Scientists probe DNA of E. coli for outbreak clues (AP)

LONDON � Scientists are quickly combing the DNA of the killer bacteria behind the world's worst E. coli outbreak to find clues about how to treat patients and prevent future epidemics.

So far, one strain from a German patient has been sequenced by Chinese and German scientists. While the genetic information is preliminary, experts say there are a few hints about where the bacteria came from and why it might be so lethal.

The E. coli causing Europe's massive outbreak is likely the product of another strain first detected a decade ago in Germany, but with some dangerous mutations, experts say. German investigators have declared the outbreak was caused by contaminated sprouts from an organic farm in northern Germany. So far, the bug has killed 33 people and sickened nearly 3,100, including several hundred who have developed life-threatening kidney failure.

Flemming Scheutz, head of the World Health Organization's Collaborating Centre laboratory in Denmark, said the strain is particularly good at picking up new genes. Because E. coli is constantly evolving, it is riddled with genes swapped from other strains found in animals and humans, giving it countless opportunities to acquire something lethal.

"It's just very unfortunate that in this case, it recombined and took on these (dangerous) genes and that it happened to do it in the food chain," he said.

Scheutz said some previously seen related strains were also quite toxic but that scientists needed more samples to have a better understanding of how the new strain behaves. "It's like looking at a family photo with three people and the 50 others are missing," he said.

Others say the DNA sequences they've seen so far appear worrying enough.

Stephen Smith, a microbiologist at Trinity College in Dublin, said the new E. coli appears to stick to human intestines in a different way and that the bacteria might reproduce faster than other E. coli strains. More bacteria in the intestines could explain why the disease is so deadly, he said. Smith was not involved in the sequencing work.

"It could be the bacteria's genes are causing it to produce more toxin, which may affect patients differently," he said. The toxin usually targets the kidney, triggering a severe E. coli complication. But in the European outbreak, many of those patients have also suffered from neurological problems including paralysis.

Frederick Blattner of the University of Wisconsin, who has analyzed the new sequence information, said the toxin released by the German E. coli seemed extremely potent.

"With other strains, it can take a million of them in your stomach to make you sick," he said. "But with this bacteria, it might be possible to be infected with much lower numbers."

Researchers have also found the E. coli bacteria has at least eight genes that make it resistant to many antibiotics.

"That could give suggestions to doctors about what treatments to select for patients," said Bicheng Yang, a spokeswoman for BGI, the Chinese laboratory that sequenced the bacteria. In Germany, many patients with the most severe form of the disease, which involves kidney failure, have been treated with dialysis and blood transfusions.

"The next step is to do further tests at the molecular level to see what drugs might work," she said. Yang added that knowing more about the bacteria's origins could help stop future outbreaks and avoid things that could speed up the mutation process.

Gad Frankel, a microbiologist at Imperial College in London, said DNA information might help scientists figure out how the bacteria sticks to certain vegetables � and then stop it before it happens. "It's possible we could develop inhibitors to prevent the interaction between E. coli and vegetables," he said, explaining a biodegradeable spray could theoretically be made to do the job.

Experts agreed that narrowing down where the new E. coli came from was key to averting future epidemics. "The evolution of E. coli just happens when bugs get together," Smith said. "We can't stop evolution, but if we can learn today how and where it happens, we might be able to save lives in the future."

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Premature aging seen as issue for AIDS survivors (AP)

SAN FRANCISCO � Having survived the first and worst years of the AIDS epidemic, when he was losing three friends to the disease in a day and undergoing every primitive, toxic treatment that then existed, Peter Greene is grateful to be alive.

But a quarter-century after his own diagnosis, the former Mr. Gay Colorado, now 56, wrestles with vision impairment, bone density loss and other debilitating health problems he once assumed he wouldn't grow old enough to see.

"I survived all the big things, but now there is a new host of things. Liver problems. Kidney disease. It's like you are a 50-year-old in an 80-year-old body," Greene, a San Francisco travel agent, said. "I'm just afraid that this is not, regardless of what my non-HIV positive friends say, the typical aging process."

Even when AIDS still was almost always fatal, researchers predicted that people infected with HIV would be more prone to the cancers, neurological disorders and heart conditions that typically afflict the elderly. Thirty years after the first diagnoses, doctors are seeing these and other unanticipated signs of premature or "accelerated" aging in some long-term survivors.

Government-funded scientists are working to tease apart whether the memory loss, arthritis, renal failure and high blood pressure showing up in patients in their 40s and 50s are consequences of HIV, the drugs used to treat it or a cruel combination of both. With people over 50 expected to make up a majority of U.S. residents infected with the virus by 2015, there's some urgency to unraveling the "complex treatment challenges" HIV poses to older Americans, according to the National Institutes of Health.

"In those with long-term HIV infection, the persistent activation of immune cells by the virus likely increases the susceptibility of these individuals to inflammation-induced diseases and diminishes their capacity to fight certain diseases," the federal health agency's chiefs of infectious diseases, aging and AIDS research wrote, summing up the current state of knowledge on last September's National HIV/AIDS and Aging Awareness Day. "Coupled with the aging process, the extended exposure of these adults to both HIV and antiretroviral drugs appears to increase their risk of illness and death from cardiovascular, bone, kidney, liver and lung disease, as well as many cancers not associated directly with HIV infection."

In San Francisco, where already more than half of the 9,734 AIDS cases are in people 50 and over, University of California, San Francisco AIDS specialists are collaborating with geriatricians, pharmacists and nutritionists to develop treatment guidelines designed to help veterans of the disease cope with getting frail a decade or two ahead of schedule and to remain independent for as long as possible.

"Wouldn't it be helpful to be able to say, are you at high risk, low risk or moderate risk for progressing to dependency in the next five, the next 10 years, being less mobile, less able to be functional in the workplace. Are you going to be safe in your home, are you going to remember to take all those medications? How are they going to interact?" explained Dr. Malcolm John, who directs UCSF's HIV clinic. "All those questions need to be brought into the HIV field at a younger age."

Research so far suggests that HIV is not directly causing conditions that mimic old age, but hastens patients toward ailments to which they may have been genetically or environmentally predisposed. Plus, their immune systems are being weakened over time even when they are being successfully treated for AIDS, John said.

"That's probably true for a lot of these things. We aren't saying HIV's starting the problem, but it's added fuel on top," he said.

Stokes, a patient of John's who goes by only his last name, is a prime example. At 53, HIV-positive since 1985 and in substance abuse recovery for the last 11 years, he says he is happier than he ever has been. Yet the number of ailments for which he is being treated would be more commonly found in someone 30 years his senior: a condition called Ramsay Hunt syndrome that causes facial paralysis, a rare cartilage disorder for which he has undergone four ear surgeries, bone death in the hip and shoulder, deterioration of his heart muscle, osteoporosis and memory loss.

A specialist recently diagnosed a Kaposi's sarcoma spot on Stokes' ankle. Although the cancer is not life-threatening, the sight of young men disfigured by KS lesions was a harbinger of the early AIDS crisis, and its presence on his own body is unsettling.

At his therapy group for men with HIV, aging "comes up frequently," he said. "I say, `Just think what we have come through to have a life today.'" At the same time, he acknowledges sometimes feeling self-conscious about his physical appearance and worries if "people are not attracted to me and unwilling to go the length of what it means to be with me, no matter how brilliant my mind or my zest for life."

Loneliness, financial worries and concerns about who will care for them and where can weigh on long-term AIDS survivors in the same way as all adults living in a society that values youth, Charles Emlet, a social work professor at the University of Washington, Tacoma, said.

As they get older and sicker, many feel "doubly stigmatized," he said. Some people who have lived with the virus for a long time have been getting by on private disability benefits that will run out when they turn 65, forcing them to move to less expensive locations or to consider turning to estranged family members. Like soldiers from a distant war, many lost partners and their closest friends to AIDS.

Such emotional side effects, combined with the physical toll of managing chronic health problems, put older AIDS patients at risk for depression. At the same time, Emlet has uncovered evidence that a majority of long-term survivors also share another trait that typically comes with advanced age: that is, the ability to draw strength from their difficult experiences.

"The older adults I've interviewed, many of them talk about how much it means to them to give back, to do something positive with the years they never expected to have," he said.

Peter Greene can relate to that. At times, like the days he is so exhausted he can't get out of bed or the pain from his multiple maladies is too intense, he asks himself "the Carrie Bradshaw question--are we really lucky to still be alive?"

As frightening and uncertain as this phase of AIDS is, he thinks he knows the answer.

"I've tried to make the time I have count, and really, now that I have the body of an 80-year-old, I probably have the wisdom of an 80-year-old as well, which counts for a lot," Greene said. "Everything becomes clear at the end of your life and in some ways, thinking you've been dying all these years, you get moments of clarity that I don't think everyone gets."

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Government lists formaldehyde as cancer causer (AP)

WASHINGTON � The strong-smelling chemical formaldehyde causes cancer, while styrene, a second industrial chemical that's used worldwide in the manufacture of fiberglass and food containers, may cause cancer, the National Institutes of Health says.

The NIH said Friday that people with higher measures of exposure to formaldehyde are at increased risk for certain types of rare cancers, including those affecting the upper part of the throat behind the nose.

The chemical is widely used to make resins for household items, including paper product coatings, plastics and textile finishes. It also is commonly used as a preservative in medical laboratories, mortuaries and consumer products including some hair straightening products.

The government says styrene is a component of tobacco smoke, and NIH says the greatest exposure to the chemical is through cigarette smoking.

The two chemicals were among eight added to the government's list submitted to Congress of chemicals and biological agents that may put people at increased risk of for cancer.

Also on the list as a known carcinogen is a botanical agent called aristolochic acids, shown to cause high rates of bladder or upper urinary tract cancer in people with kidney or renal disease.

A warning issued a decade ago by the U.S. Food and Drug Administration advised consumers to discontinue using botanical products containing aristolochic acids. They are still available on the Internet and abroad and may be a contaminant in herbal products for treating symptoms for arthritis, gout, and inflammation.

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Online:

NIH: http://ntp.niehs.nih.gov/go/roc12

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Germany: outbreak waning, but more deaths possible (AP)

HAMBURG, Germany � Germany's health minister says he's hopeful that the worst of an E. coli outbreak blamed on sprouts is over � but he is warning that the number of deaths, now at 33, may still increase.

Minister Daniel Bahr's comments came after health officials announced on Friday that they had traced the outbreak to sprouts from a farm in northern Germany. They also lifted a warning against eating cucumbers, tomatoes and lettuce, which initially had been suspected as possible culprits.

The E. coli outbreak, the world's deadliest, has sickened nearly 3,100 people � most of them in Germany � and prompted many in Europe to shun vegetables over recent weeks.

"The (E. coli) wave is gradually abating � there is reason to hope the worst is now over," Bahr was quoted Saturday as telling the Bild am Sonntag newspaper. He added that a major new flare-up is "very unlikely."

However, "further deaths are not ruled out, as painful as that is," he added.

In Hamburg, one of the areas worst hit by the outbreak, customers at the city's Wandsbek market were back to buying cucumbers, tomatoes and lettuce on Saturday.

With the end of the warning, "now they are coming back to the markets," said farmer Wolfgang Sannmann, who was selling vegetables and fruit. "And the consumer can buy again what he wants and what his appetite tells him."

Still, some customers remained wary despite officials' assurances that they had pinned down the source.

"I am still very cautious, because in the first place they said it's the cucumbers, and everyone stopped eating them, and now it's the sprouts," said real-estate agent Jessica Hemblen, 27. "I'm not sure whether this is it, or whether it's not going to be something different again."

"It can occur everywhere, and other things can come up too, so I am trying to get a good mixture (of vegetables) to lower the risk," said retiree Edith Karg.

Health officials say they tracked the bacteria's path from hospital patients struggling with diarrhea and kidney failure, to restaurants where they had dined, to specific meals and ingredients they ate, and finally back to a single farm.

Also on Friday, officials in Germany's North Rhine-Westphalia state said tests had confirmed the deadly E. coli strain in a bag of sprouts from the farm that was in the garbage of a family near Cologne, two of whose members had been sickened.

There are more questions to answer, including what contaminated the sprouts in the first place � perhaps tainted seeds or water, or nearby animals.

Interviews with thousands of patients, mostly women ages 20 to 50 with healthy lifestyles, led investigators to conclude initially that salads could be the problem. That resulting in the warning to avoid cucumbers, tomatoes and lettuce, which caused major losses for European farmers.

"Of course I have understanding for the companies that have been left sitting on their cucumbers, tomatoes and lettuces," said Bahr, the health minister.

"But I say that protecting health is the priority; if, thanks to the warning, a single human life was not endangered, that is in everyone's interest."

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Bill Gates in China push against secondhand smoke (AP)

BEIJING � Microsoft founder and philanthropist Bill Gates is visiting China to raise awareness of the dangers of secondhand smoke.

Gates appeared at a news conference in Beijing on Saturday alongside Chinese Internet executive Robin Li and Vice Health Minister Huang Jiefu to encourage nonsmokers to stand up for their right to a smoke-free environment.

According to government statistics, smoking is linked to the deaths of at least 1 million people in China every year, making it one of the greatest health threats the country faces. Nearly 30 percent of adults in China smoke � about 300 million people, a number roughly equal to the entire U.S. population.

The risks of secondhand smoke include increased asthma attacks, ear and respiratory infections, and cancer.

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Like sprouts? Experts say cook first to be safe (AP)

LONDON � Salad eaters, beware. Experts say it's little surprise that sprouts are behind the world's deadliest E. coli outbreak.

Sprouts need warm and humid conditions to grow � precisely the same conditions required by bugs like E. coli and salmonella to thrive. And raw sprouts have been blamed before in food poisoning outbreaks, in the U.S. and a large outbreak in Japan in 1996.

German officials said Friday that sprouts caused the deadly outbreak there, although they don't know which kind. The organic farm linked to the outbreak grew a wide variety, including alfalfa, onion and radish.

Sprouts are grown in water from seeds, which are rinsed daily. They can be grown from numerous kinds of vegetables and are often eaten raw in salads and sandwiches.

Officials in Germany say they're not yet sure whether the sprout seeds were infected or whether the sprouts got contaminated by dirty water. Public health agencies have long been concerned about the risks of bacterial contamination of water used to produce sprouts.

E. coli can stick to the surface of sprout seeds.

"They can lay dormant on the seeds for months," said Stephen Smith, a microbiologist at Trinity College in Dublin.

Unfortunately for sprout-eaters, the germs are then inside the sprout as well as outside.

At that point, "washing has no effect," Smith said.

The European Food Safety Authority doesn't recommend avoiding certain foods, but advises consumers to take basic precautions, like washing all fruits and vegetables with clean water and peeling or cooking them when possible.

For now, German authorities are recommending people avoid all sprouts.

In the U.S., the Food and Drug Administration recommends children, the elderly, pregnant women and people with weakened immune systems avoid eating any kind of raw sprouts. The agency also recommends cooking sprouts thoroughly to reduce the risk of illness.

Because most sprouts � including alfalfa, bean, and mung � are eaten raw, they're not exposed to temperatures high enough to kill bacteria.

But experts say it's not necessary to ditch sprouts entirely because they are a good source of protein and vitamins.

"It's not that all sprouts are bad," Smith said. "But if you're desperate to eat sprouts and you want to be safe, try stir-frying them first."

Bob Sanderson, president of the U.S.-based International Sprout Growers Association, said the industry is working to update food safety guidelines issued by the FDA more than a decade ago. Sanderson's group � which represents 45 producers around the world � named June "Sprout Health and Wellness Month."

"In a way, it is kind of international sprout month," he said. "Just maybe not in the way we hoped."

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David Rising in Berlin and J.M. Hirsch in Concord, N.H., contributed to this report.

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