Outbreak of hemolytic uremic syndrome caused by E. coli O104:H4 in Germany: a pediatric perspective

Abstract

In May-June 2011, an unprecedented outbreak of hemolytic uremic syndrome (HUS) caused by Shiga toxinproducing E. coli (STEC) O104:H4 affected >800 adults, in whom this disorder is usually rarely seen. Over 90 children were also affected in the largest STEC-associated HUS outbreak in children to date. Despite high patient numbers and chronic staff shortages in pediatric institutions, almost all patients were treated locally, mainly because of maximally increased staff input. Epidemiologic features were characterized by relatively high age at presentation, possibly related to the isolated etiologic agent, raw bean sprouts. Fortunately, in children, other clinical features, including neurological complications, dialysis requirement, and short-term outcome, were comparable to previous historical series. Only one child died, compared to 35 adults. Differences in treatment recommendations and approaches between adults and children were noted. Treatment with eculizumab was available, but handled more restrictively in children. Despite treatment differences, children and adult clinical outcomes were comparable, pending a final analysis. In summary the STEC O104:H4 HUS outbreak was challenging for pediatric resources but clinical presentation and complications were comparable to previous experience. Acute outbreak onset made structured approaches to treatments impossible, however, ongoing analysis may provide evidence for improving care of children with STEC HUS.

Renal Failure in the Recent 2011Escherichia coliO104:H4 Outbreak: A Summary on Up-to-Date Data

“…11,14 Another interesting treatment is the use of complement-blocking antibody (eculizumab). 15 This has proved to be effective but has not been well studied on some specific groups of patients, especially for the pediatric patients. 15 Finally, an interesting therapeutic approach is immunoadsorption.…”

“…15 This has proved to be effective but has not been well studied on some specific groups of patients, especially for the pediatric patients. 15 Finally, an interesting therapeutic approach is immunoadsorption. 16,17 This method is proved for its effectiveness in the reduction of renal and neurological disorders in patients with HUS and is suggested for patients for whom other therapeutic choices have failed.…”

“…16 If good management is provided, follow-up of the patients usually reveals complete recovery. [11][12][13][14][15][16][17][18][19] …”

“…But in case that infection has already occurred, a good follow-up of the patient is required. [11][12][13][14][15][16][17][18][19] Recognition of the fact that the renal problem is common and can be easily seen in a short period brings the need for good fluid management and early hospitalization of the patients presenting with severe bloody diarrhea. [33][34][35] Early dialysis in patients with significant rapid impairment can be a good tool for prevention of severe clinical outcomes.…”

“…[33][34][35] Early dialysis in patients with significant rapid impairment can be a good tool for prevention of severe clinical outcomes. 15 …”