title: Management of Food-Related Diarrhea Outbreak in the Emergency Department: Lessons Learned from the German STEC O104:H4 Epidemic.
abstract: Emergency department (ED) management of the German STEC O104:H4 outbreak in 2011 was not limited to patients being truly infected with STEC. In parallel to spread of alarming news in public media, patients suffering from diarrhea due to other reasons fearfully presented, equally. We retrospectively characterized these two cohorts for anamnestic, clinical, and laboratory findings at their first ED contact. From 15th of May to July 2011, 302 adult patients with diarrheal complaint presented at the EDs of two tertiary hospitals in Lubeck, northern Germany. Fecal testing for STEC was obtained in 245 (81%) patients: 105 were STEC-positive and 140 were STEC-negative. Anamnestic characteristics (defecation rate, visible bloody diarrhea, and lower abdominal pain), abdominal tenderness, and some laboratory findings were significantly different between both cohorts but not reliable to exclude STEC. In >90% of STEC-positive patients diarrheal symptoms had started in May, reflecting the retrospective nationwide peak of infections, whereas the majority of STEC-negative patients became symptomatic in June 2011. During the German STEC O104:H4 outbreak a definite distinction at initial ED contact between STEC-positive versus STEC-negative patients by clinical judgment alone was not reliable. Fecal testing in the ED, however, might survey the outbreak of foodborne infections with the utmost precision.
authors.affiliation: Department of Internal Medicine II/Emergency Department, University Hospital of Schleswig-Holstein, Campus Lübeck, 23560 Lübeck, Germany.
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Sayk
authors.affiliation: Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Campus Lübeck, 23560 Lübeck, Germany.
authors.forename: Niels Henrik
authors.initials: NH
authors.lastname: Asselborn
authors.affiliation: Institute for Clinical Epidemiology, University of Lübeck, 23560 Lübeck, Germany.
authors.forename: Nora
authors.initials: N
authors.lastname: Eisemann
authors.affiliation: Institute for Clinical Epidemiology, University of Lübeck, 23560 Lübeck, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Katalinic
authors.affiliation: Emergency Department, Sana-Kliniken, 23560 Lübeck, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Metzner
authors.affiliation: Department of Internal Medicine II/Emergency Department, University Hospital of Schleswig-Holstein, Campus Lübeck, 23560 Lübeck, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wolfrum
authors.affiliation: Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Campus Lübeck, 23560 Lübeck, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Fellermann
authors.affiliation: Institute of Medical Microbiology and Hygiene, University Hospital of Schleswig-Holstein, Campus Lübeck, 23560 Lübeck, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Knobloch
authors.affiliation: Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Campus Lübeck, 23560 Lübeck, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Nitschke
mesh_terms: D000328:Adult; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy*; D004196:Disease Outbreaks; D004636:Emergency Service, Hospital; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy*; D005260:Female; D005516:Food Microbiology; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D054323:Shiga-Toxigenic Escherichia coli / Q000472:pathogenicity