead author in a review article about shiga toxin-producing E. coli. It was published recently in the New England Journal of Medicine. (Leah Hennel/The Canadian Press - image credit)
Dr. Stephen Freedman, a professor of pediatrics and emergency medicine in the University of Calgary's Cumming School of Medicine, is the lead author in a review article about shiga toxin-producing E. coli. It was published recently in the New England Journal of Medicine. (Leah Hennel/The Canadian Press - image credit)

A University of Calgary doctor is working to raise awareness about shiga toxin-producing E. coli and delve into the long-term implications for children.

Dr. Stephen Freedman has been studying this type of E. coli for years and was on the front lines treating children in the recent daycare-related outbreak in the city.

When the magnitude of that outbreak became clear, he recognized that while it was tragic, it could help unravel some of the mysteries around this infection, known as STEC.

"We realized this does present an opportunity to learn a lot about the long-term impacts of shiga toxin-producing E. coli," said Freedman, a professor of pediatrics and emergency medicine in the University of Calgary's Cumming School of Medicine.

Previous research has focused on children who experience severe complications, including kidney failure, according to Freedman, who hopes to learn more about the implications for kids who experience mild infections

"It'll actually put into perspective the risk associated with this bacteria," he said.

Freedman is one year into a four-year study involving 1,000 children at 26 sites in Canada and the United States looking at the best use of IV fluids to treat STEC in children. He has received additional funding from the U.S. National Institutes of Health.

He hopes to follow 500 kids exposed during the Calgary outbreak (including those who tested positive and those who did not) for over two years.

The children will be monitored — at six months, 12 months and two years post-infection — for health impacts ranging from kidney and intestinal problems to early diabetes and high blood pressure.

"If we find that even children with mild infections are having complications down the road, it actually raises the bar of the severity of this infection for all children and really will allow us to treat all children similarly and also increase the importance of preventing any infections in the first place."

Information for doctors 

Freedman is also the lead author of a review article on STEC published recently in the New England Journal of Medicine. The project was in the works for over two years.

"It's an uncommon disease, and so many people will go their entire career with never seeing a single case," said Freedman.

Even those who have encountered a case or two may not be aware of all the research, he noted.

"They're not going to know how to interpret the result of a stool test. They won't know how to manage it. They won't be aware of the potential complications," he said.

According to Freedman, roughly 60 per cent of shiga toxin-producing E. coli infections are the type that can cause serious complications.

The article is the first of its kind in 20 years, he said, and it outlines updated information on diagnosis, therapies and monitoring.

"We really tried to review and create a state-of-the-art article that summarized all the key things that … people taking care of these kids need to know, need to consider," said Freedman.

Dr. Sam Wong, president of the pediatrics section of the Alberta Medical Association, said the article will be helpful for physicians on the front lines.

"It nicely summarizes the current data on STEC bacteria, diagnostic testing, treatment options/management and potential pitfalls when caring for these patients," he said in an email.

"It is a good review for [infectious disease] specialists and a good resource for in-hospital clinicians."

According to Alberta Health Services, as of Oct. 13, there were 360 lab-confirmed cases connected to the Calgary daycare outbreak and 45 secondary cases.