by Eveline Gan   Since late last month, Escherichia coli, or E coli, infection outbreak has claimed 22 lives, at press time. More than 2,000 people have fallen ill in Germany and from various regions in Europe.   The Ministry of Health has advised Singaporeans who are travelling to Germany to follow certain precautionary measures:   - practice good hygiene   - avoid eating leafy vegetables, raw tomatoes and cucumbers   - ensure that food is thoroughly cooked before consumption   Travellers returning from Germany should seek medical care immediately if they develop diarrhoea and abdominal cramps.   E coli is a type of bacteria commonly found in the gut of humans and animals, and some of them are capable of producing a toxin called Shiga-toxin, said Dr Leong Hoe Nam, infectious disease specialist at Raffles Hospital.   One particular strain of Shiga-toxin producing E coli (STEC), called O157:H7, can be fatal. For the outbreak in Germany in May, the strain was O104.       What Are The Signs?   Typical symptoms of STEC infection include having non-bloody watery diarrhoea with severe abdominal cramps, which occurs about three to four days after ingesting the offending bacteria, said Dr Leong.   Bloody diarrhoea and vomiting may develop three to four days later. Like some of the cases in Germany, a rare condition characterised by renal failure called Haemolytic uraemic syndrome (HUS), can occur five to six days later.   "The person develops decreased urine output, pallor and confusion, and bruising may also occur because of low platelets," said Dr Leong.       Skip The Salad, Please   According to Dr Leong, the infection occurs when a person consumes contaminated food. Reports have indicated that consumption of contaminated fresh vegetables in Germany is the main risk factor at present.   "Contamination may occur in the kitchen where poor kitchen hygiene is practiced. It can also be passed on from person-to-person through faecal-oral transmission or within the household, when an infected person does not wash hands after using the toilet," said Dr Leong.   However, he added that the bacteria are killed at temperatures higher than 70 degrees Celsius, so do stick to eating only properly cooked food.   Most people, especially those with the non-O157 strain recover within five to 10 days.   If you suspect you have STEC, see a doctor immediately.   Drink adequate fluids, and avoid using certain medications such as NSAIDs including voltaren, ponstan, arcoxia, as they may affect blood supply to the kidneys, especially with prolonged use, advised Dr Leong. He also stressed good hand and toilet hygiene. Eveline Gan           This article was featured in Today June 7, 2011. http://www.todayonline.com/Health/EDC110607-0000427/Travelling-to-Germany?-Ta...