An outbreak of shiga-toxin producing E. coli O104:H4 hemolytic uremic syndrome (STEC-HUS) in Germany: Presentation and short-term outcome in children
Posted: June 10th, 2012 - 6:15pm
Source: Clinical Infectious Diseases
Background. In May and June 2011 the largest known HUS-outbreak occurred in northern Germany. Since, quite unusually, a large number of adults was affected and the causative E. coli strain, serotype O104:H4, showed an atypical virulence factor pattern, it was speculated that this outbreak was associated with an aggressive course and an unfavorable prognosis also in children.
Methods. Retrospective analysis of medical records of 90 children and comparison to previous outbreak and sporadic case series.
Results. Median age in was unusually high compared to historical series (11.5 years). Only one patient (1.1%) died in the acute phase. Most patients (67/90, 74%) received supportive care only. Renal replacement therapy was required in 64/90 (71%) of the children. Neurological complications, mainly seizures and altered mental stage, were present in 23/90 (26%) patients. Ten patients received plasmapheresis, six eculizumab, and seven a combination of both.
After a median follow-up of four months, renal function normalized in 85/90 (94%) patients, while three patients still had CKD stage III or IV, and one patient (1.1%) still requires dialysis. Complete neurological recovery occurred in 18/23 patients. Mild to moderate and major residual neurological changes were present in three and one patient, respectively, although all patients were still improving.
Conclusions. E. coli O104:H4 caused the largest HUS-outbreak in children reported in detail to date and most patients received supportive treatment only. Initial morbidity as well as short-term outcome due to this pathogen is comparable to previous pediatric series of STEC-HUS.