Abstract
BackgroundIn May 2011 an outbreak of Shiga toxin-producing enterohaemorrhagic E. coli (STEC) O104:H4 in Northern Germany led to a high number of in-patients, suffering from post-enteritis haemolytic-uraemic syndrome (HUS) and often severe affection of the central nervous system. To our knowledge so far only neurological manifestations have been described systematically in literature.AimTo examine psychiatric symptoms over time and search for specific symptom clusters in affected patients.Methods31 in-patients suffering from E. coli O104:H4 associated HUS, were examined and followed up a week during the acute hospital stay. Psychopathology was assessed by clinical interview based on the AMDP Scale, the Brief Symptom Inventory and the Clinical Global Impressions Scale.ResultsAt baseline mental disorder due to known physiological condition (ICD-10 F06.8) was present in 58% of the examined patients. Patients suffered from various manifestations of cognitive impairment (n = 27) and hallucinations (n = 4). Disturbances of affect (n = 28) included severe panic attacks (n = 9). Psychiatric disorder was significantly associated with higher age (p<0.0001), higher levels of C-reactive protein (p<0.05), and positive family history of heart disease (p<0.05). Even within the acute hospital stay with a median follow up of 7 days, symptoms improved markedly over time (p <0.0001).ConclusionsAside from severe neurological symptoms the pathology in E.coli O104:H4 associated HUS frequently includes particular psychiatric disturbances. Long term follow up has to clarify whether or not these symptoms subside.
Highlights
From May to July 2011 an outbreak of Shiga toxin-producing enterohaemorrhagic Escherichia coli (STEC) O104:H4 infections in Northern Germany occurred
According to the German Shiga toxin-producing enterohaemorrhagic E. coli (STEC)-haemolytic-uraemic syndrome (HUS) registry 69% of all HUS patients presented with neurological symptoms like headache or visual disturbances or neurological signs ranging from tremor and aphasia to delirium, coma and seizures [2]
One explanation for this unusual high incidence of neurological symptoms/signs was the increased virulence of the outbreak-strain O104:H4, which combined virulence factors of typical enteroaggregative and Shiga toxin-producing E. coli and showed an unusual age distribution of the affected patients as STEC-HUS usually occurs in pre-school children, were it shows lower rates of central nervous system (CNS) involvement. [3]
Summary
From May to July 2011 an outbreak of Shiga toxin-producing enterohaemorrhagic Escherichia coli (STEC) O104:H4 infections in Northern Germany occurred. According to the German STEC-HUS registry 69% of all HUS patients presented with neurological symptoms like headache or visual disturbances or neurological signs ranging from tremor and aphasia to delirium, coma and seizures [2] One explanation for this unusual high incidence of neurological symptoms/signs was the increased virulence of the outbreak-strain O104:H4, which combined virulence factors of typical enteroaggregative and Shiga toxin-producing E. coli and showed an unusual age distribution of the affected patients as STEC-HUS usually occurs in pre-school children, were it shows lower rates of central nervous system (CNS) involvement. In May 2011 an outbreak of Shiga toxin-producing enterohaemorrhagic E. coli (STEC) O104:H4 in Northern Germany led to a high number of in-patients, suffering from post-enteritis haemolytic-uraemic syndrome (HUS) and often severe affection of the central nervous system. To our knowledge so far only neurological manifestations have been described systematically in literature
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