Americans are being warned to take care while swimming in lakes this summer — after several children suffered from kidney failure after taking a dip in freshwater.
The patients fell ill days after playing in Lake Anna, Virginia, over Memorial Day weekend, with symptoms including diarrhea, dehydration and stomach cramps.
In total 20 people — mostly children — have fallen sick after swimming in the lake, while several have also been hospitalized. No deaths have been reported.
Testing shows many of the patients are infected with E.coli, a bacteria that can infest lakes and rivers, usually when sewage is dumped into them.
Officials are testing for other bugs, however, including the deadly brain-eating amoeba Naegleria fowleri — which kills more than 97 percent of those it infects.
Ava Inglett, 15, is among those to have been sickened with kidney failure after catching E.coli from a freshwater lake in Virginia
The infections have been linked to Lake Anna, which is about 70 miles south of Washington DC
Amoebas appear to be becoming more common in freshwater, as warmer weather heats lakes and streams.
Families who have lost loved ones to the amoeba are raising awareness over the organism this year, including the mother of 10-year-old Lily Avant — who died in 2019 after catching the disease from a local river.
Most people catch E.coli from eating foods like salad, which may have been sprayed with water contaminated with the bacteria.
But it is also possible to catch the bacteria from lakes and rivers if someone swallows contaminated water. Three to five percent of patients die from the disease.
Fifteen-year-old Ava Inglett was among those who have been hospitalized in the Virginia E.coli outbreak.
Her mother Judy told local news her daughter fell ill a few days after visiting the lake for a boating weekend, before she was rushed to the hospital.
She has now had at least four rounds of dialysis and three blood transfusions as she battles the infection.
'She's going through all these things that never in a million years would I have imagined that my daughter would be dealing with,' Ms Inglett said.
'There's something in the water that's making all these kids sick.'
She added: 'I want people to know and think twice before they let their child take a swim in that water, because I would hate for anyone else to go through what my daughter's been through.'
The lake, about 70 miles south of Washington DC, is popular with families and for boating activities — as well as swimming and kayaking. About 3million visitors enjoy days at the lake every year.
Ava has been on dialysis because of kidney failure, where a machine is used to filter her blood
She had swum in the lake with friends on Memorial Day. A number of others are also unwell, local reporters said
Virginia Department of Health officials revealed the spike in illnesses in an alert and said they were testing the water to determine the cause.
All patients are also being interviewed to ensure the E.coli had not come from food, a common way in which people are infected.
Ten of the patients are confirmed to be infected with E.coli.
Health director Dr Olugbenga Obasanjo said: 'As we head to pools, lakes and beaches to enjoy the warmer weather and spend time with our families, it is important to remember to take precautions to prevent illness.
'Showering before and after swimming, washing your hands before eating and being sure not to drink the lake water are some of the ways to stay healthy this summer.
'It is also important not to swim if you have diarrhea.'
He added: 'Children may need extra monitoring and reminders to follow these precautions.'
E.coli often enters lakes via leaks from sewer pipes or animal feces, as well as run-off from storm drains.
Swimmers can then become infected if they accidentally swallow contaminated water or handle food after swimming without washing their hands.
The bacteria can survive the stomach acid and travel to the small intestine, where they trigger an infection that causes the typical gastrointestinal symptoms.
But they also release toxins in the gut that can pass into the bloodstream and destroy red blood cells.
The detritus of destroyed cells can then build-up in the kidneys, leaving them unable to filter the blood correctly — causing kidney failure.
Doctors treat the condition via dialysis — which filters the blood when the kidneys are unable to — which gives the kidneys time to heal.
To treat an E.coli infection, doctors prescribe antibiotics — such as ciprofloxacin and azithromycin — which kill the bacteria.
About three to five percent of patients who catch E.coli die from the disease, the World Health Organization says.
It is particularly dangerous for children under five years old, adults over 65 years old and anyone with a weakened immune system.
