title: Shiga toxin-producing E. coli O104:H4 outbreak 2011 in Germany: radiological features of enterohemorrhagic colitis.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors: Diagnostikzentrum, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany. P.bannas@uke.de
authors: P
authors: P
authors: Bannas
authors: K
authors: K
authors: Fraedrich
authors: A
authors: A
authors: Treszl
authors: T A
authors: TA
authors: Bley
authors: J
authors: J
authors: Herrmann
authors: C R
authors: CR
authors: Habermann
authors: T
authors: T
authors: Derlin
authors: F O
authors: FO
authors: Henes
authors: U
authors: U
authors: Wenzel
authors: G
authors: G
authors: Adam
authors: J
authors: J
authors: Yamamura
mesh_terms: D003092:Colitis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000382:microbiology*; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D054324:Enterohemorrhagic Escherichia coli; D004927:Escherichia coli Infections / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography