Abstract
An outbreak of enterohemorrhagic Escherichia coli (EHEC) occurred in Toyama and other prefectures in Japan during 2011. Some patients, including adults, showed complications such as encephalopathy, disseminated intravascular coagulation, and hemolytic–uremic syndrome, and the disease course was extremely aggressive. This report describes the clinical features of four patients infected with Escherichia coli (E. coli) O111 who developed very severe to fatal complications. The initial symptoms in all patients included abdominal pain, diarrhea, and bloody stools, and neurological abnormalities started to appear from 1 to 3 days after admission. Vomiting and pyrexia developed in three patients. Leukocyte counts, lactate dehydrogenase (LDH), and fibrin/fibrinogen degradation products were elevated, and thrombocytopenia was evident. Extremely elevated LDH and severe thrombocytopenia were characteristic at the time encephalopathy became apparent. All patients received oral fosfomycin, intravenous antibiotics, and anticoagulant therapy, three received gamma globulin, plasma exchange, and blood transfusion, and two received steroids and dialysis. Three patients required mechanical ventilation, and two adult patients died. E. coli O111 positive for Shiga toxin 2 was detected in stool culture in two patients, and serological tests for E. coli O111 were positive in the other two patients. In conclusion, EHEC O111 can cause severe illness in children and adults, and the prognosis becomes poorer as the severity of complications increases. Close monitoring including platelet counts and LDH are useful. Once these clinical parameters change, intensive treatment should be provided to prevent the development of severe complications.
References
Infectious Agents Surveillance Report (IASR). 2011;32:127 (in Japanese).
Tanaka H, Ohseto M, Yamashita Y, Shinohara N, Inoue H, Sasaki Y, et al. Bacteriological investigation on an outbreak of acute enteritis associated with verotoxin-producing Escherichia coli O111:H-. Kansenshogaku Zasshi. 1989;63:1187–94. (in Japanese).
Kishimoto M. An outbreak of enterohemorrhagic Escherichia coli O111 infections at a nursery school in Hiroshima Prefecture. Nippon Koshu Eisei Zasshi. 2000;47:440–4 (in Japanese).
Tanaka H, Tanio S, Hoshina T, Tomita M, Nakajima H, Sakaki M, et al. Epidemiological and bacteriological investigation of enterohemorrhagic Escherichia coli infection in the Chugoku-Shikoku area. Kansenshogaku Zasshi. 2002;76:439–49 (in Japanese).
Kato K, Shimoura R, Nashimura K, Yoshifuzi K, Shiroshita K, Sakurai N, et al. Outbreak of enterohemorrhagic Escherichia coli O111 among high school participants in excursion to Korea. Jpn J Infect Dis. 2005;58:332–3 (in Japanese).
Kanazawa Y, Ishikawa T, Shimizu K, Inaba S. Enterohemorrhagic Escherichia coli outbreaks in nursery and primary schools. Jpn J Infect Dis. 2007;60:326–7.
Goldwater PN, Bettelheim KA. New perspectives on the role of Escherichia coli O157:H7 and other enterohaemorrhagic E. coli serotypes in human disease. J Med Microbiol. 1998;47:1039–45.
Piercefield EW, Bradley KK, Coffman RL, Mallonee SM. Hemolytic uremic syndrome after an Escherichia coli O111 outbreak. Arch Intern Med. 2010;170:1656–63.
Gerber A, Karch H, Allerberger F, Verweyen HM, Zimmerhackl LB. Clinical course and the role of Shiga toxin-producing Escherichia coli infection in the hemolytic–uremic syndrome in pediatric patients, 1997–2000, in Germany and Austria: a prospective study. J Infect Dis. 2002;186:493–500.
Brooks JT, Sowers EG, Wells JG, Greene KD, Griffin PM, Hoekstra RM, et al. Non-O157 Shiga toxin-producing Escherichia coli infections in the United States, 1983–2002. J Infect Dis. 2005;192:1422–9.
Scheiring J, Andreoli SP, Zimmerhackl LB. Treatment and outcome of Shiga-toxin-associated hemolytic uremic syndrome (HUS). Pediatr Nephrol. 2008;23:1749–60.
Mizuguchi M, Abe J, Mikkaichi K, Noma S, Yoshida K, Yamanaka T, et al. Acute necrotising encephalopathy of childhood: a new syndrome presenting with multifocal, symmetric brain lesions. J Neurol Neurosurg Psychiatry. 1995;58:555–61.
Acknowledgments
We thank the Toyama Institute of Health and Tonami Kosei Center for EHEC antibody testing and for Shiga toxin detection.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Matano, S., Inamura, K., Konishi, M. et al. Encephalopathy, disseminated intravascular coagulation, and hemolytic–uremic syndrome after infection with enterohemorrhagic Escherichia coli O111. J Infect Chemother 18, 558–564 (2012). https://doi.org/10.1007/s10156-011-0336-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10156-011-0336-9