Symptoms and Clinical Course of EHEC O104 Infection in Hospitalized Patients: A Prospective Single Center Study

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”.

Quiescent complement in nonhuman primates during E coli Shiga toxin-induced hemolytic uremic syndrome and thrombotic microangiopathy

“…It is not clear whether Eculizumab was effective during the German 2011 outbreak, 21,22 but this was an enteroaggregative E coli O104:H4 strain that acquired both Stx2 expression and unusual virulence in young adults with differing clinical presentation from more typical enterohemorrhagic strains. 23 Our baboon HUS models are induced by Stx challenge and not an enteric bacterial infection, and bacterial translocation from the intestines is not observed in the baboons. 24 However, there is considerable intestinal injury in EHEC patients that may contribute to complement activation.…”

Coma caused by Shigella toxin-producing Escherichia coli in the absence of haemorrhagic uraemic syndrome (HUS)

“…This rate was significantly higher than that in a group of patients who only had STEC-HUS. Whereas isolated HUS in STEC without neurological symptoms is common, neurological symptoms complicating STEC infection without HUS are rare, but were nevertheless reported in 3/61 and 4/104 patients, respectively, in the above-mentioned studies [3,4] . Interestingly, most of these neurological symptoms were caused by the O-104 enterohaemorrhagic E. coli serotype.…”

“…In 2011 an outbreak of STEC occurred in Western Europe, with around 3,000 cases of Shigella toxin-mediated gastro-enteritis reported in Germany alone. While HUS is a common complication of STEC, studies based on the 2011 outbreak reported neurological symptoms in unusually high numbers of patients (26-48%) [2][3][4] . Reported symptoms included tremors, seizures and neuropsychiatric disorders.…”

“…Reported symptoms included tremors, seizures and neuropsychiatric disorders. A prospective single centre study [3] carried out among 61 confirmed STEC patients reported that neurological symptoms were seen in 43% of these patients, of whom 50% had seizures and 34% had tremors. Furthermore, nearly all cases involving neurological symptoms were rapidly progressive, with symptoms deteriorating within hours towards complex syndromes.…”

“…Recent studies on STEC epidemics report a high prevalence of neurological symptoms with a rapid degenerative course, often requiring intubation and admission to the intensive care unit [1][2][3][4][5] . While most of these cases occur with concurrent HUS, we describe a patient with severe neurological symptoms due to infection with STEC in the absence of HUS.…”