December 2, 2023

HUS Kidney Failure from Shredded Lettuce: The Federico’s Story

E. coli HUS patients from last summer’s major E. coli O157:H7 restaurant outbreak are able to look back now with durable evidence that contaminated shredded lettuce caused their kidney failure. Records produced by the Maricopa County Departments of Public Health and Environmental Services explain in some detail how the E. coli food poisoning cases clustered among scores of people who dined at one Phoenix-area Federico’s Mexican Restaurant.

Federico's E. coli OutbreakFoodborne outbreaks of E. coli O157:H7 in restaurants can have devastating effects. What typically starts with fever may develop into full-blown hemolytic uremic syndrome (HUS) — a disease that is particularly devastating in children, the elderly or others who have underdeveloped or weakened immune systems. In the Federico’s outbreak, public health officials announced an E. coli alert on August 2, soon after two outbreak victims hospitalized with bloody diarrhea were confirmed to be sufferers of potentially fatal HUS.

“Just to be clear, it is only this one Federico’s establishment where many of the cases have reported eating or purchasing food,” Dr. Bob England, director of MCDPH said at the time. “The investigation remains ongoing and we have all hands on deck to figure out the specific source.”

England referred to the Federico’s at 13132 W. Camelback Road in Litchfield Park, Arizona. By the time the outbreak was contained, there were 81 people sick with confirmed or suspected E. coli food poisoning. A review of the records indicates that green salsa was suspected as a possible source of the outbreak, but the final analysis indicated through laboratory testing that tainted lettuce — shredded at the restaurant — was to blame.

Contact an E coli Lawyer - Free Case EvaluationThe county urged anyone who ate at the restaurant after mid-July to be tested for toxic E. coli infection if they were experiencing bloody diarrhea. “This toxin can cause severe illness and, especially in children, can lead to kidney failure and even death,” the announcement from Maricopa County said.

Dr. England promised to share the results of the investigation with the community, and he did.

A Food Analysis Safety Summary Report said that from August 1-9, the county submitted 44 food samples in connection with the E. coli O157:H7  foodborne outbreak linked to Federico’s in the West Valley. Three of the foods sampled — green salsa, Jalapeno pepper and shredded lettuce — had elevated levels of E. coli, the report said. “As the case-control study results were analyzed, lettuce became the most highly suspect food item,” officials later reported.


Federico’s closed its West Valley location during the investigation, but reopened after officials indicated that it corrected handling processes and complied with all other recommendations, ending the outbreak.

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