Klinische Symptomatik, Therapie und Verlauf stationär behandelter EHEC/EHEC-HUS Patienten

Abstract

This monocentric case series describes one of the so far largest published series of mostly young and female patients with EHEC and EHEC-HUS.

Recovery of thalamic microstructural damage after Shiga toxin 2-associated hemolytic–uremic syndrome

“…Neurological complications were severe and frequent (48-56%). The outcome with neurological sequelae in only 3% [13,14] was clearly better than that reported for children [3,5]. Most frequently, patients had alterations of consciousness, cognitive dysfunction (attention, orientation, working or short-term memory deficits), apraxia, dys-or aphasia, hyperreflexia, central oculomotor disturbances, visuoconstructive and psychiatric disorders, and epileptic seizures.…”

“…By employing POAS in combination with rigorous spatial normalization, we intended to increase the sensitivity of DTI to detect microstructural damage. Based on recent studies identifying the thalamus as "main target structure" in patients with neurological impairment due to Stx2-associated HUS [8,9,13,14,16,19], we assumed a-priori microstructural alterations in the thalamus. Thereby, we chose the left and right thalamus and cortico-thalamic white matter (WM) as regions of interest (ROIs) and 15 control regions for the quantitative FA and MD analysis.…”

“…HUS is the most common cause of acute renal failure in childhood [3][4][5][6][7] and occurs predominantly in children younger than five years [2,[6][7][8][9][10][11]. Between May and July 2011, the world's largest reported HUS outbreak affected northern Germany [8,12,13]. While previous outbreaks could all be traced back to the serotype O157:H7 [2,14,15], this one was caused by O104:H4 [2,12,14].…”

“…It was remarkable that unusually more adults (88%), primarily women (68-69%), were affected [2,8,[12][13][14]. More people developed HUS after infection with O104:H4 as opposed to those infected with the common serotype O157:H7 (20-25% versus 10-15%) [2,4,8,15].…”

“…However, inconsistent results were achieved by this method [7,10,11,16,19]. A few studies succeeded to identify the thalamus as "main target structure" in patients with neurological complications due to Stx2-associated HUS [8,9,13,14,16,19]. Thus convMRI including DWI of seven patients of the study of Meuth et al [9] revealed -despite severe neurological deficits -only slight thalamic hyperintensities in T2 weighted (T2w)/FLAIR images and mildly reduced ADC values in the thalamus, whereas T1 weighted (T1w) images were inconspicuous.…”