Low incidence of colonic complications after severe Shiga toxin-producing E. coli O104:H4 infection

Abstract

Background In summer 2011, Shiga toxin producing Escherichia coli (EHEC) serotype O104:H4 caused the most severe EHEC outbreak in Germany to date. The case of a previously recovered patient with symptomatic postinflammatory colonic stenosis following EHEC- infection prompted us to conduct a prospective study to assess the macro- and microscopic intestinal long-term damage in a cohort of patients who had suffered from severe EHEC colitis.

Methods Following EHEC infection in 2011, 182 patients were offered to participate in this study between January 2013 and October 2014 as part of the post-inpatient follow-up care at the University Medical Center Hamburg-Eppendorf and to undergo colonoscopy with stepwise biopsies. Prior to colonoscopy, medical history and persistent post-infectious complaints were assessed.

Results Out of 182 patients, 22 (12%) participated in the study, 18 (82%) were female. All patients had been hospitalized due severe EHEC enterocolitis: 20 patients (90%) had subsequently developed hemolytic uremic syndrome (HUS), 16 patients (72%) had additionally required dialysis. On assessment prior to colonoscopy, all patients denied any abdominal complaints before EHEC-infection but 8 (36%) patients reported persistent post-infectious symptoms. According to the ROME IV criteria, 4 (18%) patients met the definition for post-infectious irritable bowel syndrome (PI-IBS). In all patients with persistent symptoms, colonoscopies and histological examination were unremarkable. Only in one symptom-free patient, biopsy revealed a locally limited cryptitis of the caecum, while all patients without complaints had inconspicuous histological and endoscopical findings.

Conclusion Following infection colonic stenosis is a serious but rare long-term complication in patients who had suffered from severe enterocolitis. However, a significant proportion of these patients develop PI-IBS.

Zusammenfassung

Hintergrund Im Sommer 2011 verursachten Shiga-Toxin produzierende Escherichia coli (EHEC) -Serotyp O104: H4 den bislang schwersten EHEC-Ausbruch in Deutschland und Europa. Der Fall einer zuvor gesunden Patientin mit symptomatischer, postentzündlicher Kolonstenose nach EHEC-Infektion veranlasste uns, die makro- und mikroskopischen Langzeitschäden des Kolons prospektiv in einer Kohorte von Patienten zu untersuchen, die an einer schweren EHEC-Kolitis gelitten hatten.

Methoden Zwischen Januar 2013 und Oktober 2014 wurden 182 Patienten mit nachgewiesener EHEC O104:H4-Infektion im Rahmen der poststationären Nachsorge am Universitätsklinikum Hamburg-Eppendorf eine Studienteilnahme einschließlich einer kompletten Ileo-Koloskopie mit Stufenbiopsien angeboten. Der bisherige Krankheitsverlauf sowie postinfektiös anhaltende Beschwerden wurden vor der Koloskopie erfasst.

Ergebnisse Von 182 Patienten nahmen 22 (12%) an der Studie teil,18 (82%) waren weiblich. Alle Patienten waren aufgrund einer schwerer EHEC-Enterokolitis stationär behandelt worden: 20 Patienten (90%) hatten während der Infektion ein hämolytisch-urämisches Syndrom (HUS) entwickelt, 16 Patienten waren intermittierend dialysepflichtig. Alle Patienten verneinten abdominelle Beschwerden vor der stattgehaben EHEC-Infektion, aber 8 (36%) Patienten berichteten über anhaltende postinfektiöse Symptome. Gemäß den ROME IV-Kriterien erfüllten 4 (18%) Patienten die Definition für das postinfektiöse Reizdarmsyndrom (PI-IBS). Bei allen Patienten mit persistierenden Beschwerden zeigte sich in der folgenden Koloskopie ein unauffälliger makro- und mikroskopischer Befund. Nur bei einem symptomfreien Patienten ergab die Biopsie eine lokal begrenzte Kryptitis des Coecums.

Fazit Nach einer Infektion ist eine Kolonstenose eine schwerwiegende, aber seltene Langzeitkomplikation bei Patienten mit schwerer Enterokolitis. Ein signifikanter Anteil dieser Patienten entwickelt jedoch PI-IBS.

Schlüsselwörter

EHEC O104:H4 - postinfektiöses Reizdarmsyndrom - Kolonstenose - intestinale Langzeitschänden nach EHEC-Infektion

Keywords

EHEC O104:H4 - post-inflammatory irritable bowel syndrome - colonic stenosis - intestinal long-term damaga

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