Clinical and radiologic features of encephalopathy during 2011 E coli O111 outbreak in Japan.
OBJECTIVE
To elucidate the clinical and radiologic features and analyze factors associated with neurologic outcomes of encephalopathy secondary to Shiga toxin-producing Escherichia coli (STEC) O111.


METHODS
We reviewed medical records and neuroimaging in 22 patients with neurologic symptoms among 86 with STEC O111 infection.


RESULTS
Twenty-one (6 males and 15 females, 10 children and 11 adults) of the 22 patients were diagnosed with encephalopathy. All patients with encephalopathy also presented with hemolytic-uremic syndrome. Five patients died, from day 1 to 6 months (days 1-5 in 4 patients), due to progressive encephalopathy with severe cerebral edema observed in neuroimaging (4 patients). Fifteen of the 16 surviving patients clinically recovered completely. Statistical analysis revealed differences between patients with poor (n = 6) and good (n = 15) outcomes in the interval from hemolytic-uremic syndrome presentation to encephalopathy, creatinine levels, and the methylprednisolone administration ratio.


CONCLUSIONS
We note a high incidence of encephalopathy in the Toyama STEC O111 outbreak. All fatal cases resulted from progressive encephalopathy. Methylprednisolone pulse therapy represents a possible therapeutic choice.


METHODS
This study provides Class III evidence that methylprednisolone pulse therapy increases the probability of a good outcome for patients with encephalopathy associated with STEC O111.
From the Department of Pediatrics (J.-i.T.), Kameda Medical Center, Kamogawa; Department of Pediatrics (H.T., T. Miyawaki), University of Toyama; Infectious Disease Surveillance Center (T. Misaki, Y.Y., N.O.), National Institute of Infectious Diseases, Tokyo; Department of Pediatrics (A.O.), Juntendo University Faculty of Medicine, Tokyo; Department of Nephrology (Y.-i.I.), Toyama City Hospital, Toyama; Toyama Institute of Health (T.S.), Toyama; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, the University of Tokyo, Japan.
Jun-ichi
J
Takanashi
Hiromichi
H
Taneichi
Takako
T
Misaki
Yuichiro
Y
Yahata
Akihisa
A
Okumura
Yoh-ichi
Y
Ishida
Toshio
T
Miyawaki
Nobuhiko
N
Okabe
Tetsutaro
T
Sata
Masashi
M
Mizuguchi
D000328:Adult; D002648:Child; D004196:Disease Outbreaks; D004927:Escherichia coli Infections / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007564:Japan; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D020258:Neurotoxicity Syndromes / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000382:microbiology*; D020551:Pulse Therapy, Drug; D011859:Radiography; D012189:Retrospective Studies; D054323:Shiga-Toxigenic Escherichia coli / Q000472:pathogenicity*; D016896:Treatment Outcome
D008775:Methylprednisolone