title: Symptoms and clinical course of EHEC O104 infection in hospitalized patients: a prospective single center study.
abstract: OBJECTIVE
  Shiga-toxin producing O157:H7 Entero Haemorrhagic E. coli (STEC/EHEC) is one of the most common causes of Haemolytic Uraemic 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 extended spectrum β lactamase (ESBL). We report symptoms and complications in patients at one of the most affected centres of the 2011 EHEC O104 outbreak in Northern Germany.
  
  
  METHODS
  The courses of patients admitted to our hospital due to bloody diarrhoea with suspected EHEC O104 infection were 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: 44±2 years). The frequency of HUS was 59% (36/61) in our cohort. An enteric colonisation with co-pathogens was found in 57%. Thirty-one (51%) patients were treated with plasma-separation/plasmapheresis, 16 (26%) with haemodialysis, and 7 (11%) with Eculizumab. Patients receiving antibiotic treatment (n = 37; 61%) experienced no apparent change in their clinical course. Twenty-six (43%) patients suffered from neurological symptoms. One 83-year-old patient died due to comorbidities after HUS was successfully treated.
  
  
  CONCLUSIONS
  EHEC O104:H4 infections differ markedly from earlier reports on O157:H7 induced enterocolitis in regard to epidemiology, symptomatology, and frequency of complications. We recommend a standard of practice for clinical monitoring and support the renaming of EHEC O104:H4 syndrome as "EAHEC disease".
authors: Department of Medicine I (Gastroenterology), Asklepios Klinik Altona, Hamburg, Germany. mi.ullrich@asklepios.com
authors: Sebastian
authors: S
authors: Ullrich
authors: Phillip
authors: P
authors: Bremer
authors: Christine
authors: C
authors: Neumann-Grutzeck
authors: Helge
authors: H
authors: Otto
authors: Christoph
authors: C
authors: Rüther
authors: Cay Uwe
authors: CU
authors: von Seydewitz
authors: Gerd Peter
authors: GP
authors: Meyer
authors: Keihan
authors: K
authors: Ahmadi-Simab
authors: Joachim
authors: J
authors: Röther
authors: Barbara
authors: B
authors: Hogan
authors: Wolfgang
authors: W
authors: Schwenk
authors: Roman
authors: R
authors: Fischbach
authors: Jörg
authors: J
authors: Caselitz
authors: Jochen
authors: J
authors: Puttfarcken
authors: Susanne
authors: S
authors: Huggett
authors: Petra
authors: P
authors: Tiedeken
authors: Jordan
authors: J
authors: Pober
authors: Nancy C
authors: NC
authors: Kirkiles-Smith
authors: Friedrich
authors: F
authors: Hagenmüller
mesh_terms: D000328:Adult; D001792:Blood Platelets / Q000473:pathology; D060085:Coinfection / Q000097:blood / Q000150:complications / Q000382:microbiology / Q000821:virology; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D004724:Endoscopy; D054324:Enterohemorrhagic Escherichia coli; D005243:Feces / Q000382:microbiology; D005260:Female; D041981:Gastrointestinal Tract / Q000382:microbiology / Q000473:pathology; D005858:Germany / Q000453:epidemiology; D006463:Hemolytic-Uremic Syndrome / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D008297:Male; D011446:Prospective Studies; D013997:Time Factors; D014463:Ultrasonography
chemical_list: D003404:Creatinine; D007770:L-Lactate Dehydrogenase