Abstract
ObjectivesShiga-toxin producing O157:H7 Entero Haemorrhagic E. coli (STEC/EHEC) is one of the most common causes of Haemolytic Uraemic Syndrome (HUS) related to infectious haemorrhagic colitis. Nearly all recommendations on clinical management of EHEC infections refer to this strain. The 2011 outbreak in Northern Europe was the first to be caused by the serotype O104:H4. This EHEC strain was found to carry genetic features of Entero Aggregative E. coli (EAEC) and extended spectrum β lactamase (ESBL). We report symptoms and complications in patients at one of the most affected centres of the 2011 EHEC O104 outbreak in Northern Germany.MethodsThe courses of patients admitted to our hospital due to bloody diarrhoea with suspected EHEC O104 infection were recorded prospectively. These data include the patients’ histories, clinical findings, and complications.ResultsEHEC O104 infection was confirmed in 61 patients (female = 37; mean age: 44±2 years). The frequency of HUS was 59% (36/61) in our cohort. An enteric colonisation with co-pathogens was found in 57%. Thirty-one (51%) patients were treated with plasma-separation/plasmapheresis, 16 (26%) with haemodialysis, and 7 (11%) with Eculizumab. Patients receiving antibiotic treatment (n = 37; 61%) experienced no apparent change in their clinical course. Twenty-six (43%) patients suffered from neurological symptoms. One 83-year-old patient died due to comorbidities after HUS was successfully treated.ConclusionsEHEC O104:H4 infections differ markedly from earlier reports on O157:H7 induced enterocolitis in regard to epidemiology, symptomatology, and frequency of complications. We recommend a standard of practice for clinical monitoring and support the renaming of EHEC O104:H4 syndrome as “EAHEC disease”.
Highlights
In May and July 2011 Germany experienced an Entero Haemolytic Escherichia coli (EHEC) O104 infection outbreak
EHEC O104 infection was confirmed in 61 patients
We recommend a standard of practice for clinical monitoring and support the renaming of EHEC O104:H4 syndrome as ‘‘Entero Aggregative Haemorrhagic Escherichia coli (EAHEC) disease’’
Summary
In May and July 2011 Germany experienced an Entero Haemolytic Escherichia coli (EHEC) O104 infection outbreak. Most former EHEC outbreaks were related to the O157:H7 strain of E. coli, while the recent cases have been caused by the O104:H4 strain. Prior to the recent episode in Germany, only minor outbreaks related to EHEC O104 H4 had been reported [6,7]. Genome sequence analysis has demonstrated that the current pathogen represents a new phenotype which combines the characteristics of EHEC and Entero Aggregative Escherichia coli (EAEC) [9]. This finding may explain the strong adherence of the O104:H4 strain to the colon mucosa and the enhancement of virulence. Brzuszkiewicz et al suggest the term Entero Aggregative Haemorrhagic Escherichia coli (EAHEC) to describe this new phenotype [3]
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