Survivor of E. coli tells story of ordeal (AP)

BERLIN � 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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Germany presses to find cause of E.coli outbreak (AP)

BERLIN � Was it a restaurant in Luebeck? A port festival in Hamburg? Or a yet-unknown site, still churning out deadly E. coli infections?

Speculation ran high Saturday about exactly where people were infected, especially since German health officials had no concrete proof yet about the source of the bacterial outbreak that has killed 18 people and sickened hundreds.

Local media reported Saturday that 17 persons fell ill with E. coli after they ate in the northern German city of Luebeck last month, and that researchers from Germany's national disease control center were inspecting the restaurant.

Other media said health experts were investigating whether the disease first spread at a festival in the northern city of Hamburg last month that was visited by 1.5 million people.

Those sickened at the Luebeck restaurant included eight women who participated in a workshop in the city, a group of tourists from Denmark and a child from southern Germany.

"The restaurant is not responsible for this, however by looking at their delivery companies, we may be able to find out how and from where the bacteria spread," Werner Solback, a microbiologist from the university hospital in Luebeck, was quoted as telling the Luebecker Nachrichten paper.

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

The news magazine Focus reported Saturday that the first patients were hospitalized a week after the Hamburg festival and said the national disease control center, the Robert Koch Institute, assumes that many people likely were infected there. The institute has not discussed this theory and could not be reached for comment Saturday.

German Health Minister Daniel Bahr, meanwhile, warned Saturday that the cause of the infection may still be active.

"We have to continue to be alert," Bahr told daily paper Ruhr Nachrichten. "Health officials are working nonstop to find the cause for all the infections, however, from outbreaks in the past we know that often the cause cannot be clearly identified."

Bahr reiterated the general warning to avoid eating cucumbers, tomatoes and lettuce.

Researcher Dag Harmsen at the Muenster University Hospital, which has been closely involved in the investigation, said that scientists were hoping to know enough about the E. coli strain by next week to be able to prevent new infections and better treat patients.

To avoid illness, the World Health Organization recommends that people wash their hands, keep raw meat separate from other food, thoroughly cook any food, and wash fruits and vegetables. Experts also recommend peeling raw fruits and vegetables if possible.

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4 in US now linked to German E. coli outbreak (AP)

ATLANTA � Four people in the U.S. were apparently sickened by the food poisoning outbreak in Europe, health officials said Friday. Three are hospitalized with a serious complication.

All four were in northern Germany in May. Though they didn't stay at the same hotel or eat at the same restaurants, officials are confident that they were infected with E. coli in that country.

Three of them � two women and a man � are hospitalized with kidney failure, a complication of E. coli that has become a hallmark of the outbreak. One of the four fell ill while on a plane to the U.S.

Two other cases are being investigated in U.S. service members in Germany, said Dr. Chris Braden, of the Centers for Disease Control and Prevention.

The source of the outbreak hasn't been pinpointed but the focus has been on fresh tomatoes, lettuce and cucumbers. More than 1,800 people have fallen ill, nearly all in Germany.

In a teleconference Friday with reporters, a Food and Drug Administration official said produce in the U.S. remains safe. The government has stepped up testing of food from Germany and Spain, but very little is imported from those countries or the rest of Europe.

The United States has "one of the safest food supplies in the world," said Don Kraemer, deputy director of the FDA's Center for Food Safety and Applied Nutrition.

Few details about the four ill people in the U.S. have been released. It's not known if they are U.S. residents or visitors. Milwaukee Health Commissioner Bevan Baker said Friday that one of the four � an adult who traveled from Germany � was in an area hospital.

Health officials have been reluctant to discuss the cases because of patient confidentiality. "We don't want there to be an overreaction, or people to feel stigmatized because they just happened to get back from Germany," said Dr. Robert Tauxe, a CDC foodborne disease expert.

The risk of the four cases triggering outbreaks in the U.S. is considered very small, he added.

"We don't think it spreads from one person to another rapidly" and will not move through the population like the flu, he said.

The CDC sent a notice to U.S. doctors Friday, advising them to be on the alert for cases.

As the investigation into the E. coli strain from the outbreak continues, CDC officials say they have never seen the strain here but are aware of at least two previous reports of a similar strain elsewhere. One was a 29-year-old woman in South Korea, reported in 2006. The other was a small cluster of cases in the Republic of Georgia in 2009.

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Online:

CDC: http://www.cdc.gov/ecoli

.

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Germany: E. coli patients continue to rise (AP)

BERLIN � The number of people sickened by a mysterious strain of E. coli in Europe is still rising more than a month after it was first detected, but officials say there are now signs the bacterial outbreak responsible for at least 18 deaths could be slowing.

Since the first case of a patient in Germany detected with the bacteria on May 1, the country's national disease control center reported Friday that there are now 1,733 people in the country who have been sickened, including 520 suffering from a life-threatening complication that can cause kidney failure.

The World Health Organization said that 10 other European nations and the U.S. have reported a total of 90 people sick from the bacteria, all but two of whom had recently visited northern Germany or, in one case, had contact with a visitor from the region.

Though nearly 200 new cases of E. coli infection were reported in Germany in the first two days of June, the Robert Koch Institute disease control center said new infections peaked on May 21 and May 22, and have since then been dropping.

Though it cautioned that what appears to be a downward trend could change if there are new cases that have not yet been reported, there are other signs that the outbreak could be waning.

Kidney specialist Dr. Reinhard Brunkhorst, the president of the German Nephrology Society, told reporters in Hamburg that hospitals are now seeing fewer new infections reported each day, though cautioned that "it may be less, but it's not over yet."

"There is no reason for hysteria, because it's not spreading and it's not increasing � it's decreasing," he said.

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

The outbreak is considered the third-largest involving E. coli in recent world history, and it is already the deadliest. Twelve people died in a 1996 Japanese outbreak that reportedly sickened more than 9,000, and seven died in a Canadian outbreak in 2000.

Researcher Dag Harmsen at the Muenster University Hospital, which has been closely involved in the investigation of the outbreak, said that scientists were hoping to know enough about the E. coli strain by next week to be able to prevent new infections and better treat patients.

The WHO recommends that to avoid food-borne illnesses, people wash their hands, keep raw meat separate from other foods, thoroughly cook their food, and wash fruits and vegetables, especially if eaten raw. Experts also recommend peeling raw fruits and vegetables if possible.

As the number of consumers avoiding vegetables grows, European farmers say they are losing millions of euros every day.

Russia on Thursday extended a ban on vegetables from Spain and Germany to the entire European Union to try to stop the outbreak spreading east, a move the EU quickly called disproportionate and Italy's farmers denounced as "absurd." No deaths or infections have been reported in Russia.

Russian Prime Minister Vladimir Putin on Friday rejected the EU claim, saying that authorities in Russia can't risk population's health by allowing EU vegetable imports at a time when the authorities in countries affected have failed to determine the cause of the outbreak.

Meanwhile, Chancellor Angela Merkel agreed with Spanish Prime Minister Jose Luis Rodriguez Zapatero in a telephone conversation late Thursday to push for EU help for affected farmers, Merkel's spokesman said.

Merkel, however, also defended the decision of state officials in Hamburg to announce their suspicions that Spanish cucumbers were the possible source of the outbreak. The warning was given after three cucumbers from Spain tested positive for E. coli, but further tests then revealed that it was a different strain to the one that has sickened so many people in the northern port city and elsewhere.

"The chancellor indicated great understanding for the urgent economic situation in the Spanish produce sector," spokesman Steffen Seibert said.

"At the same time she noted the responsibility of the German agencies to keep citizens informed in all phases and to report test results to the European early warning system."

In the southern Spanish tourist resort town of Torremolinos, Spaniards handed out about 7 tons of cucumbers free to the public in a show of support for the farmers affected by the outbreak who have seen their market collapse.

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Ciaran Giles in Madrid and Kirsten Grieshaber in Berlin contributed to this story.

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30 years after first AIDS cases, hope for a cure (AP)

Sunday marks 30 years since the first AIDS cases were reported in the United States. And this anniversary brings fresh hope for something many had come to think was impossible: finding a cure.

The example is Timothy Ray Brown of San Francisco, the first person in the world apparently cured of AIDS. His treatment isn't practical for wide use, but there are encouraging signs that other approaches might someday lead to a cure, or at least allow some people to control HIV without needing medication every day.

"I want to pull out all the stops to go for it," though cure is still a very difficult goal, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

For now, the focus remains on preventing new infections. With recent progress on novel ways to do that and a partially effective vaccine, "we're starting to get the feel that we can really get our arms around this pandemic," Fauci said.

More than 25 million people have died of AIDS since the first five cases were recognized in Los Angeles in 1981.

More than 33 million people have HIV now, including more than 1 million in the United States.

About 2 million people die of the disease each year, mostly in poor countries that lack treatment. In the U.S. though, newly diagnosed patients have a life expectancy only a few months shorter than people without HIV. Modern drugs are much easier to take, and many patients get by on a single pill a day.

But it wasn't that way in 1995, when Brown, an American working as a translator in Berlin, learned he had HIV. He went on and off medicines because of side effects but was holding his own until 2006, when he was diagnosed with leukemia, a problem unrelated to HIV. Chemotherapy left him so sick he had to be put into a coma to allow his body to recover.

"They didn't know if I'd survive that," Brown said.

Dr. Gero Huetter, a blood cancer expert at the University of Berlin, knew that a transplant of blood stem cells (doctors used to use bone marrow) was the best hope for curing Brown's cancer. But he aimed even higher.

"I remembered something I had read in a 1996 report from a study of people who were exposed to HIV but didn't get infected," Huetter said.

These people had gene mutations that provide natural resistance to the virus. About 1 percent of whites have them, and Huetter proposed searching for a person who also was a tissue match for Brown.

But transplants are grueling. Huetter would have to destroy Brown's diseased immune system with chemo and radiation, then transplant the donor's cells and hope they would take hold and grow. Many cancer patients die from such attempts and Brown wasn't willing to risk it.

His mother, Sharon Brown of Seattle, agreed.

"Before I knew he had HIV I used to have nightmares about it," and gambling on a transplant to try to cure it didn't seem smart when the cancer seemed to be in remission, she said.

Several months later, the return of leukemia changed their minds.

Brown discussed the transplant with his boss "and she said, `wow, this is amazing. Because you have leukemia, you could be cured of HIV.'"

A registry turned up more than 200 possible donors and Huetter started testing them for the HIV resistance gene. He hit pay dirt at No. 61 � a German man living in the United States, around 25 years old.

Brown had the transplant in February 2007. A year later, his leukemia returned but HIV did not. He had a second transplant in March 2008 from the same donor.

Now 45, Brown needs no medicines, and his only health problems are from the mugging he suffered two years ago as he returned home one night in Berlin. Brown was knocked unconscious, required brain surgery and therapy to walk and talk again, and doesn't have full use of one arm. He moved back to the United States in December.

"He's now four years off his antiretroviral therapy and we have no evidence of HIV in any tissue or blood that we have tested," even places where the virus can lie dormant for many years, Huetter said.

Brown's success inspired scientists to try a similar but less harsh tactic: modifying some of a patient's infection-fighting blood cells to contain the mutation and resist HIV. In theory, this would strengthen the immune system enough that people would no longer need to take HIV drugs to keep the virus suppressed.

Scientists recently tried this gene therapy in a couple dozen patients, including Matthew Sharp of suburban San Francisco. More than six months later, the number of his infection-fighting blood cells is "still significantly higher than baseline," he said.

It will take more time to know if gene therapy works and is safe. Experiments on dozens of patients are under way, including some where patients go off their HIV medicines and doctors watch to see if the modified cells control the virus.

The results so far on the cell counts "are all wonderful findings but they could all amount to nothing" unless HIV stays suppressed, said Dr. Jacob Lalezari, director of Quest Clinical Research in San Francisco who is leading one of the studies.

The approach also is not practical for poor countries.

"I wouldn't want people to think that gene therapy is going to be something you can do on 33 million people," said Fauci.

Other promising approaches to a cure try new ways to attack the dormant virus problem, he said. They hinge on getting people tested and into care as soon as they become infected.

Fauci's institute has boosted money for cure research, and the International AIDS Society, a professional organization for those who work in the field, has added finding a cure to its strategic plan.

"There are paths forward now" to a day when people with AIDS might be cured, said Dr. Michael Horberg, president of President Obama's HIV/AIDS council and of the HIV Medicine Association, doctors who treat the disease. "But it's not tomorrow, and it's not today."

___

Online:

AIDS information: http://www.aidsinfo.nih.gov

and http://www3.niaid.nih.gov/topics/HIVAIDS/

___

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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App for mobile phones helps diagnose concussions (AP)

CHAPEL HILL, N.C. � The next tool in the campaign against concussions might be your smartphone.

A doctor at the University of North Carolina teamed with other head-trauma researchers to develop an application for mobile devices that helps determine whether someone may have suffered a concussion.

Jason Mihalik of UNC's brain injury research center joined Justin Smith of Psychological Assessment Resources Inc. and the Children's National Medical Center in developing the program.

Smith says it's the first observer-based concussion app. After the user answers a series of questions, the app determines the likelihood of a concussion and can email information to a doctor. Mihalik said Thursday that the basis for the app's question flow comes from materials provided by the Centers for Disease Control.

The introduction of the app is just one way to speed the response to possible concussions. One of the key issues discussed during the National Sports Concussion Cooperative's daylong seminar was how to most effectively bridge the communication gap between team doctors and the team athletic trainers, who often are the first to act when players suffer concussion-like symptoms.

"The documentation (of immediate symptoms) is very important, from, 'How did they get hurt?' to the mechanism of injury through those initial signs and symptoms, to 'How did they progress over time?'" said Bill Griffin of the National Athletic Trainers' Association. "It's not only what happens at the time of the injury, but how things change."

The cooperative consists of coaches, doctors, equipment manufacturers and parents, and the group was formed in March to study concussions and brain trauma injuries in an attempt to make sports safer.

"We're trying to do more. We think there is an opportunity to do more," said Art Chou, Rawlings' vice president of research and development. "The caution that we have as manufacturers is, are we ready to draw definitive conclusions? ... There's a balance there, and I think it's up to the research community to determine whether it is ready for prime time or not, because the issue is going to be one of public perception.

"The issue is, have we confused the public? ... I would like to see more consensus from the research community that supports that, because we need more data. We need to move the needle. ... The last thing we need, I think now, as a whole football community, is going back and forth and confusing the issue any more."

Mike Oliver, the executive director of the National Operating Committee on Standards for Athletic Equipment, continued to express a longstanding desire to come up with a safety standard for youth helmets.

But he cautioned that it's dangerous to rush to a conclusion before the scientific research is complete. NOCSEA, a nonprofit corporation, formed in 1969 in response to a need for a performance test standard for helmets.

"You want to have an answer. You want to have a solution to the problem," Oliver said. "You want to be able to say ... 'We do have a solution to the problem and you can have a level of confidence (that) you will have a level of protection. ... But we can't do that until we have the science behind it."

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