Z Gastroenterol 2012; 50 - K210
DOI: 10.1055/s-0032-1324145

EHEC O104 infection in hospitalized patients: A prospective single center study on symptoms and clinical courses

S Ullrich 1, JP Bremer 1, C Neumann-Grutzeck 1, H Otto 1, C Rüther 1, CU von Seydewitz 2, GP Meyer 3, K Ahmadi 4, J Röther 5, BC Hogan 6, W Schwenk 7, R Fischbach 8, J Caselitz 9, J Puttfarcken 10, S Huggett 10, P Tiedecken 11, F Hagenmüller 1
  • 1Asklepios Klinik Altona, I. Medizinische Klinik, Hamburg, Germany
  • 2Asklepios Klinik Altona, II. Medizinische Klinik, Hamburg, Germany
  • 3Asklepios Klinik Altona, III. Medizinische Klinik, Hamburg, Germany
  • 4Asklepios Klinik Altona, IV. Medizinische Klinik, Hamburg, Germany
  • 5Asklepios Klinik Altona, Neurologie, Hamburg, Germany
  • 6Asklepios Klinik Altona, Zentrale Notaufnahme, Hamburg, Germany
  • 7Asklepios Klinik Altona, Abteilung für Allgemeinchirurgie, Hamburg, Germany
  • 8Asklepios Klinik Altona, Radiologie, Hamburg, Germany
  • 9Asklepios Klinik Altona, Pathologie, Hamburg, Germany
  • 10Asklepios Klinik Altona, MEDILYS Laborgesellschaft, Hamburg, Germany
  • 11Dialysezentrum Hamburg West, Hamburg, Germany

Aims: Shiga-like-toxin producing O157:H7 Entero Haemorrhagic E. coli (STEC/EHEC) are the most common cause of Haemolytic Uremic 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 the ESBL attribute. We report symptoms and complications from patients of one of the most affected centres of the 2011 EHEC O104 outbreak in Northern Germany.

Material and methods: The courses of patients that were admitted to our hospital due to bloody diarrhoea with suspected EHEC O104 infection have been 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 of 43.5±2.2 years). The frequency of HUS was 59% (36/61) in our cohort, within this group 31 patients received plasma-separation, 16 haemodialysis and 7 Eculizumab. 26 patients suffered from neurological symptoms. Patients undergoing antibiotic treatment (n=37) experienced no impairment of their clinical course. An enteric colonisation with co-pathogens was found in 57%. One 83-year-old patient died due to comorbidities after HUS was successfully treated.

Conclusions: EHEC O104:H4 infections differ markedly from earlier reports in regard to epidemiology, symptomatology and a higher frequency of complications. We recommend a standard of practice for clinical monitoring and the renaming of EHEC O104:H4 syndrome as „EAHEC disease“.