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EHEC 2011 – aus der Sicht des Klinikers

EHEC 2011 – from the point of view of a clinician

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Zusammenfassung

Im Frühsommer 2011 wurde Norddeutschland vom bis dato größten Ausbruch einer Infektion mit EHEC O104:H4 heimgesucht. Im Unterschied zu früheren EHEC-Ausbrüchen betraf die Erkrankung vorwiegend junge Erwachsene und führte in unserem Kollektiv bei 72% unserer 61 hospitalisierten Patienten zu teils schwerwiegenden Komplikationen. Aufgrund der genetischen und klinischen Eigenständigkeit der Infektion schließen wir uns dem Vorschlag der von Brzuszkiewicz et al. an, die Erkrankung als EAHEC-Syndrom („Entero-Aggregative-Haemorrhagic Escherichia coli“) zu bezeichnen. Die Wechselhaftigkeit und Vielfalt der Verläufe zwingt zu einem engmaschigen klinischen Monitoring; wir schlagen den „Altona EAHEC Monitoring Standard“ vor. Einen ungünstigen Einfluss der Gabe von Antibiotika auf den Krankheitsverlauf konnten wir – im Gegensatz zu früher publizierten Bedenken – nicht beobachten.

Abstract

In early summer 2011 northern Germany was overrun by the greatest Entero-Haemorrhagic Escherichia coli (EHEC) O104:H4 outbreak so far. In contrast to earlier reported EHEC outbreaks young adults were affected mainly, and complications were frequent with 72% of 61 hospitalized patients in our cohort. In consequence of the genetic and clinical characteristics we concur with Brzuszkiewicz et al. to describe this syndrome as EAHEC syndrome (“Entero-Aggregative-Haemorrhagic Escherichia coli”). Because of the variability of the clinical courses, intensified monitoring at close intervals is necessary; we suggest the “Altona EAHEC Monitoring Standard”. From the clinical point of view we could not observe an unfavorable influence of antibiotics.

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Literatur

  1. Robert Koch-Institut (2011) Bericht: Abschließende Darstellung und Bewertung der epidemiologischen Erkenntnisse im EHEC O104:H4 Ausbruch, Deutschland 2011. Berlin 2011. http://www.rki.de/cln_153/nn_205760/DE/Content/InfAZ/E/EHEC/EHEC-Abschlussbericht, templateId=( raw, property=publicationFile.pdf/EHEC-Abschlussbericht.pdf. Zugegriffen: 9. Sept. 2011

  2. Gasser C, Gautier E, Steck A et al (1955) Hemolytic-uremic syndrome: bilateral necrosis of the renal cortex in acute acquired hemolytic anemia. Schweiz Med Wochenschr 85: 905–909

    PubMed  CAS  Google Scholar 

  3. Karmali MA, Petric M, Lim C et al (2004) The association between idiopathic hemolytic uremic syndrome and infection by verotoxin-producing Escherichia coli 1985. J Infect Dis 189: 556–563

    Article  PubMed  Google Scholar 

  4. Deutsche Gesellschaft für Nephrologie (2011) Therapeutische Apheresebehandlung bei EHEC assoziiertem HUS. http://www.dgfn.eu/index.php?eID=tx_nawsecuredl&u=0&file=uploads/media/Apheresebehandlung_bei_EHEC_assoziiertem_HUS.pdf&t=1331926213&hash=e1a503a5801a6341c1512d296c8e9771f94158ff. Zugegriffen: 2. Juni 2011

  5. Ake JA, Jelacic S, Ciol MA et al (2005) Relative nephroprotection during Escherichia coli O157:H7 infections: association with intravenous volume expansion. Pediatrics 115: e673–e680

    Article  PubMed  Google Scholar 

  6. Tarr PI, Gordon CA, Chandler WL (2005) Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome. Lancet 365(9464): 1073–1086

    PubMed  CAS  Google Scholar 

  7. Brigotti M, Tazzari PL, Ravanelli E et al (2011) Clinical relevance of shiga toxin concentrations in the blood of patients with hemolytic uremic syndrome. Pediatr Infect Dis J 30: 486–490

    PubMed  Google Scholar 

  8. Ridolfi RL, Bell WR (1981) Thrombotic thrombocytopenic purpura. Report of 25 cases and review of the literature. Medicine (Baltimore) 60: 413–428

  9. Karpac CA, Li X, Terrell DR et al (2008) Sporadic bloody diarrhoea-associated thrombotic thrombocytopenic purpura-haemolytic uraemic syndrome: an adult and paediatric comparison. Br J Haematol 141: 696–707

    Article  PubMed  Google Scholar 

  10. Riley LW, Remis RS, Helgerson SD et al (1983) Hemorrhagic colitis associated with a rare Escherichia coli serotype. N Engl J Med 308: 681–685

    Article  PubMed  CAS  Google Scholar 

  11. Bielaszewska M, Mellmann A, Zhang W et al (2011) Characterisation of the Escherichia coli strain associated with an outbreak of haemolytic uraemic syndrome in Germany, 2011: a microbiological study. Lancet Infect Dis 11: 671–676

    PubMed  CAS  Google Scholar 

  12. Mellmann A, Bielaszewska M, Kock R et al (2008) Analysis of collection of hemolytic uremic syndrome-associated enterohemorrhagic Escherichia coli. Emerg Infect Dis 14:1287–1290

    Article  PubMed  Google Scholar 

  13. Bae WK, Lee YK, Cho MS et al (2006) A case of hemolytic uremic syndrome caused by Escherichia coli O104:H4. Yonsei Med J 47: 437–439

    Article  PubMed  Google Scholar 

  14. Brzuszkiewicz E, Thurmer A, Schuldes J et al (2011) Genome sequence analyses of two isolates from the recent Escherichia coli outbreak in Germany reveal the emergence of a new pathotype: Entero-Aggregative-Haemorrhagic Escherichia coli (EAHEC). Arch Microbiol 193: 883–891

    Article  PubMed  CAS  Google Scholar 

  15. Rohde H, Qin J, Cui Y et al (2011) Open-source genomic analysis of Shiga-toxin-producing E. coli O104:H4. N Engl J Med 365: 718–724

    Article  PubMed  CAS  Google Scholar 

  16. Dücker C, Dautel P, Wagner K et al (2011) Clinical symptoms, treatment and outcome of EHEC and EHEC-HUS patients treated as in-patients. Dtsch Med Wochenschr 136: 1770–1776

    Article  PubMed  Google Scholar 

  17. Garg AX, Suri RS, Barrowman N et al (2003) Long-term renal prognosis of diarrhea-associated hemolytic uremic syndrome: a systematic review, meta-analysis, and meta-regression. JAMA 290: 1360–1370

    Article  PubMed  CAS  Google Scholar 

  18. Small G, Watson AR, Evans JH et al (1999) Hemolytic uremic syndrome: defining the need for long-term follow-up. Clin Nephrol 52: 352–356

    PubMed  CAS  Google Scholar 

  19. Spizzirri FD, Rahman RC, Bibiloni N et al (1997) Childhood hemolytic uremic syndrome in Argentina: long-term follow-up and prognostic features. Pediatr Nephrol 11: 156–160

    Article  PubMed  CAS  Google Scholar 

  20. Gianantonio CA, Vitacco M, Mendilaharzu F et al (1968) The hemolytic-uremic syndrome. Renal status of 76 patients at long-term follow-up. J Pediatr 72: 757–765

    Article  PubMed  CAS  Google Scholar 

  21. Dai C, Jiang M (2012) The incidence and risk factors of post-infectious irritable bowel syndrome: a meta-analysis. Hepatogastroenterology 59(113): 67–72

    PubMed  Google Scholar 

  22. Hickey CA, Beattie TJ, Cowieson J et al (2011) Early volume expansion during diarrhea and relative nephroprotection during subsequent hemolytic uremic syndrome. Arch Pediatr Adolesc Med 165: 884–889

    Article  PubMed  Google Scholar 

  23. Deutsche Gesellschaft für Infektiologie (2011) EHEC und Antibiotikabehandlung. http://www.dgfn.eu/index.php?eID=tx_nawsecuredl&u=0&file=uploads/media/DGI-Positionspapier_EHEC_und_Antibiotika_20110601.pdf&t=1326109329&hash=4de04fa2cb7318246a5fed969bed286a7b863bb2. Zugegriffen: 2. Juni 2011

  24. Bielaszewska M, Idelevich EA, Zhang W et al (2012) Epidemic Escherichia coli O104:H4: Effects of antibiotics on Shiga toxin 2 production and bacteriophage induction. Antimicrob Agents Chemother

  25. Nitschke M, Sayk F, Hartel C et al (2012) Association between azithromycin therapy and duration of bacterial shedding among patients with Shiga toxin-producing enteroaggregative Escherichia coli O104:H4. JAMA 307: 1046–1052

    Article  PubMed  CAS  Google Scholar 

  26. Slavicek J, Puretic Z, Novak M et al (1995) The role of plasma exchange in the treatment of severe forms of hemolytic-uremic syndrome in childhood. Artif Organs 19: 506–510

    Article  PubMed  CAS  Google Scholar 

  27. Goldwater PN, Bettelheim KA (2012) Treatment of enterohemorrhagic Escherichia coli (EHEC) infection and hemolytic uremic syndrome (HUS). BMC Med 10: 12

    Article  PubMed  Google Scholar 

  28. Perez N, Spizzirri F, Rahman R et al (1998) Steroids in the hemolytic uremic syndrome. Pediatr Nephrol 12: 101–104

    Article  PubMed  CAS  Google Scholar 

  29. Lapeyraque AL, Malina M, Fremeaux-Bacchi V et al (2011) Eculizumab in severe Shiga-toxin-associated HUS. N Engl J Med 364: 2561–2563

    Article  PubMed  CAS  Google Scholar 

  30. Orth D, Khan AB, Naim A et al (2009) Shiga toxin activates complement and binds factor H: evidence for an active role of complement in hemolytic uremic syndrome. J Immunol 182: 6394–6400

    Article  PubMed  CAS  Google Scholar 

  31. Thurman JM, Marians R, Emlen W et al (2009) Alternative pathway of complement in children with diarrhea-associated hemolytic uremic syndrome. Clin J Am Soc Nephrol 4: 1920–1924

    Article  PubMed  CAS  Google Scholar 

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  1. 1. Medizinische Abteilung, Asklepios Klinik Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Deutschland

    J.P. Bremer, C. Neumann-Grutzeck, S. Ullrich &  F. Hagenmüller

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  1. J.P. Bremer
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  2. C. Neumann-Grutzeck
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  3. S. Ullrich
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  4. F. Hagenmüller
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Correspondence to F. Hagenmüller.

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Bremer, J., Neumann-Grutzeck, C., Ullrich, S. et al. EHEC 2011 – aus der Sicht des Klinikers. Gastroenterologe 7, 234–241 (2012). https://doi.org/10.1007/s11377-011-0600-7

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