PLoS ONE (Jan 2013)

Symptoms and clinical course of EHEC O104 infection in hospitalized patients: a prospective single center study.

  • Sebastian Ullrich,
  • Phillip Bremer,
  • Christine Neumann-Grutzeck,
  • Helge Otto,
  • Christoph Rüther,
  • Cay Uwe von Seydewitz,
  • Gerd Peter Meyer,
  • Keihan Ahmadi-Simab,
  • Joachim Röther,
  • Barbara Hogan,
  • Wolfgang Schwenk,
  • Roman Fischbach,
  • Jörg Caselitz,
  • Jochen Puttfarcken,
  • Susanne Huggett,
  • Petra Tiedeken,
  • Jordan Pober,
  • Nancy C Kirkiles-Smith,
  • Friedrich Hagenmüller

DOI
https://doi.org/10.1371/journal.pone.0055278
Journal volume & issue
Vol. 8, no. 2
p. e55278

Abstract

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OBJECTIVES: Shiga-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. METHODS: The 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. RESULTS: EHEC 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. CONCLUSIONS: EHEC 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".