Tag Archives: e coli

PCR in Sweden

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Enteroinvasive Escherichia coli (EIEC) and Shigella spp. are both Gram-negative bacteria causing diarrheal disease worldwide [1,2]. The clinical presentations of these two pathogens are very similar [3,4] and commonly manifested through diarrhoea, abdominal cramps, nausea and fever both in children and adults [5,6]. In addition to a similar clinical picture, EIEC and Shigella share laboratory features that can make it difficult to distinguish between them in routine clinical laboratory practice. Both pathogens are transmitted via the faecal-oral route and infections are frequently associated with consumption of contaminated food and water [7–10]. While Shigella is associated with large-scale food-borne outbreaks [11,12], outbreaks caused by EIEC are rarely recorded.

High prevalence of EIEC infections have been documented in rural areas and settings with poor sanitation in high-risk countries [5,13] while EIEC infections in Europe are typically sporadic and travel related [14]. Nevertheless, a few EIEC outbreaks have been reported in Europe, with the most recent ones having occurred in Italy in 2012 [15] and in the United Kingdom (UK) in 2014 [16]. These outbreaks affected 109 cases and 157 probable cases, respectively, highlighting the fact that EIEC, like Shigella, has the capacity to cause large gastrointestinal disease outbreaks. The outbreak strain identified in these recent European outbreaks, EIEC O96:H19, is an emergent type of EIEC that has phenotypic characteristics more resembling those of non-invasive Escherichia coli (E. coli) than those described for Shigella [17]. These characteristics are suggested to contribute to improved survival abilities as well as the ability to better adapt to different ecological niches [17].

Traditionally, culturing of faecal specimens has been the mainstay of laboratory diagnostics for enteric bacteria, and EIEC has been differentiated from Shigella by assessing a combination of several phenotypic characteristics, including biochemical, motility and serological traits [18,19]. This is now changing as PCR-based methods are becoming routine in many diagnostic laboratories [20]. In contrast to non-invasive E. coli, EIEC and Shigella can invade and multiply in intestinal epithelial cells [21], a process that is partially mediated by the products of the invasion plasmid antigen (ipa) genes [22]. For this reason, PCR targeting the ipaH gene can separate EIEC from other non-invasive E. coli, but cannot differentiate between EIEC and Shigella [23]. The lacY gene has been proposed as an additional molecular marker for which most E. coli are positive and Shigella is negative [24]. Its use as a PCR target in separating Shigella and EIEC is restricted to bacterial isolates since many faecal samples are lacY positive because of the presence of E. coli in the normal flora.

In Sweden, several clinical laboratories have shifted towards the use of direct PCR testing on faecal specimens as the primary diagnostic tool. However, most of these laboratories culture PCR-positive samples, so called PCR-guided culturing. Although culturing of PCR-positive faecal specimens is routinely performed, it can be difficult to obtain EIEC isolates since the morphology of EIEC strains on commonly used substrates can mimic the morphology of the enteric background flora, yellow colonies on xylose lysine deoxycholate (XLD) agar, rather than the morphology of Shigella, red colonies on XLD agar. Hence, separating EIEC from other bacteria in the normal flora usually whhttps://www.technologynetworks.com/applied-sciences/news/sticker-could-improve-safety-of-our-cold-chain-food-333138?utm_campaign=NEWSLETTER_TN_Food%20%26%20Beverage%20Analysis&utm_source=hs_email&utm_medium=email&utm_content=86254121&_hsenc=p2ANqtz–MMoS1KFFGpgRZ_seNnO0bmNz_SMVvraj4jqMu9SDGvKY_0jhrfEnmyzyUGUG4KMiZPINfu3qM8tMQOAJhBtcRodwdNw&_hsmi=86254121

Which is considered too time consuming for most clinical laboratories. For this reason, it is likely that a patient with specimens that are ipaH PCR-positive but culture negative would not be notified as a case if the diagnostic algorithm at the laboratory requires a detected Shigella isolate. In addition, PCR is a more sensitive method than culturing [25] and Shigella is known for its limited survival ability in faecal samples [26], which also may lead to samples being ipaH PCR-positive but culture negative.

Shigellosis is notifiable by law in Sweden as in the majority of countries in Europe [27]. In 2017, the incidence was 2.1 per 100,000 inhabitants in Sweden, and the majority of cases had been infected abroad [28]. The mandatory reporting of diseases allows the implementation of a series of public health actions, including public health management and surveillance activities, and helps define risk exposures. In contrast to shigellosis, reporting is not mandatory for EIEC and the occurrence of this pathogen in Sweden is currently unknown.It requires additional laboratory procedures such as screening large numbers of colonies,

Outbreak of gastroenteritis highlighting the diagnostic and epidemiological challenges of enteroinvasive Escherichia coli, county of Halland, Sweden, November 2017, 12 December 2019

Eurosurveillance

Nina Lagerqvist1,2, Emma Löf1,3, Theresa Enkirch1,2, Peter Nilsson4, Adam Roth1, Cecilia Jernberg1

https://doi.org/10.2807/1560-7917.ES.2020.25.9.1900466

https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.9.1900466

Whittaker: Market food safety

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Ashley Nickle of The Packer wrote in Oct. 2019 (did I mention the bit about catch up, 8 broken ribs and a broken collarbone) PMA chief science and technology officer Bob Whitaker gave an impassioned presentation at Fresh Summit on the improvements that need to be made in food safety across the industry. Ten years after the formation of the Center for Produce Safety, companies can’t assert anymore that there isn’t relevant research to inform practices, Whitaker said.

Whitaker gave specific examples of potentially risky practices that are common. He mentioned setting harvest containers on the ground before they’re filled, and spoke about relying on the presence of generic E. coli in agricultural water to indicate pathogenic E. coli, along with several other examples.

Whitaker encourages companies to get competitive on food safety if that will get them to push past the status quo. He urged industry members to consider the costs when outbreaks happen, and he mentioned the death of a toddler during the 2006 outbreak linked to spinach.

“If we look at the recent issues we’ve had, we had an issue that involved water,” Whitaker said. “People said, ‘Well, we measured the water, we looked at generic E. coli.’ Well yeah, but the research has told us for years that generic E. coli does not represent the presence of pathogenic E. coli or salmonella. And In fact, at the volumes we do, we’re not going to find it.

“We also know that in every water system we’ve looked at around the U.S., I don’t care what crop, it has nothing to do with crop, every place the researchers have looked at and we’ve had a concentrated effort, we found contamination in open water sources — back east, out west, up north, doesn’t make a difference,” Whitaker said. “That’s where it is.”

Growing near concentrated animal feeding operations is another practice that the research indicates carries some risk.

“We know that dust will make the stuff travel,” Whitaker said. “Now we don’t know how far, but we know the one experiment that was done went out to 600 and it was there, so maybe it went farther …”

He also noted several practices in the field that he described as problematic yet commonplace.

“If I had a nickel for every picture I get every summer of people showing me Port-A-Johns being serviced in the field next to a harvest crop, I could have retired a couple years ago,” said Whitaker, who plans to retire from PMA in January.

“Don’t tell me it doesn’t drip, and then we wonder how we get some of these things like parasites in our fields,” Whitaker said.

He mentioned harvest sleds being left in the field overnight with the day’s debris still on them as another potential problem.

 “I’m seeing companies now breaking away from what everybody else is doing and say, ‘You know what, this is what we’re going to do,’” Whitaker said. “And we’ve always abhorred that idea. We’ve always said that food safety is something we share with each other, we don’t compete on it.

“To hell with that,” Whitaker said. “One thing this industry knows how to do is compete … You’ve always been marketing it anyway — you know you have. I see the stories. I see myself show up in people’s marketing things to their customers. I know that they’re marketing that.

“So do it,” Whitaker said. “If that’s what it’s going to take to get better, to create competition to get better, then do it. Because that’s what we need to do. We need the impetus to do it.”

Persister, I don’t even know her: STEC in produce

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Bacterial persistence is a form of phenotypic heterogeneity in which a subpopulation, persisters, has high tolerance to antibiotics and other stresses. Persisters of enteric pathogens may represent the subpopulations capable of surviving harsh environments and causing human infections. Here we examined the persister populations of several shiga toxin-producing Escherichia coli (STEC) outbreak strains under conditions relevant to leafy greens production.

The persister fraction of STEC in exponential-phase of culture varied greatly among the strains examined, ranging from 0.00003% to 0.0002% for O157:H7 strains to 0.06% and 0.08% for STEC O104:H4 strains. A much larger persister fraction (0.1–11.2%) was observed in STEC stationary cells grown in rich medium, which was comparable to the persister fractions in stationary cells grown in spinach lysates (0.6–3.6%). The highest persister fraction was measured in populations of cells incubated in field water (9.9–23.2%), in which no growth was detected for any of the STEC strains examined. Considering the high tolerance of persister cells to antimicrobial treatments and their ability to revert to normal cells, the presence of STEC persister cells in leafy greens production environments may pose a significant challenge in the development of effective control strategies to ensure the microbial safety of fresh vegetables.

Enhanced formation of shiga toxin-producing Escherichia coli persister variants in environments relevant to leafy greens production

Science Direct, Food Microbiology, Volume 84

Sandy Thao, Maria T. Brandl, Michelle Qiu Carter

https://www.sciencedirect.com/science/article/pii/S0740002018311353

Jimmy John’s and sprouts — again

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Remember when Jimmy John’s, the sandwich favored by university faculty department meetings and college students across the U.S., sickened hundreds of people across the U.S linked to raw alfalfa sprouts so they switched to raw clover sprouts and made more people sick?

It’s happened again.

Chris Koger of The Packer reported in late Dec. 2019 that Sprouts Unlimited, Marion, Iowa, is recalling clover sprouts, which have been linked to a cluster of E. coli cases under investigation in Iowa.

The Iowa Department of Inspections and Appeals is investigating the link between the outbreak and the product from Sprouts Unlimited, according to a Dec. 27 recall notice from the company.

The sprouts were shipped to Hy-Vee and Fareway Foods stores, and Jimmy John’s restaurants.

The retail packs in the recall are in pint containers with a blue label on the lid, according to Sprouts Unlimited. The Universal Product Code is 7 32684 00013 6 is on the bottom right side of the label.

The Iowa Department of Inspections and Appeals told Sprouts Unlimited the sprouts are epidemiologically linked to the outbreak. More tests are being conducted to determine the source, according to the recall notice.

We document at least 55 sprout-associated outbreaks occurring worldwide affecting a total of 15,233 people since 1988. A comprehensive table of sprout-related outbreaks can be found here.

Failures in sprouts-related risk communication

Food Control.2012. 10.1016/j.foodcont.2012.08.022

Erdozain, M.S., Allen, K.J., Morley, K.A. and Powell, D.A.

http://www.sciencedirect.com/science/article/pii/S0956713512004707?v=s5

Nutritional and perceived health benefits have contributed to the increasing popularity of raw sprouted seed products. In the past two decades, sprouted seeds have been a recurring food safety concern, with at least 55 documented foodborne outbreaks affecting more than 15,000 people. A compilation of selected publications was used to yield an analysis of the evolving safety and risk communication related to raw sprouts, including microbiological safety, efforts to improve production practices, and effectiveness of communication prior to, during, and after sprout-related outbreaks. Scientific investigation and media coverage of sprout-related outbreaks has led to improved production guidelines and public health enforcement actions, yet continued outbreaks call into question the effectiveness of risk management strategies and producer compliance. Raw sprouts remain a high-risk product and avoidance or thorough cooking are the only ways that consumers can reduce risk; even thorough cooking messages fail to acknowledge the risk of cross-contamination. Risk communication messages have been inconsistent over time with Canadian and U.S. governments finally aligning their messages in the past five years, telling consumers to avoid sprouts. Yet consumer and industry awareness of risk remains low. To minimize health risks linked to the consumption of sprout products, local and national public health agencies, restaurants, retailers and producers need validated, consistent and repeated risk messaging through a variety of sources.

Australian smallgoods company Wintulichs recalls mettwurst products amid contamination fears

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Several types of mettwurst, manufactured by a South Australian Company, have been recalled after it was discovered the products may be contaminated with harmful bacteria.

Wintulichs, based in Gawler, recalled their Metwurst Garlic 300g, 375g, 500g, 700g, Mettwurst Plain 700g and Mettwurst Pepperoni 375g products.

Food Standards Australia New Zealand say the products have been sold at Woolworths, IGA and independent stores across SA.

The recall is due to incorrect pH and water activity levels, which may lead to microbial contamination and could cause illness if consumed.

Customers should return the products to the place of purchase for a full refund.

In Australia and around the world, the incidence of reported foodborne  illness is on the increase. Regularly cited estimates suggest that Australia is  plagued with over two million cases of foodborne  illness each year, costing  the community in excess of $1 billion annually.

Based on the case studies cited here and a thorough examination of a variety of documents disseminated for public consumption, government and  industry in Australia are well aware of the challenges posed by greater public  awareness of foodborne illness. They are also well aware of risk  communication basics and seem eager to enter the public fray on contentious issues. The primary challenge for government and industry will be to provide evidence that approaches to managing microbial foodborne risks are indeed mitigating and reducing levels of risk; that actions are matching words.

There  is a further challenge in impressing upon all producers and processors the  importance of food safety vigilance, as well as the need for a comprehensive crisis management plan for critical food safety issues.

On Feb. 1, 1995, the first report of a food poisoning outbreak in Australia  involving the death of a child from hemolytic uremic syndrome (HUS) after  eating contaminated mettwurst reached the national press. The next day, the causative organism was identified in news stories as E. coli 0111, a Shiga-toxin E. coli (STEC) which was previously thought to be destroyed by the acidity in fermented sausage products like mettwurst, an uncooked, semi-dry fermented sausage. By Feb. 3, 1995, the child was identified as a four-year-old girl and the number sickened in the outbreak was estimated at 21.

The manager of the company that allegedly produced the contaminated mettwurst had to hire security guards to protect his family home as threats continued to be made on his life, and the social actors began jockeying for position in the  public discourse. The company, Garibaldi, blamed a slaughterhouse for  providing the contaminated product, while the State’s chief meat hygiene  officer insisted that meat inspections and slaughtering techniques in  Australian abattoirs were “top class and only getting better.”

On Feb. 4, just three days after the initial, national report, the South  Australian state government announced it was implementing new food regulations effective March 1, 1995. The federal government followed suit the next day, announcing intentions to bolster food processing standards and  launching a full inquiry. Even the coroner investigating the death of the girl  said on Feb. 9 that investigations relating to inquests usually took about three months to complete, but he would start the hearing the next day if possible.

By Feb. 6, 1995, Garibaldi Smallgoods declared bankruptcy. Sales of smallgoods  like mettwurst were down anywhere from 50 to 100 per cent according to the National Smallgoods Council.

The outbreak of E. coli O111 and the reverberations fundamentally changed the public discussion of foodborne illness in Australia, much as similar outbreaks of STEC in Japan, the U.K. and the U.S. subsequently altered public perception, regulatory efforts and industry pronouncements in those countries. The pattern of public reporting and response followed a similar pattern of reporting on the medical implications of the illness, attempts to determine causation and finger pointing. Such patterns of reporting are valid; when people are sick and in some cases dying from the food they consume, people want to know why. The results altered both the scientific and public landscapes regarding microbial foodborne illness, and can inform future risk communication and management efforts.

In all, 173 people were stricken by foodborne illness linked to consumption of mettwurst manufactured by Garibaldi smallgoods. Twenty-three people,  mainly children, developed HUS, and one died. Although sporadic cases of HUS had been previously reported, this was the first outbreak of this condition recognized in Australia.

Once public attention focused on Garibaldi as the source of the offending foodstuff, the company quickly deflected criticism, blaming an unnamed Victorian-based company of supplying contaminated raw meat, and citing historical precedent as proof of safety. Garibaldi’s administration manager Neville Mead was quoted as saying that he was confident hygiene and processing at the plant were up to standard, adding, “We stand by our processing. We’ve done this process now for 24 years and it’s proved successful.” Such blind faith in tradition, even in the face of changing science-based recommendations, even in the face of tragedy, is often a hallmark of outbreaks of foodborne illness, reflecting the deep cultural and social mythologies that are associated with food.

However, given the uncertainties at the time, a spokesman with the Australian Meat and Livestock Association appropriately rejected such allegations, saying, “I believe it is irresponsible of them (Garibaldi) to make that statement when there is absolutely no evidence of that at all.” Likewise, Victorian Meat Authority chairman John Watson said his officers were investigating Garibaldi’s claims, but that even if the raw meat had come from

Victoria, the supplier may not necessarily be the source of the disease, but rather it could be based in Garibaldi’s processing techniques.

Similarly, when Garibaldi accused the watchdog South Australian Health Commission of dragging its feet with investigations, Health Minister, Dr. Michael Armitage responded by publicly stating that, “They indicated to us that they wanted their lawyers first to be involved before they provided us with information (concerning the mettwurst). It was only (after) earlier this week, under the Food Act, we issued a demand for that information, that we got it. So indeed, I would put it to Garibaldi that the boot is completely on the other foot.”

Likewise, South Australia’s chief meat hygiene officer, Robin Van de Graaff rejected such claims, saying that, “These organisms are part of a large family of bugs that are normal inhabitants of the gut of farm animals … If a tragedy like this occurs it is usually because, and it no doubt is in this case, not because of a small amount of contamination at the point of slaughter but because of the method of handling and processing after that.” The statements of government regulators would be subsequently validated.

Shiga toxin-producing Escherichia coli survives storage in wheat flour for two years

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Wheat flour has recently been recognised as an exposure vehicle for the foodborne pathogen Shiga toxin-producing Escherichia coli (STEC). Wheat flour milled on two sequential production days in October 2016, and implicated in a Canada wide outbreak of STEC O121:H19, was analysed for the presence of STEC in November 2018.

Stored in sealed containers at ambient temperature, the water activity of individual flour samples was below 0.5 at 6 months post-milling and remained static or decreased slightly in individual samples during 18 months of additional storage. STEC O121 was isolated, with the same genotype (stx2a, eae, hlyA) and core genome multilocus sequence type as previous flour and clinical isolates associated with the outbreak. The result of this analysis demonstrates the potential for STEC to persist in wheat flour at levels associated with outbreak infections for periods of up to two years. This has implications for the potential for STEC to survive in other foods with low water activity.

Shiga toxin-producing Escherichia coli survives storage in wheat flour for two years

Food Microbiology

AlexanderGill1TanisMcMahon1ForestDussault2NicholasPetronella2

https://doi.org/10.1016/j.fm.2019.103380

https://www.sciencedirect.com/science/article/pii/S0740002019309906

Udder Delights in Australia recalling cheese after E. coli found

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Some of its most popular cheeses, including its 200g camembert and brie are being recalled. Dixie Sulda and Jessica Galletly of Adelaide Now report the SA company said there was no evidence the form of E.coli found was dangerous but it was recalling them as a precaution.

The cheeses are available from Coles and independent retailers in SA, Queensland, Victoria and WA. In NSW they also sell at Woolies and in Tasmania they are sold at independent retailers.

Udder Delights chef executive Sheree Sullivan said the team was “devastated” after small levels of the bacteria were found in some of the company’s white mould 200g cheeses.

“It is with a very heavy heart that Udder Delights is doing its first voluntary recall since we began 20 years ago,” Ms Sullivan said.

“The whole team is devastated, because we all just work so hard to create a really high quality product.

“You always learn some of your best lessons through disasters, and I never really understood what a voluntary recall was. It means you have a choice – do you want to recall or not? We decided as a business we wanted to be 100 per cent sure it was safe.

“It was great SA Health and Dairysafe confirmed it wasn’t a dangerous bacteria, which can sometimes be a little bit of sunshine in a dark cloud.”

Ms Sullivan would not speculate on what caused the contamination, but said they were working with SA Health and their quality assurance team to quickly resolve the issue.

24 now sick from shiga-toxin producing E. coli in Newfoundland and Labrador

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Newfoundland and Labrador’s provincial health department is advising residents of an outbreak of E. coli bacteria.

There have been 22 cases of E.coli confirmed in the province, according to an advisory issued last Friday afternoon.

Another two suspected cases have since emerged.

Dr. Janice Fitzgerald said some of the cases are connected to an advisory issued by Memorial University last week, saying Eastern Health was investigating reports of students experiencing gastrointestinal illness.

The university said Wednesday that test results indicated one student living in residence “may have contracted the E. coli bacteria” and 21 students had reported similar symptoms.

Fitzgerald said it’s too early in the investigation to determine a cause of the outbreak.

What foods are most likely to cause illness by shiga toxin-producing Escherichia coli (STEC) and how best to control secondary infections

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Two abstracts attempt to provide guidance to these important questions to reduce the toll of STEC.

FAO and WHO conclude shiga toxin-producing Escherichia coli (STEC) infections are a substantial public health issue worldwide, causing more than 1 million illnesses, 128 deaths and nearly 13 000 Disability-Adjusted Life Years (DALYs) annually.

To appropriately target interventions to prevent STEC infections transmitted through food, it is important to determine the specific types of foods leading to these illnesses.

An analysis of data from STEC foodborne outbreak investigations reported globally, and a systematic review and meta-analysis of case-control studies of sporadic STEC infections published for all dates and locations, were conducted. A total of 957 STEC outbreaks from 27 different countries were included in the analysis.

Overall, outbreak data identified that 16% (95% UI, 2-17%) of outbreaks were attributed to beef, 15% (95% UI, 2-15%) to produce (fruits and vegetables) and 6% (95% UI, 1-6%) to dairy products. The food sources involved in 57% of all outbreaks could not be identified. The attribution proportions were calculated by WHO region and the attribution of specific food commodities varied between geographic regions.

In the European and American sub-regions of the WHO, the primary sources of outbreaks were beef and produce (fruits and vegetables). In contrast, produce (fruits and vegetables) and dairy were identified as the primary sources of STEC outbreaks in the WHO Western Pacific sub-region.

The systematic search of the literature identified useable data from 21 publications of case-control studies of sporadic STEC infections. The results of the meta-analysis identified, overall, beef and meat-unspecified as significant risk factors for STEC infection. Geographic region contributed to significant sources of heterogeneity. Generally, empirical data were particularly sparse for certain regions.

Care must be taken in extrapolating data from these regions to other regions for which there are no data. Nevertheless, results from both approaches are complementary, and support the conclusion of beef products being an important source of STEC infections. Prioritizing interventions for control on beef supply chains may provide the largest return on investment when implementing strategies for STEC control.

Second up, in 2016, we reviewed preventive control measures for secondary transmission of Shiga-toxin producing Escherichia coli (STEC) in humans in European Union (EU)/European Free Trade Association (EEA) countries to inform the revision of the respective Norwegian guidelines which at that time did not accommodate for the varying pathogenic potential of STEC.

We interviewed public health experts from EU/EEA institutes, using a semi-structured questionnaire. We revised the Norwegian guidelines using a risk-based approach informed by the new scientific evidence on risk factors for HUS and the survey results.

All 13 (42%) participating countries tested STEC for Shiga toxin (stx) 1, stx2 and eae (encoding intimin). Five countries differentiated their control measures based on clinical and/or microbiological case characteristics, but only Denmark based their measures on routinely conducted stx subtyping. In all countries, but Norway, clearance was obtained with ⩽3 negative STEC specimens. After this review, Norway revised the STEC guidelines and recommended only follow-up of cases infected with high-virulent STEC (determined by microbiological and clinical information); clearance is obtained with three negative specimens.

Implementation of the revised Norwegian guidelines will lead to a decrease of STEC cases needing follow-up and clearance, and will reduce the burden of unnecessary public health measures and the socioeconomic impact on cases. This review of guidelines could assist other countries in adapting their STEC control measures.

Mapping of control measures to prevent secondary transmission of STEC infections in Europe during 2016 and revision of the national guidelines in Norway

Cambridge University Press vol. 147

  1. Veneti(a1)(a2), H. Lange (a1), L. Brandal (a1), K. Danis (a2) (a3) and L. Vold 

DOI: https://doi.org/10.1017/S0950268819001614
https://www.cambridge.org/core/journals/epidemiology-and-infection/article/mapping-of-control-measures-to-prevent-secondary-transmission-of-stec-infections-in-europe-during-2016-and-revision-of-the-national-guidelines-in-norway/1990D2338B220F80F0E683DF6F622A40

British girl, 2, dies from E. coli after holiday in Turkey

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A two-year-old British girl has died after contracting E.coli while on holiday in Turkey.

Allie Birchall came down with the severe illness after returning to the UK following a stay at a luxury resort east of the coastal city of Antayla.

Her family were forced to turn off Allie’s life support machine just two weeks after their holiday because of complications caused by the illness.

The family had travelled to Turkey with tour operator Jet2 Holidays on 12 July and said they had concerns about the hygeine of the Turkish resort.

Katie Dawson, Allie’s mother, said her daughter did not start getting ill until five days after getting back to their home in Atherton, Greater Manchester.

According to Ms Dawson, Allie began suffering with stomach cramps, diarrhoea, loss of appetite and lethargy before being admitted to Royal Bolton Hospital on July 30.

The hospital confirmed Allie had contracted Shiga-Toxin producing E.Coli (STEC), which later led to her developing deadly Haemolytic Uraemic Syndrome (HUS) – a life-threatening complication related to the poisoning.

Allie was moved to the Manchester Royal Infirmary and put in an induced coma on August 1.

An MRI scan was carried out, which revealed that she had sustained severe brain trauma and damage. Katie had to make the difficult decision to terminate Allie’s life support following the advice from doctors.

“While nothing will bring her back, we need to know what caused her illness and if anything could have been done to prevent it.

The family have now instructed specialist international serious injury lawyers, Irwin Mitchell, to investigate what happened.

Public Health England is also currently investigating the matter, and an inquest has been opened to examine the circumstances surrounding Allie’s death.