title: Outbreak of Escherichia coli O104:H4 haemolytic uraemic syndrome in France: outcome with eculizumab.
abstract: BACKGROUND
  An outbreak of haemolytic uraemic syndrome (HUS) due to Shiga toxin-secreting Escherichia coli (STEC) O104:H4 from contaminated fenugreek sprouts occurred in June 2011 near Bordeaux, France. In the context of this outbreak, all patients were treated with the monoclonal anti-C5 antibody, eculizumab.
  
  
  METHODS
  The diagnosis of HUS was made based on haemolytic anaemia, low platelet count and acute kidney injury. Data were obtained from initial gastrointestinal symptoms to the end of follow-up 10 weeks after the start of eculizumab.
  
  
  RESULTS
  Among 24 cases of STEC gastroenteritis, HUS developed in nine patients (eight adults and one child), 6 (median; range 3-12) days after digestive symptoms begun. The median (range) highest or lowest biological values were platelet count 26 (range 14-93) G/L; haemoglobin 6.6 (range 5-10.7) g/dL; LDH 1520 (range 510-2568) IU/L; creatinine 152 (range 48-797) µmol/L. All patients had extra-renal complications (liver 9, pancreas 5, brain 3 and heart 3). Two patients were dialysed, and one was ventilated. After failure of plasma exchange to increase platelets in the first three patients, eculizumab was administered in all nine patients, 0-4 days after HUS diagnosis (median 1 day). One patient with very severe neurological HUS received immunoadsorption. Outcome was favourable in all patients, with rapid normalization of haemoglobin, platelets, LDH levels, renal function and neurological improvement. There were no deaths and no serious adverse events related to eculizumab.
  
  
  CONCLUSIONS
  Early treatment of O104:H4 STEC-HUS by eculizumab was associated with a rapid and efficient recovery. Controlled prospective evaluation of eculizumab in STEC-HUS is warranted.
authors.affiliation: Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
authors.forename: Yahsou
authors.initials: Y
authors.lastname: Delmas
authors.forename: Benoît
authors.initials: B
authors.lastname: Vendrely
authors.forename: Benjamin
authors.initials: B
authors.lastname: Clouzeau
authors.forename: Hiba
authors.initials: H
authors.lastname: Bachir
authors.forename: Hoang-Nam
authors.initials: HN
authors.lastname: Bui
authors.forename: Adeline
authors.initials: A
authors.lastname: Lacraz
authors.forename: Sébastien
authors.initials: S
authors.lastname: Hélou
authors.forename: Cécile
authors.initials: C
authors.lastname: Bordes
authors.forename: Armel
authors.initials: A
authors.lastname: Reffet
authors.forename: Brigitte
authors.initials: B
authors.lastname: Llanas
authors.forename: Sophie
authors.initials: S
authors.lastname: Skopinski
authors.forename: Patrick
authors.initials: P
authors.lastname: Rolland
authors.forename: Didier
authors.initials: D
authors.lastname: Gruson
authors.forename: Christian
authors.initials: C
authors.lastname: Combe
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D002675:Child, Preschool; D003967:Diarrhea / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D004196:Disease Outbreaks; D004927:Escherichia coli Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005602:France; D006463:Hemolytic-Uremic Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D054323:Shiga-Toxigenic Escherichia coli; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; C481642:eculizumab
keywords: Escherichia coli; complement inhibition; eculizumab; haemolytic uraemic syndrome; thrombotic microangiopathy