ドイツの電脳冊子のSPIEGEL:ONLINEの病原性大腸菌(EHEC)の記事

ドイツの電脳冊子のSPIEGEL:ONLINEの病原性大腸菌(EHEC)の記事

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Outbreak in germany
The mirror - 06/06/2011
epidemiologists, microbioligists, food inspectors, a whole host of experts hunt the dangerous EHEC bacterium. But the gut bacterium is unbelievable. The problem: Right at the start was wasted valuable time. There should be a short break ... who

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06/06/2011
  
Outbreak in Germany Friedmann, Jan; grill, Markus; Grolle, Johann; Hackenbroch, Veronika; small Hubbert, Guido; Latsch, Gunther Ludwig, Udo; shafy, Samiha; Thadeusz, Frank; Verbeet, Markus
Epidemiologists, microbiologists, food inspectors, a whole host of experts hunt the dangerous EhecBakterium. But the gut bacterium is unbelievable. The problem: Right at the start was wasted valuable time.
There should be a short vacation in a fancy hotel in Lower Saxony, with a fireplace room, sauna and near 18-hole course.
Together with 30 other members of their golf clubs in Gothenburg Hammarby put the couple and Göran Lena Broberg of Trelleborg and Travemünde, the mood was good, the group had chartered a bus.
In the Swedish hotel guests had booked full board, three meals per day. In between, they played golf, she wanted to relax from work - Goran, 64, works as a logistics provider for a technology company, including his 63-year-old woman is still working.
The Broberg will retain the four days in Germany probably always be remembered - as a horror trip.
A week after their return, the complaints began. The couple both had blood in the stool and severe abdominal cramps. They settled in the Gothenburg study Sahlgrenska University Hospital. Göran distinctly remember that it is the 19th May was: That's his birthday. He was allowed to go home, but his wife is now on dialysis for two weeks. The doctors are talking about a serious medical event.
In half of the Swedish golfer has since been demonstrated to the EHEC pathogens. A woman has died from the group, who are well meet in the clubhouse and ponder what it may have been: "We talk and talk," says Broberg.
Also the Swedish epidemic inspectors have taken the investigation: Where have the passengers infected - on the trip? On the way back? Or was it the hotel?
"Our house has been turned on its head," says German hotel manager. Eight experts were engaged, "rosters, menus, receipts, see everything they wanted." He just sent them 45 pages invoices, delivery notes and other documents.
Also of sprouts, herbs and other ingredients, samples were taken, even by previously unopened bottles of mineral water. He and all his employees were asked about their eating habits, a stool sample had to give it.
Soup, main course, dessert, asparagus and fish, but no pickle ". After all, did well understand what the guests had eaten you had booked a package with a unified menu," says the director. According to Robert Koch Institute, the hotel will be moved from the vegetable wholesale center in Hamburg.
After a few days, the experts told him by e-mail with the results of their investigations: results of investigations. For the hotel's chef, it is reassuring that in his house nothing was found. For all other rather not: Again a hot track has been the source of the pathogen as a dead end.
The search now goes elsewhere, fanning out across the country, investigators, sights set on a tiny rod-shaped, a few thousandths of a millimeter long and highly acid resistant. The germ feels exactly 37 degrees Celsius warmer liquid at ease and nests preferentially to intestinal walls.
His name: Enterohemorrhagic Escherichia coli, short Ehec. Three weeks ago, yet this organism was at best a term the experts. He now holds its breath over Germany.
Ambulances raced from Hamburg to Hanover and Berlin, in order to provide patients with failing kidneys among the few remaining places available. Hospitals dropped to their operating plans in order to mobilize more personnel for the Ehec front. In the emergency rooms are crowded, the diarrheal patients. And the fear among doctors excited before a shortage of plasma. Hamburg's mayor, Olaf Scholz, was therefore draw off blood ever public appeal.
Nowhere else in Germany are so many seriously ill patients as in Ehec University Hospital Hamburg-Eppendorf (UKE). On the fifth floor of the new building, the station is 5B. A red "Stop" sign stuck to the glass door, underneath is "isolation" - the "Iso", say the nurses.
In twelve-hour shifts to replace the guards from a private security service. Embarrassingly, they make sure that everyone who enters the station, is one of the dark green or blue disposable gowns and disposable gloves attracts over grazing. Their food (this past Friday it was potato soup) to get the patient in a plastic dish, which is then destroyed.
Tim S., a 27-year-old lawyer with a beard and glasses, is in penultimate Thursday here. He is a researcher at the Bucerius Law School and wrote his doctoral thesis on piracy and maritime terrorism. Unit of the hospital in his pajamas, he lies in his bed on the bedside table, a pack of gummy bears. To the right of his neck dangling two catheters: "The thing is, Shaldon catheter, which I've learned here."
For five days, Tim S. was a daily dialysis, have followed him to the doctors at UKE new, widely unexplored antibody eculizumab added (see box on page 138). Meanwhile, Tim's kidney values ​​are again very good, he says, the balance problems are gone. Now he hopes that he has suffered no permanent kidney damage - and is soon able to devote the maritime terrorism.
Also on the North German stores, hamburger restaurants and supermarkets in the disease is rampant. To the vegetable counters of Edeka, Aldi and Real makes a bow to customers. The canteens emphasize the salads on the menu. Every second hamburger indicates currently avoid raw vegetables, while Michael Durst is looking forward to the increased demand of Hamburg butchers' guild sausage and chops.
"Do you want some pickles?", A trader asks at Hamburg Wholesale Market and laughs, "because I had a few over." His name will not call the man, the only pity the shop and run into these days, "to put it mildly, crap." He has sold in recent days, only half of its full range. As the woman from the mixed stand one next door, then he should be quite happy times. They do currently, "at best one third" of their usual sales.
Desperate farmers were meanwhile forced to throw in the middle of their harvest cucumbers and plow into the shredder soft green lettuce heads (see page 68). And the Spaniards demanded a reparation, because they saw themselves through the rash of warnings Hamburg authorities wrongly placed in the pillory. € 200 million they estimate the damage.
By Friday evening the disease guardian of the Robert Koch Institute (RKI) 2000 Ehec infections were counted. At every fourth of them it was the dreaded hemolytic-uremic syndrome (HUS) come in at least 18 cases, the disease ended in death.
"A significant proportion of patients will lose their kidney function and duration of life sentences be dependent on dialysis," the nephrologist Rolf Steel warns of UKE. Like so many doctors now, so he advises: no milk, no raw meat, wash vegetables thoroughly and peel - and while he says it does, it becomes a blue bottle with disinfectant liquid on his desk and rubs his hands one with it.
Of particular concern are the steel neurological symptoms of his patients. Frightening, many people are confused, they do not know where they are or they would be shaken by epileptic seizures: "The neurologists are confronted with an entirely new disease" (see page 132). Never before has a Ehec germ has raged similar aggressive. A new epidemic is therefore in the world. And this time it is not, such as Ebola or AIDS, sprung from the jungle. This time it is not, such as avian flu, from faraway China, where people live in the country with chickens and pigs under one roof. Ground Zero is the disease this time in Hamburg - Outbreak in the middle of the North German Plain.
And the whole world is watching: When speculating about German guards disease microbes on cucumbers and tomatoes, then the camera crews from Spain, France and Great Britain in the press room. For days, reports the "New York Times" on its front page from the plague drama in faraway Germany. And U.S. disease control specialists monitor the CDC in Atlanta each new message from German laboratories.
Painful moves the sudden eruption into consciousness, how many surprises the world of bacteria that still holds. Plague, typhoid, cholera, tuberculosis, scarlet fever, diphtheria - all the major bacterial flagella, the doctors were hoping the final victory to have suffered. This time, however, fail to antibiotics, their more powerful weapons in the fight against the single-cell opponents. The microbes, which the Hamburg Ehec alarm reminds keep getting ready new tricks. And neither hospitals nor authorities were prepared so well.
The birth of the new nucleus, so one of the few certainties is in the otherwise still largely enigmatic disease events, contributed to a little appetizing place. Where billions of bacteria of different types meet, the emergence of new pathogens is programmed in the intestines. "The gut is a supermarket for genes," says Helge Karch, director of the Robert Koch Institute in Ehec Konsiliarlabors Munster, who has been working for almost 30 years with Ehec bacteria.
Particularly the rumen, the largest of the three fore-stomachs of ruminant cattle and also the home of Ehec is nothing but a huge breeding ground, a giant bioreactor to the emergence of potentially dangerous pathogens.
This murky liquid in the billows around 100 liter hollow muscle. More than one trillion bacteria at least 200 different species and many viruses romp about two full buckets into the digestive juice. The microorganisms break up the indigestible cellulose in the grass. The only way to feed the cow from the meager fare. About the digestive fluid forms in this case a foul-smelling bubble from biogas.
Tightly packed together, the bacteria constantly exchange genetic material from each other. And eventually they end up where a direct hit: A new epidemic is here.
Just as it has been at the now rampant bacteria Ehec be: because the nutrients of the grass enough for a little beef, the bacteria themselves serve as food for the animals. With the help of a virus, they split up the germs and break them down into their component parts. Without these digestive own colonizers of the cows would simply starve.
But also a dangerous virus smuggled into the genetic code actually harmless, in the rumen based E. coli bacteria: the information for the formation of destructive Shiga toxin.
The pathogen is now rampant on the O104 strain: H4, which has been described only in individual cases worldwide. What makes it new is that it further, new Genpassagen other bacteria has built into its DNA, those that make it particularly aggressive. "The germ is highly dangerous," says Karch, who in this hot phase of the investigation currently Ehec usually after just four hours sleep at night goes back to the lab.
Some of the gene fragments, he says, make the seed resistant to antibiotics. Others bind him more closely to the intestinal cells or the cells can be more damaging to him. Parts of the genetic information of plague bacteria had O104: H4 apparently assumed, however, these are also already in other intestinal bacteria. "The plague bacterium Genpassagen of making these Ehec germ fit," says Karch, "for example, because he can thereby better absorb iron."
Had begun the hunt for the deadly pathogens on Thursday the 19th May, when the findings from the Hamburg UKE Ehec triggered alarm in Berlin's Robert Koch Institute. The very next morning were four employees of the top disease control agency in the Hanseatic city, the patients were still responsive, meticulously questioning after their food consumption over the last ten days.
What followed was, first of all for a rapid investigation of success: In the interviews crystallized rapidly lettuce, tomatoes and cucumbers out as a prime suspect. On Thursday week before the last finally sat the Hamburger Health Senator Cornelia Examiner Storck at a news conference at City Hall along with two experts from the Institute for Hygiene and Environment, and a "real breakthrough" was to proclaim: "You can say the population now clear," said the Senator "Cucumbers are one source."
And their origin, they continued triumphantly, lay "not in northern Germany, but clearly in Spain". On four salad cucumbers from Hamburg Wholesale Market, food microbiologists have made Ehec germs arrested, three of these proven cucumbers came from Spain. It could certainly be said Storck Examiner at the time that the pathogen also find on other samples. For an all-clear for lettuce and tomatoes, it is still too early. But at least you can now use to trace the trail of contaminated cucumbers.
The relief lasted five days. Then had to sheepishly admit that hamburger that Ehec germs on the Spanish cucumbers could not be the source of the disease - more detailed analysis revealed that they are not dangerous to the serotype O104: H4 belonged.
So everything was back to zero. To the thousands of experts across the country now looking for a new, hot track, while sacrificing doctors and nurses in the clinics and recreation and sleep the onslaught of severely ill patients Hus can barely cope.
Every morning, the experts advise maintaining the RKI and again, whether they send their recommendation, tomatoes, cucumbers and lettuce not to eat raw. So far, however, had only confirmed what had surrendered their first study, namely, that a striking number of these patients had three foods eaten. The recent study by the last Friday came to this conclusion. That one of these three vegetables are actually the seed source is, therefore more likely.
The hot but not that in the end but perhaps not radishes and strawberries were the catalyst that reduces the RKI expert Gérard Krause in at once. Not even if the "vehicle", so that food, with which the germs are transmitted, have changed the course of the outbreak, can be excluded with certainty. The hunt for O104: H4 is always mysterious.
Here, the pattern seems clear: The epicenter of the epidemic is seen in Hamburg. Almost one in three infected live in the Hanseatic city, and almost all 90 cases Ehec abroad can be traced back to the Hamburg area.
The victims are mostly women, children, however, were less affected than most previously known Ehec outbreaks. Above all, there are clearly identifiable cluster: Travel companies such as those golfers band from Sweden, a union official program for women in Lübeck, the canteens a consulting firm in Frankfurt - it is really possible that that is not enough to make the outbreak arrest?
Especially the city of Hamburg was once in the history of disease as a prime example of the successful search for the nests of a germ killer: Almost 120 years ago, in the hot summer of 1892, went into the city to ever fall through an aggressive pathogen. Nearly 17 000 patients were registered by the authorities, many lost so much fluid that they dried up inside. The official death toll stood at the end of 8605th
One last time, still had the cholera raged in the emerging German industrial nation. And it took the ingenuity of Robert Koch, to understand the disease occurrence. Quickly summoned the expert from Berlin to recognize poor hygiene as the origin of evil. Shuddering, he said after a tour of the district programs, "Gentlemen, I forget that I am in Europe!"
A few years before Koch had identified the "Commabazillus" as the cause of the dreaded diarrheal disease and demonstrated that it is in the water increased and spread. Therefore, he found it not difficult to see that the tide was to blame for the disaster: they had pushed the contaminated water from feces harbor a few miles upriver, to where the water was removed from the river Elbe. In neighboring Altona, so Koch noted, there was a sand filter system. Accordingly, there was mild cholera epidemic.
Will it succeed this time again the researchers to track the epidemic of the new pathogen? Late last week, disappeared among the researchers hope. Tomatoes, cucumbers, lettuce: Even after all her research she had no more to offer as a conjecture.
? Spread all the more lively the rumors: the agents do not could perhaps have been brought even deliberately circulated suspected that one, while others thought they knew that the tomato and cucumber under the tarps on the Spanish Mediterranean coast are still sprinkled with water, and on the Internet circulated the theory of germs on cut flowers: no wonder, it said that after the mothers of the victims were women preferred.
At least it seems to give evidence - and lead them again to Hamburg Wholesale Market, the place where the four Ehec contaminated cucumbers were discovered. "We have in recent days had long switching conferences with other agencies and found that traces always point to the Hamburg Wholesale Market," Bremer said a health official, and concludes: "He seems in some way to play a role."
Friday morning, six clock. On the site of the Hamburg Wholesale Market, which is as big as 30 football fields, will work for four hours. Forklift truck whiz by almost 200 meters long aisles, workers heave plastic boxes on handcarts, buyers take folding bikes, because the distances between the suppliers are so far. About 150 fruit and vegetable wholesalers sell goods here from over 100 countries: bananas from Ecuador, tomatoes from Italy, Cauliflower from Poland. Metre-high cardboard towers are built every night, millions and millions of fruit stored in it. Somewhere in the hall could still hold a focus of infection, can not exclude that. But how do you find him?
A number of wholesalers who offer here their fruit and vegetable plots have already checked their products voluntarily Ehec bacteria. The auditors have found absolutely nothing, as you can see on the website of the wholesale market. But what does it matter if ten, eleven crops are safe? What evidence is there, if a dealer sends six cucumbers to a laboratory and another three kohlrabi, as stated in the reports? Because it is everywhere doubt, remain on this day there are thousands of boxes. Some can be offered again tomorrow, most goes into the composting and biogas plants.
It may be far too late to order in these mountains of cabbage, cucumbers, zucchini, and leeks still looking to track down the midget. Because of a fundamental law of any effective disease control was the same violation at the beginning, speed is paramount. Otherwise, the tracks that lead to the source of a new disease, are blurred.
"When the first people became ill after a few days," says Lothar Wieler, Managing Director of the Institute of Microbiology and Infectious Diseases at the Free University of Berlin, "was perhaps sold the contaminated batch of long ago." When, after another week occurred the first serious cases of Hus, the vegetables were then eaten already or potentially spoiled - and there's not much more from the germ. In most outbreaks, the source Ehec therefore remains unknown. "That one does not find anything," says Andreas Hensel, President of the Federal Institute for Risk Assessment (BfR), "is completely normal."
That is why it is so unfortunate that just at the beginning of the epidemic, valuable time was wasted. Not later than 1 May, and it is now known, the first patient became ill with diarrhea. Then passed 18 precious days before the RKI was alerted.
That may have been the fact that many patients have been reluctant to go with a supposedly innocuous diarrhea to the doctor. An intestinal flu, so the commonly experience sounds, anyway after a few days. But more important is that the family physicians the possibility of an EHEC infection do not pull too often considered. They often send the patients with good advice and maybe a prescription for an antibiotic to go home. Far too often they send a stool sample to the laboratory for evaluation.
Like most physicians were unprepared for the Ehec outbreak, demonstrated by a 24-year economic psychology student from Hamburg who, four months pregnant, was the end of the penultimate week with abdominal pain and diarrhea to her doctor. Who diagnosed gastritis, and the young woman spent two days at home and then went back to work.
Only when she learned that a colleague was diagnosed with Ehec they sought again to the family doctor - especially from concern for her unborn child, as she says. At this point, however, the bacterial toxin had already begun the work of destruction in their blood: The pregnant woman, it turned out well, was suffering from Hus.
But even watchful care physicians are not often heard quickly enough. Although Ehec is notifiable - but are allowed the health boards with the passing of Ehec alarm ample leave time: according to Clause 11 of the Infection Protection Act, the offices have illnesses, deaths, and the evidence of pathogens just weekly, but no later than the third working day of the following week, at the competent state authority report. This in turn is obliged to forward the messages within a further week to the RKI.
And the Berlin animal disease expert Wieler asks: "Why is it so not just send something electronically?" The reporting system must necessarily be faster.
Too long had the uncanny pathogen Ehec a blind spot of the German health monitors. "Wraps itself about the secret epidemic Germany - unlike many other developed countries - in silence," the ARD journalist Klaus Weidmann writes in a rousing research report he wrote in 1999 about the danger Ehec. "Ignored for many years, German doctors, government agencies and consumer groups to the new killer virus." The German media had "slept through" the issue. The warnings of scientists like Karch Ehec remained unheard.
While this country may get dusty on the reports of the potentially deadly events are officially for up to two weeks in the drawers of the offices, was installed in the U.S. and Japan in an early warning system for EHEC pathogens.
"A quick response is crucial in such situations," says Robert Tauxe, deputy director of the Division of Foodborne, Bacterial and mycotic Diseases at the CDC in Atlanta. Back in 1993, shortly after the worst outbreak so far Ehec the U.S., the authorities reacted. Since then, each suspicious cluster of infections is registered with intestinal germs.
Since 2001, nationwide register in each of the 50 U.S. states and analyze in some big cities like New York laboratories, the suspect bacteria strains from the stool samples of all patients and the genetic information of the various tribes.
"The database is gathered in all of this is accessible to everyone," says Tauxe, "and we check them at the CDC, of ​​course, every day." If the same pathogen suddenly appear in several places, it is noticed in this way very quickly. "A similar system should be introduced not only in Germany but throughout Europe," advises Tauxe.
After all, since 2008, the interdisciplinary research project "FBI Zoo," which also deals extensively with Ehec sponsored by the Federal Ministry of Research. Direct research on cattle, however, is not possible within this framework.
It is still a major problem in the fight against EHEC pathogens that shockingly little about them is known. "There are probably several thousand varieties of EHEC, but who is going to look at them all?" Asks FBI Director Lothar Wieler zoo. Only 42 different types Ehec have so far found in humans and has been closely examined.
For many is that the food they have paved the way into the human organism. "Ehec germs on food products are relatively common," says Wieler. The discovery of the Spanish cucumber it has therefore not surprising really. But in the end ends up only a small part of Ehec really germs in the intestines of man and makes him sick. "Why," asks Wieler and answers himself immediately: ". We do not know"
The early eighties, the new pathogen was first talked about. One of the first well-documented outbreaks occurred in 1982 in the U.S. states of Oregon and Michigan. 47 people seriously ill there, after they had eaten hamburgers at McDonald's, which were not quite cooked through.
Several years later, it met with dozens of branches burger chain "Jack in the Box": Your contaminated meat had over 500 people ill in Washington state, 45 Infected developed Hus, 4 died.
Ever since scientists discovered ever new and unpredictable ways by which the pathogen can spread. 1999, some microbiologists found a rare variant of Würzburg from toxic Escherichia coli bacteria in the feces of Würzburg pigeons. Previously, British researchers Ehec in the feces were identified by seagulls.
Some cases seem to like a bad joke, has been a few years ago, the food experts at the University of Hohenheim called in as a street party in the Stuttgart area several visitors seriously ill. The search for clues led scientists rapidly to a lettuce field in southern France.
Under pressure because of chord shifts and a portable toilet was missing, is relieved in the middle of harvest workers had vegetables.
Such fast reconnaissance is not the rule. Only about 25 percent of the cases would be the source of the pathogen identified, Herbert Smith, says food microbiologist at the University of Hohenheim.
In Germany Ehec appears again and again. More than 800 isolated cases per year are reported by doctors and hospitals. But also to smaller outbreaks occurred again and again: In southern Germany, it was probably apple juice, the nearly nine years ago 48 people, mostly children made sick. Many of the parents remembered it, bought juice from a small cider mill and a farm to have. In Lower Saxony, three years ago affected more than 30 primary school pupils in Ehec after they had drunk during a school trip to a farm raw milk.
However, that even the most careful eaters are not safe from Ehec, appeared in 1993 in New York: 35 000 residents had to boil their drinking water after the pathogen had been detected in their water supply.
To date most serious outbreak occurred in 1996 in Japan: About 10 000 children and adults infected with radish sprouts from a school canteen, twelve people died.
Arrived in California with Rinderkot polluted water in September 2006 to a single spinach field - with devastating effect. Because the field grew baby spinach, which can be enjoyed in the opinion of the crude producers particularly well: "The leaves are wonderful in salads."
In the following weeks, the pathogen Ehec raged in 26 U.S. states, over 200 people became ill, some seriously, 3 died. The U.S. Food and Drug Administration took seven months "and painstaking detective work" to solve the case.
Clear, however, the experts at fertilizer from composting and biogas plants. Its use is safe, if the laws are complied with. Compost must be at least two weeks be exposed to temperatures of 55 degrees Celsius. In biogas plants have more than an hour with temperatures of about 70 degrees Celsius. The germ can not survive Ehec.
In any case, there is every reason to Ehec take very seriously. Whether smallpox, typhoid and AIDS: Almost all the major diseases of mankind originated in animals. Often at the end gave a small change of the pathogen or a change in the environment to make a minor nuisance to a malicious disease.
BSE broke out about after they had begun to feed cattle with meat and bone meal. The devastating epidemic of Spanish flu, the world that killed 50 million people, took his exit, as strains of chickens, pigs and humans come into contact with each other. AIDS came into the world, as a monkey virus jumping into the human body succeeded.
Is perhaps O104: H4 remain permanently in man? Usually this is at Ehec bacteria is not the case, it is all the experts agree. So far in this outbreak had been observed only rarely in the case of a person-to-human transmission, says Krause.
"But can that change," warns Karch. "There are a few, usually very aggressive Ehec tribes, whose reservoir is not in animals but in humans." Whether O104: H4 strains belongs to this, is open.
Some Ehec pathogens excreted by infected for months with the chair. Whether convalescent O104: H4-patients are still contagious for months, perhaps, is currently being tested in a study.
If this were the case, these people in order to prevent further spread more, but may need to be treated with antibiotics - even though the bacteria are so irritated to secrete a lot of very dangerous Shiga toxin. Which antibiotics for this risky form of treatment are likely candidates, is being investigated.
On the first floor of the Robert-Koch Institute headquarters, meanwhile, still meet up every morning at 8.30 clock on the situation Conference. Gérard Krause's employees have moved other projects, business trips and vacations, Ehec going on now. Penetrates from the outside noise up the street, the window remains closed so often. Forward, hanging on a bulletin board, the tasks of the day. A card for each study, for each cluster, for each new order.
Late last week, Krause was again swarming several teams of interviewers. "We have expanded the exploratory survey to provide additional food to the most absurd idea not to omit," he says. Even imaginative ideas of concerned citizens who currently received in batches with him, he took on.
The new, 34 pages thick questionnaire reads like a document of helplessness. The valid up to that guide for interviewing Ehec patients comprised just 4 pages. Was asked to not only after the suspect trio salad cucumber tomato. The consumption of mozzarella, goat's or sheep's milk cheese, raw carrots, asparagus, strawberries and meat has been documented.
In the new interview guide "Hus outbreak in Germany, spring 2011" is missing, however, hardly any food. The disease is now of interest to experts for every type of meat, fish and meat products, milk, milk products, bread spreads, vegetable, fruit and eggs, beverages, frozen foods and sweets. Even after dried herbs like oregano or marjoram, they ask, on the average consumption of tap water, and also for recently purchased cut flowers. Past results: lettuce, tomatoes, cucumbers.
While the disease investigators build their net ever tighter and ever cast, the enemy seems to be nowhere to evaporate. How helpless the experts in these days, can be in the Lower Saxony State Office for Consumer Protection and Food Safety experience (Laves). The headquarters of the food watchdog is housed in a plain building in Castle Ward, near Oldenburg. The men and women to understand something of Agriculture, Lower Saxony is an important agricultural country.
Since the raw food warning from the RKI worked veterinarians, chemists and laboratory personnel "in the chord," says Silke Huber block from the aegis of the Office. Nevertheless, there are no quick results: The first indications of whether a sample is contaminated with Ehec have the laboratory after 36 hours. The final result would be only after two to three days. And even that does not mean that the pathogen O104 really the root: H4 belongs. This can only determine the national reference laboratory - as more days go by.
So far, investigators have focused on the Laves cucumbers, tomatoes and salads. Meanwhile, they have controlled all domestic manufacturers, and traced the flow of goods and distribution channels of food - nothing found. Finally, they have taken samples of food that were on the surveys of the health authorities as suspects, including strawberries, egg and milk. The result, here too negative.
Meanwhile, he had little hope of finding the source of the disease, Anselm Lehmacher, food microbiologist admitted at the Institute for Hygiene and Environment, where all samples from Hamburg to Ehec nuclei are investigated. "We are now analyzing samples from the budgets of priority disease patients and from restaurants, where the patients have eaten," says Lehmacher. "And the Hamburg Wholesale Market is of course sampled intensively."
Colleagues from the BfR in Berlin last week had again been in the wholesale market. Found, says Lehmacher, they have also so far - nothing.


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