Epidemic Profile of Shiga-Toxin–Producing<i>Escherichia coli</i>O104:H4 Outbreak in Germany

Frank, Christina; Werber, Dirk; Cramer, Jakob P.; Askar, Muhammad; Faber, Mirko; Heiden, Matthias an der; Bernard, Helen; Fruth, Angelika; Prager, Rita; Spode, Anke; Wadl, Maria; Zoufaly, Alexander; Jordan, Sabine; Kemper, Markus J.; Follin, Per; Müller, Luise; King, Lisa A.; Rosner, Bettina; Buchholz, Udo; Stark, Klaus; Krause, Gérard

doi:10.1056/nejmoa1106483

Cited by 1,018 publications

(841 citation statements)

References 25 publications

(29 reference statements)

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“…Of the outbreak, at least 810 developed hemolytic uremic syndrome (HUS), resulting in more than 54 deaths in 2011 [1,2]. 30% of HUS patients showed encephalopathy.…”

Section: Introductionmentioning

confidence: 99%

Proposal for effective treatment of Shiga toxin-producing Escherichia coli infection in mice

Amran

Fujii

Kolling

et al. 2013

Microbial Pathogenesis

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“…Of the outbreak, at least 810 developed hemolytic uremic syndrome (HUS), resulting in more than 54 deaths in 2011 [1,2]. 30% of HUS patients showed encephalopathy.…”

Section: Introductionmentioning

confidence: 99%

Proposal for effective treatment of Shiga toxin-producing Escherichia coli infection in mice

Amran

Fujii

Kolling

et al. 2013

Microbial Pathogenesis

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“…Overall, approximately 90% of HUS cases are due to STEC, which although predominantly considered a paediatric disease, is well known to also affect adults [24]. The frequency of STEC-HUS in North America has been reported as approximately two or three cases per 100,000 in children under 5 years of age [9].…”

Section: Hus: Stec-hus and Ahusmentioning

confidence: 99%

“…The frequency of STEC-HUS in North America has been reported as approximately two or three cases per 100,000 in children under 5 years of age [9]. Worldwide the reported incidence varies widely, and it should also be noted that large, localised outbreaks occur due to the ingestion of contaminated food or water [9,24]. For example, the outbreak in Germany in 2011 resulted in almost 4000 people being infected with a particularly virulent enteroaggregative E. coli strain, leading to 854 cases of HUS of which 54 (6.3%) died [24].…”

Section: Hus: Stec-hus and Ahusmentioning

confidence: 99%

“…Worldwide the reported incidence varies widely, and it should also be noted that large, localised outbreaks occur due to the ingestion of contaminated food or water [9,24]. For example, the outbreak in Germany in 2011 resulted in almost 4000 people being infected with a particularly virulent enteroaggregative E. coli strain, leading to 854 cases of HUS of which 54 (6.3%) died [24]. A pooled analysis of almost 3500 patients from 49 studies of STEC-HUS found that overall the incidence of death or end-stage renal disease (ESRD) was 12% and clinically significant renal damage occurred in 25% of patients [11].…”

Section: Hus: Stec-hus and Ahusmentioning

confidence: 99%

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Atypical hemolytic uremic syndrome: from diagnosis to treatment

Franchini¹

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Thrombotic microangiopathy (TMA) is a relatively rare condition but a medical urgency requiring immediate intervention to avoid irreversible organ damage or death. Symptoms on presentation include microangiopathic haemolytic anaemia, thrombocytopenia and organ damage. The most frequent direct causes of TMA are thrombotic thrombocytopenic purpura (TTP) and haemolytic uremic syndrome (HUS). The most common form of HUS is related to Shiga toxin producing Escherichia coli (STEC) infection while approximately 10% of cases are due to dysregulation of the complement pathway (atypical haemolytic uremic syndrome, aHUS). Optimal treatment regimens differ depending on the underlying cause; however, differential diagnosis may be difficult. The most accurate method of diagnosis is based on exclusion and should consider, beyond the symptoms common to TMA, ADAMTS13 activity levels and STEC infection status. For the management of TTP, plasma exchange (PE) is the most important acute intervention and is associated with lower mortality and better outcomes than plasma infusion. In most patients with STEC-HUS, the course of disease is selflimiting although management of acute kidney injury is often required. Until recently, the management of aHUS consisted of early and intensive PE, although this was mostly ineffective in protecting from subsequent organ damage. Eculizumab, an inhibitor of the alternative complement pathway, produces a rapid and sustained inhibition of the TMA process, with significant improvements in long-term clinical outcomes. Due to the significant improvement achieved, eculizumab has subsequently been approved as first-line therapy when an unequivocal diagnosis of aHUS has been made.

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“…A highly resistant, hybrid enteroaggregative ---Shiga-toxin producing E. coli 4 is thought to be an evolved combination of adhesion proteins that makes it particularly hard to remove from enterocytes and food, helping the bacteria to survive and persist in the environment. Another particular feature is its production of extended-spectrum beta-lactamase (ESBL), 5,6 considering that E. coli enteritis usually are not treated with antibiotics. Both these characteristics could explain why the outbreak lasted so long (usually it lasts 2 weeks).…”

Section: Introductionmentioning

confidence: 99%

E. coli O104:H4 outbreak and haemolytic–uraemic syndrome

Borgatta

Kmet-Lunaček

Rello

2012

Medicina Intensiva (English Edition)

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Background: The first cases of the European epidemic of Shiga toxin-producing Escherichia coli O104:H4 (STEC-O104:H4) infection were reported in Germany in April 2011. Objectives: To characterize the 2011 STEC-O104:H4 outbreak and its management. A literature review is made to assess the state of the art in STEC---haemolytic---uraemic syndrome (HUS) epidemiology, pathogenesis, management and prognosis, focusing on critically ill adults. Methods: References were obtained from the European Center for Disease Control and World Health Organization epidemiological updates, in addition to a PubMed search covering the period from 1980 to August 2011, including all published work on STEC-014:H4 and reviews on HUS management and prognosis. Results: The epidemic originated from a bean and seed sprouts farm in Lower Saxony, and was caused by the O104:H4 strain ---a highly antibiotic resistant, hybrid enteroaggregative ---Shiga toxin producing E. coli strain (STEC). The infection was characterized by increased HUS (25%) and a higher mortality rate. STEC enteritis and HUS are associated with significant mortality and morbidity, especially amongst patients with severe renal and neurological disorders. Management should center on prompt kidney protection by maintaining adequate renal perfusion, in addition to avoiding diuretics and nephrotoxic agents. Conclusions:The published studies regarding antibiotic treatment lack good quality evidence. However, recent data suggest a potential modulating effect that explains the conflicting data but moreover suggests that azithromycin might be of use. Neutralizing monoclonal antibodies are a promising new therapy for STEC---HUS, with currently ongoing studies. Other treatments have not been shown to be superior to supportive therapy alone. E. coli O104:H4 outbreak and haemolytic---uraemic syndrome 577 PALABRAS CLAVEE. coli O104:H4; STEC-O104; Revisión; Síndrome urémico-hemolítico Brote de E. coli O104:H4 y síndrome hemolítico-urémico ResumenAntecedentes: Los primeros casos de la epidemia europea de infección por E. coli productora de la toxina Shiga (STEC-O104:H4) se detectaron en Alemania en abril de 2011. Objetivos: Caracterizar el brote de STEC-O104:H4 de 2011 y su gestión. Se realiza una revisión bibliográfica para evaluar el estado del arte en epidemiología, patogenia, tratamiento y pronósitico de la STEC-síndrome urémico-hemolítico (SHU), con especial hincapié en los adultos críticamente enfermos. Métodos: Se obtuvieron referencias de las actualizaciones epidemiológicas del Centro Europeo de Control de Enfermedades y de la Organización Mundial de la Salud, además de una búsqueda en PubMed relativa al periodo de 1980 a agosto de 2011, incluidas todas las publicaciones sobre la STEC-014:H4 y las revisiones sobre el tratamiento y el pronóstico del SHU. Resultados: La epidemia tuvo su origen en unos brotes germinados de una plantación de Baja Sajonia y estuvo causada por la cepa O104:H4, una cepa híbrida de E. coli enteroagregativa productora de la toxina Shiga (STEC) con una e...

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Epidemic Profile of Shiga-Toxin–ProducingEscherichia coliO104:H4 Outbreak in Germany

Abstract: In this outbreak, caused by an unusual E. coli strain, cases of the hemolytic-uremic syndrome occurred predominantly in adults, with a preponderance of cases occurring in women. The hemolytic-uremic syndrome developed in more than 20% of the identified cases.

Cited by 1,018 publications

References 25 publications

Proposal for effective treatment of Shiga toxin-producing Escherichia coli infection in mice

Proposal for effective treatment of Shiga toxin-producing Escherichia coli infection in mice

Atypical hemolytic uremic syndrome: from diagnosis to treatment

E. coli O104:H4 outbreak and haemolytic–uraemic syndrome

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