Food & Nutrition

Here Are the Symptoms of E. Coli—and Everything Else You Need to Know About the Romaine Lettuce Outbreak

You’ve probably heard about the romaine lettuce E. coli outbreak that’s taken hold across the country, whether you’re a regular salad eater or not.

Since mid-March, 53 people in 16 states have been infected with this bacteria, which has been traced back to contaminated romaine lettuce. So far, 31 people have been hospitalized. While no deaths have been reported, five people have developed a type of kidney failure called hemolytic uremic syndrome (HUS).

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The CDC has issued an advisory about the outbreak, warning consumers not to eat any romaine lettuce unless they know for sure it doesn’t come from the Yuma, Arizona growing region, where they suspect the tainted lettuce originated. The warning includes whole heads and hearts of romaine lettuce, as well as chopped romaine and salad mixes containing romaine.

While the investigation is ongoing as to exactly what started the outbreak, here’s what you need to know to stay safe. 

What is E. coli?

Escherichia coli, or E. coli, is a bacteria that inhabits the gut of humans as well as other animals, says Pritish Tosh, MD, an infectious disease physician and researcher at the Mayo Clinic. Many types of E. coli are normal, harmless parts of the flora of the gut.

The strain in this case is called Shiga toxin-producing E. coli (STEC), says the CDC. It’s one of the nasty, pathogenic types of E. coli that can sicken a person who consumes food harboring the bacteria. How does E. coli end up on your leafy greens? One way is through tiny, even invisible amounts of animal or human fecal matter. When you dive into your chef salad, you might unknowingly ingest fecal particles that contain E. coli. (Gross, yes.)

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Contamination with E. coli can occur at any point in the food production cycle, from when it’s picked to when it’s processed and packaged. Says Dr. Tosh: “Let’s say a person is making a chicken salad in their own kitchen, and doesn’t use good food preparation habits, like hand-washing first. That could contaminate the vegetables in the salad.”

E. coli symptoms to watch for

Dr. Tosh says that common symptoms of an E. coli infection are diarrhea, fever, and abdominal cramping. You’ll typically get sick with bloody diarrhea about three to four days after you’ve been contaminated, and most people recover in a week with proper rest and hydration, says Laura Gieraltowski, PhD, MPH, an epidemiologist at the CDC. “It’s a tough week, but it’s usually over within a week.”

Sometimes, however, an E. coli infection turns into the much more serious hemolytic uremic syndrome, as has happened during this current outbreak. HUS is most common among children under the age of five, older adults, and people with weakened immune systems, says Gieraltowski. Symptoms include fever, abdominal pain, pale skin tone, and decreased urination. Anyone who has these symptoms should seek emergency medical care, advises Gieraltowski.

What types of lettuce are safe?

Gieraltowski says that if you are 100% sure the romaine lettuce you want to consume is not from the Yuma, Arizona, growing region (in other words, you grew it yourself in your own garden), avoid all romaine lettuce until further notice from the CDC.

“We recognize this can be challenging,” she explains. “A lot of products don’t identify the growing region, so unless you can confirm that, our advice is to avoid romaine lettuce … Even if you ate half of a bag of romaine and didn’t get ill, don’t eat it and throw it away.”

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The CDC recommendations are for romaine lettuce only, so keep getting the health benefits of greens by switching to kale, spinach, or other types of leafy greens. The advisory also recommends not eating romaine lettuce from a restaurant.

The outbreak is a reminder of how important meal prep hygiene is, so here’s a refresher. Always wash your hands before and after preparing fruits and vegetables, and wash or scrub all produce before cutting, cooking, and eating, advises the CDC. One exception: If you buy greens labeled prewashed, the CDC says you don’t have to wash them again.

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