title: Neurological Sequelae in Adults After E coli O104: H4 Infection-Induced Hemolytic-Uremic Syndrome.
abstract: In an outbreak of shiga toxin-producing Escherichia coli infections and associated hemolytic-uremic syndrome (STEC O104:H4) in Germany in the year 2011 neurological complications in adult patients occurred unexpectedly frequent, ranging between 48% and 100% in different patient groups. Few is known about the long-term effects of such complications and so we performed follow-up exams on 44 of the patients treated for STEC-HUS at Hannover Medical Scool in this observational study. Standardized follow-up exams including neurological and neuropsychological assessments, laboratory testing, magnetic resonance imaging (MRI), and EEG were carried out. Subgroups were examined 2 (n = 34), 7 (n = 22), and 19 (n = 23) months after disease onset. Additionally, at the 19-month follow-up, quality of life, sleep quality, and possible fatigue were assessed.Nineteen months after disease onset 31 patients were reassessed, 22 of whom still suffered from symptoms such as fatigue, headache, and attention deficits. In the neuropsychological assessments only 39% of the patients performed normal, whereas 61% scored borderline pathological or lower. Upon reviewal, the follow-up data most prominently showed a secondary decline of cognitive function in about one-quarter of the patients. Outcome was not related to treatment or laboratory data in the acute phase of the disease nor length of hospitalization. Prognosis of STEC-HUS associated brain dysfunction in adults with regard to severity of symptoms is mostly good; some patients however still have not made a full recovery. Patients' caretakers have to be aware of possible secondary decline of brain function as was observed in this study.
authors.affiliation: From the Clinic for Neurology (RS, JM, MD, HW, ABT, KS, KW); Clinic for Nephrology (EB, JTK); and Institute for Interventional and Diagnostic Neuroradiology, Hannover Medical School, Hannover, Germany (AMG, HL).
authors.forename: Ramona
authors.initials: R
authors.lastname: Schuppner
authors.forename: Justus
authors.initials: J
authors.lastname: Maehlmann
authors.forename: Meike
authors.initials: M
authors.lastname: Dirks
authors.forename: Hans
authors.initials: H
authors.lastname: Worthmann
authors.forename: Anita B
authors.initials: AB
authors.lastname: Tryc
authors.forename: Kajetan
authors.initials: K
authors.lastname: Sandorski
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Bahlmann
authors.forename: Jan T
authors.initials: JT
authors.lastname: Kielstein
authors.forename: Anja M
authors.initials: AM
authors.lastname: Giesemann
authors.forename: Heinrich
authors.initials: H
authors.lastname: Lanfermann
authors.forename: Karin
authors.initials: K
authors.lastname: Weissenborn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004569:Electroencephalography; D004927:Escherichia coli Infections / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006463:Hemolytic-Uremic Syndrome / Q000150:complications*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology*; D009483:Neuropsychological Tests; D054323:Shiga-Toxigenic Escherichia coli; D055815:Young Adult