PORTSMOUTH - With 41 identified cases in Canada and 17 in the United States in the past two months

PORTSMOUTH - With 41 identified cases in Canada and 17 in the United States in the past two months, public health officials are looking for the source of E. coli bacteria causing food-borne illness in both countries.

Officials at the Public Health Agency in Canada suspect the infection is stemming from romaine lettuce, but have not yet pinpointed the source of the contamination. They say the cases involve use of the lettuce at home bought at grocery stores and in meals served at restaurants.

"E. coli are bacteria that live naturally in the intestines of cattle, poultry and other animals," states a PHA Canada press release. "A common source of E. coli illness is raw fruits and vegetables that have come in contact with feces from infected animals. Leafy greens, such as lettuce, can become contaminated in the field by soil, contaminated water, animals or improperly composted manure. Lettuce can also be contaminated by bacteria during and after harvest from handling, storing and transporting the produce. Contamination in lettuce is also possible at the grocery store, in the refrigerator, or from counters and cutting boards through cross-contamination with harmful bacteria from raw meat, poultry or seafood. Most E. coli strains are harmless to humans, but some varieties cause illness."

A release from the Centers for Disease Control on Dec. 28 said the cases of E. coli reported involve 13 states, with two of the cases in New Hampshire. They have not yet concluded the cause is romaine lettuce, so no advisory has been issued about consuming the product. They are investigating and say the cases seem closely related to the cases being seen in the eastern provinces of Canada.

"Two cases in New Hampshire are not a lot yet, but there has been one death," said Dr. Apara Dave of Core Infectious Disease. "The CDC is saying that leafy greens are a possible source, and I know Canada has identified Romaine lettuce. There are lots of different kinds of E. coli, but the strain in both countries appears to be the same and causes diarrhea and gastrointestinal discomfort."

Dr. David Itkin, Infectious Disease Specialist at Portsmouth Regional Hospital, said, at this point, the CDC investigation is a "work in progress."

"The U.S. cases appear like the Canadian cases so there is some speculation about romaine lettuce. It could be that other produce is also to blame. The CDC will not issue advisories until they are sure of the source of the illness here."

Should a person choose to eat romaine lettuce, Itkin advises washing your hands thoroughly before and after handling it. Discarding the outer leaves can help and the produce should be washed under cool running water until all dirt is washed away.

"Don't soak it because that can allow bacteria to spread," said Itkin. "Wash thoroughly all utensils and cutting boards used with the product."

Itkin said a symptom of E. coli illness is often diarrhea, but in this strain, O157:H7, bloody diarrhea may be seen, along with abdominal cramps.

"The symptoms usually occur three to four days after an exposure," said Itkin. "Fortunately for most, while unpleasant, it is a brief illness. Supportive care is the best course of treatment. Avoid dehydration. Antibiotics are not used because they are not effective in this illness and could even be counter-productive. Avoid anti-diarrheal medicines like Imodium as they can actually prolong the illness."

This strain of E. coli is contagious and can spread through a household.

"If you have it, do not prepare food for the rest of the family," said Itkin. "Try to use your own bathroom. Disinfect sinks, showers, even doorknobs."

"It is a self-limiting disease in most people," Dave said. "We worry more about small kids and the elderly."

In very rare cases, the illness can cause more severe symptoms and may require hospitalization. Itkin said it can affect the kidneys, platelet counts and can cause confusion, particularly in the elderly.

"Watch the severity of the illness," said Itkin. "If there is a high-grade fever and dehydration, or if the person seems confused or lethargic, seek medical attention.