An outbreak of Shiga toxin-producing Escherichia coli O104:H4 hemolytic uremic syndrome in Germany: presentation and short-term outcome in children.
BACKGROUND
In May and June 2011 the largest known outbreak of hemolytic uremic syndrome (HUS) occurred in northern Germany. Because, quite unusually, a large number of adults was affected and the causative Escherichia coli strain, serotype O104:H4, showed an atypical virulence factor pattern, it was speculated that this outbreak was associated with an aggressive course and an unfavorable prognosis also in children.


METHODS
Retrospective analysis of medical records of 90 children and comparison to previous outbreak and sporadic case series.


RESULTS
Median age was unusually high (11.5 years) compared with that in historical series. Only 1 patient (1.1%) died in the acute phase. Most patients (67/90 [74%]) received supportive care only. Renal replacement therapy was required in 64 of 90 (71%) of the children. Neurological complications, mainly seizures and altered mental stage, were present in 23 of 90 (26%) patients. Ten patients received plasmapheresis, 6 eculizumab, and 7 a combination of both. After a median follow-up of 4 months, renal function normalized in 85 of 90 (94%) patients, whereas 3 patients had chronic kidney disease stage 3 or 4, and 1 patient (1.1%) still requires dialysis. Complete neurological recovery occurred in 18 of 23 patients. Mild to moderate and major residual neurological changes were present in 3 patients and 1 patient, respectively, although all patients were still improving.


CONCLUSIONS
E. coli O104:H4 caused the largest HUS outbreak in children reported in detail to date and most patients received supportive treatment only. Initial morbidity, as well as short-term outcome, due to this pathogen, is comparable to previous pediatric series of Shiga toxin-producing E. coli HUS.
University Medical Center Hamburg-Eppendorf, Germany. s.loos@uke.de
Sebastian
S
Loos
Thurid
T
Ahlenstiel
Brigitta
B
Kranz
Hagen
H
Staude
Lars
L
Pape
Christoph
C
Härtel
Udo
U
Vester
Laura
L
Buchtala
Kerstin
K
Benz
Bernd
B
Hoppe
Ortraud
O
Beringer
Martin
M
Krause
Dominik
D
Müller
Martin
M
Pohl
Johanna
J
Lemke
Georg
G
Hillebrand
Martin
M
Kreuzer
Jens
J
König
Marianne
M
Wigger
Martin
M
Konrad
Dieter
D
Haffner
Jun
J
Oh
Markus J
MJ
Kemper
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D005858:Germany / Q000453:epidemiology; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D008297:Male; D017582:Renal Replacement Therapy / Q000379:methods; D012189:Retrospective Studies; D054323:Shiga-Toxigenic Escherichia coli / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D016896:Treatment Outcome