Shiga Toxin-Producing E. Coli O104:H4 Outbreak 2011 in Germany: Radiological Features of Enterohemorrhagic Colitis

Abstract

Purpose: In 2011 a nationwide outbreak of Shiga toxin-producing E. coli (STEC) O104:H4 infection occurred in Germany with severe hemorrhagic colitis and hemolytic-uremic syndrome (HUS). We defined abdominal radiologic findings in these patients and correlated them with clinical parameters.

Materials and Methods: 23 patients (7 men; age: 48 ± 19 years) with O104:H4 colitis and/or HUS received abdominal CT (n = 12) or radiographs (n = 11). Colonic distension, air-fluid levels, and free intraabdominal air were assessed. Colonic wall thickening, contrast enhancement, pericolic stranding, and ascites were evaluated on CT. Laboratory parameters and clinical presentation were reviewed. Chi-square test, Student’s t-test, McNemar’s test and Spearman correlation were performed.

Results: Colonic lumen distension was seen in 16/23 patients (69.6 %). The ascending colon (11/23 patients; 47.8 %) and transverse colon (12/23 patients; 52.2 %) were dilated significantly more often (p = 0.006 and p = 0.003, respectively) than the descending colon (1/23; 4.3 %). All 12 patients undergoing CT scanning had abnormally thickened colonic wall segments, 3 (25 %) had pancolic involvement and 9 (75 %) had segmental involvement. The descending colon was predominantly affected (11/12 patients; 91.7 %) and thickened significantly more often than other colonic segments (p < 0.001).

Conclusion: The segmental type of STEC O104:H4 colitis mainly affects the descending colon with upstream distension of the transverse/ascending colon and differs from other types of colitis.

Zusammenfassung

Ziel: Im Jahre 2011 kam es in Deutschland landesweit zu Erkrankungsfällen mit dem hämolytisch-urämischen Syndrom (HUS) und blutigen Durchfällen bei einer Infektion durch Enterohämorrhagische Escherichia coli (EHEC) des Serotyps O104:H4. Ziel war es, die radiologischen Merkmale dieser Patienten zu bestimmen und mit klinischen Parametern zu korrelieren.

Material und Methoden: 23 Patienten (7 Männer; Alter: 48 ± 19 Jahre) mit O104:H4-Kolitis und/oder HUS wurden mittels CT (n = 12) oder Abdomenübersichtsaufnahme (n = 11) untersucht. Alle 23 Untersuchungen wurden retrospektiv hinsichtlich Kolondistension, Luft-Flüssigkeitsspiegeln und freier intraabdomineller Luft beurteilt. Im CT wurde zusätzlich Kolonwanddicke, Kontrastmittelanreicherung, perikolische Fettgewebsimbibierung sowie Aszitesmenge bestimmt. Laborparameter und klinische Untersuchungsmerkmale wurden notiert. Chi-Quadrat-Test, t-Test, McNemar-Test sowie Spearman-Korrelation wurden durchgeführt um die Daten zu analysieren.

Ergebnisse: Eine Kolondistension wurde bei 16/23 Patienten (69,6 %) beobachtet. Das aszendierende (11/23 Patienten; 47,8 %) und transversale Kolon (12/23 Patienten; 52,2 %) waren signifikant öfter dilatiert (p = 0,006 bzw. p = 0,003) als das deszendierende Kolon (1/23; 4,3 %). Alle 12 CT-Patienten zeigten abnormal wandverdickte Kolonsegmente, 3 (25 %) davon hatten eine Pankolitis und 9 Patienten (75 %) hatten eine segmentale Beteiligung. Das deszendierende Kolon war überwiegend (11/12 Patienten; 91.7 %) und signifikant häufiger (p < 0,001) als die anderen Kolonsegmente betroffen.

Schlussfolgerungen: Bei der STEC-O104:H4-Kolitis findet sich vornehmlich ein segmentaler Befall des deszendierenden Kolons mit vorgeschalteter Dilatation des transversalen und aszendierenden Kolons, wodurch sich dieser Typ der Kolitis möglicherweise von anderen Kolitiden unterscheidet.

Key words

hemolytic-uremic syndrome - conventional radiography - CT - Shiga toxin-producing E. coli - O104:H4 - enterohemorrhagic colitis

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