KAISERSLAUTERN, Germany — Cucumbers from Spain have been linked to the recent outbreak of E. coli, which has killed two people and sickened hundreds, mostly in northern Germany. The infection has spread to Denmark, and potential cases are being investigated in the United Kingdom, Sweden and the Netherlands.

German health officials from the Hamburg Institute for Hygiene and Environment identified three cucumbers from Spain as testing positive for the bacteria after testing a number of vegetables, said Julia Seifert, a spokeswoman from the Hamburg office of work, social issues, family and institute, on Thursday. A fourth cucumber, of unknown origin, also carried the bacteria.

None of the bacteria has been found on other foods, but officials say testing continues on tomatoes and lettuce, and those products cannot yet be ruled safe to eat in raw form, she said.

The Robert Koch Institute in Berlin, which is responsible for disease control and prevention, recommended that consumers, especially those in northern Germany, avoid eating raw tomatoes, cucumbers and lettuce.

Reinhard Burger, the institute’s head, described the outbreak as “most severe.”

As of Thursday, 214 cases have been reported, up from 140 on Tuesday evening. By comparison, in 2010, 65 cases were reported, according to the institute. At least two people have died during the current outbreak.

The strain of E. coli that has been detected is known as EHEC, or enterohemorrhagic e-coli. According to the U.S. Centers for Disease Control and Prevention, such forms of the infection can cause a potentially life-threatening complication known as hemolytic uremic syndrome (HUS) in 5 percent to 10 percent of those diagnosed. Officials say it can cause kidney failure and other problems.

Most of the sickest patients are in Hamburg, where 66 have been hospitalized with HUS. Patients range in age from 9 to 77. Forty-eight are women.

The EHEC strain of E. coli produces a toxin that damages intestinal cells, causing bloody diarrhea and other inflammation, said Army Maj. Kate Hinkle, an infectious disease physician at Landstuhl Regional Medical Center.

“We don’t understand why these strains can do this,” she said. “It’s something strictly related to this bacteria that secretes this toxin. It tends to be more of a problem with the very young and elderly” or in individuals with weaker immune systems. Because antibiotics tend to aggravate the infection, the primary treatment is helping patients stay hydrated.

As of Thursday, there were no reported cases of EHEC infection among military members and their families in Europe, said Michael Cooper, a U.S. Public Health Service Commissioned Corps commander and an epidemiologist with U.S. Army Public Health Command Region-Europe in Landstuhl, Germany.

But the outbreak has spread to Rheinland Pflaz, which includes the Kaiserslautern area, where about 50,000 U.S. military members, civilians and their families live.

Army health officials are tracking the source of raw vegetables sold in commissaries and served in their military dining facilities in Europe, officials said, and they’re reminding Army dining hall food handlers to properly wash raw vegetables.

“We are monitoring (the outbreak),” Cooper said. ”People who become ill with bloody diarrhea should see a physician.”

The incubation period – the time between ingestion of contaminated food to development of symptoms – can take two to 10 days, with the average at four days, Cooper said.

Army officials are not instructing people to avoid raw vegetables entirely, Cooper said.

“Good preparation eliminates the problem,” he said. That means washing raw vegetables with one capful of bleach per one gallon of water or spraying with one cup of white vinegar combined with three cups of water, and then rinsing.

“If you haven’t prepared it yourself and it’s raw, I would suggest avoiding it,” Cooper said.

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Jennifer reports on the U.S. military from Kaiserslautern, Germany, where she writes about the Air Force, Army and DODEA schools. She’s had previous assignments for Stars and Stripes in Japan, reporting from Yokota and Misawa air bases. Before Stripes, she worked for daily newspapers in Wyoming and Colorado. She’s a graduate of the College of William and Mary in Virginia.

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