Health officials have linked three cases of potentially fatal E. coli in Maryland to the nationwide outbreak caused by tainted spinach. They're also investigating a possible link in several other cases, including one death.
The three cases, confirmed by DNA tests of the bacteria, occurred in children who have all recovered, said Dr. Michelle Gourdine, deputy secretary for public health services at the state Department of Health and Mental Hygiene.
Among the pending cases, Gourdine would identify the person who died only as "an elderly resident." Citing privacy laws, she refused to say where the death occurred or whether it was the same one described in an account yesterday in the Hagerstown Herald-Mail.
Family members told the newspaper that June E. Dunning, 86, of Hagerstown, died Sept. 13, two weeks after consuming fresh bagged spinach and falling ill.
In the cases of the children, Gourdine said "strict privacy laws" prevented her from disclosing their ages or where they live. She did say the cases were not clustered in one locality.
All three children consumed fresh spinach before the nationwide alert to avoid bagged spinach was issued Sept. 14, and all fell ill within days. Two were hospitalized and released, she said.
Officials from the U.S. Food and Drug Administration said last night that their investigations into the causes of the outbreak were continuing.
Their focus was on farms and processing plants in three California counties where all the tainted spinach found so far originated.
Officials said they are working with growers elsewhere in efforts to get fresh spinach grown in regions that have not been implicated in the outbreak back on store shelves as early as next week.
Since Sept. 14, when retailers across the country began removing bagged spinach products, the number of known E. coli cases linked to the U.S. outbreak has grown to more than 166 in 25 states.
Maryland and Tennessee were added yesterday, officials said.
The one death confirmed so far occurred in Wisconsin, according to the U.S. Centers for Disease Control and Prevention. In Idaho, authorities are looking into the death from kidney failure this week of a 2-year-old boy whose parents said they fed him spinach in a smoothie.
But his illness had not yet been linked to E. coli, according to the CDC.
In Maryland, the three confirmed cases were among 10 E. coli infections reported to the DHMH since Aug. 1, a number that Gourdine described as "pretty much average" during that time period.
Each year, she said, 20 to 30 E. coli infections are reported to state health authorities. There have been 23 in Maryland so far in 2006. Nationally, about 5 percent of reported cases are fatal.
After the nationwide alert went out Sept. 14, Gourdine said, Maryland investigators reviewed all 10 E. coli infections reported to the state since Aug. 1 - the date of the first case in the national outbreak.
They interviewed the victims and their families and sent spinach and bacterial samples for testing. It was only late Thursday evening that investigators learned that DNA tests had positively linked bacteria in three of the cases to the nationwide outbreak, a department spokeswoman said yesterday.
DNA tests on bacteria recovered in the other seven Maryland infections since Aug. 1 determined that three cases were unrelated to the E. coli strain implicated in the nationwide outbreak. Four others remain unconfirmed pending further tests.
Gourdine said the Maryland fatality that her office is investigating might never be positively linked to the nationwide outbreak. Although the state did obtain samples of the spinach that person consumed, she said, needed tissue specimens from the patient were not available.
"That case may never be confirmed," she said.
The Hagerstown E. coli case emerged yesterday in the Herald-Mail article. Dunning's son-in-law, Warren Swartz, told the newspaper that his wife's mother "was as healthy as she could be" before she was stricken.
Dunning was hospitalized at Washington County Hospital, where she underwent surgery to remove a portion of her intestines, the newspaper reported, quoting her son-in-law.
She later fell into a coma and died. The family said her death certificate listed E. coli infection as a contributing factor.
The Hagerstown paper reported that Dunning's death certificate also listed ischemic colitis (an inflammation of the colon due to inadequate blood supply) and atherosclerotic vascular disease, or hardening of the arteries.
Dunning's Sept. 15 obituary in the Herald-Mail said she was born in 1920, in London, England. Her husband, Arthur Gordon Dunning, died in 1996. The couple has a daughter in Hagerstown, a son in Korea and three grandchildren.
A neighbor, Kathy Colby, said Dunning, her daughter and son-in-law moved into the house four or five years ago. She described her as "British and very proper. She had the beautiful accent."
News of Dunning's death spread quickly yesterday in Hagerstown.