The new face of enterohaemorrhagic Escherichia coli infections.

Citation style for this article: Jansen A, Kielstein JT. The new face of enterohaemorrhagic Escherichia coli infections. The unprecedented outbreak of Shiga toxin/vero-toxin-producing Escherichia coli (STEC/VTEC) O104:H4 in Germany in May and June 2011 displayed several novel epidemiological, microbiological and clinical features. Infection with STEC/VTEC, also referred to as enterohaemorrhagic E. coli (EHEC), with or without haemorrhagic uraemic syndrome (HUS), which is usually a disease of preschool children and equally distributed among the sexes, affected in the current outbreak mostly women over the age of 20 years (87%). In addition, several intriguing microbiological characteristics of the new epidemic strain have just been published [1,2]. With regard to the clinical characteristics, STEC/VTEC O104:H4 again differed remarkably from previously described STEC/VTEC infections. During a telephone conference on 9 June, organised by the European Centre for Disease Prevention and Control (ECDC) with clinical experts and nephrologists from 16 Member States of the European Union (EU) and several European and national professional societies, German colleagues shared their first clinical experiences from their patients. Severe infection with STEC/VTEC O104:H4 usually presented as a disease in three phases. On admission, about 80% of the patients suffered from bloody diarrhoea and 20% from watery diarrhoea. In 25% of the cases with bloody diarrhoea, signs of HUS (based on laboratory parameters of haemolysis, thrombocytopenia, and renal function tests) evolved after 3–5 days [3]. Completely unexpected, however, was the observation that severe neurological symptoms developed after about 3–10 days in roughly 50% of patients with HUS, even though clinical and laboratory markers of HUS were improving. These patients who had at first seemed to improve or respond to therapy, deteriorated again. Some patients even had to be re-hospitalised 3–4 days after they had been discharged. Neurologists were very concerned about the severity of neurological symptoms, ranging from mild disorientation and cognitive dissociation to stupor or severe, life-threatening seizures. Despite the impressive clinical presentation, routine neuroradio-logical examination revealed only mild alterations, if any. Worryingly, especially patients with seizures seemed to respond only weakly to standard antibody-based treatment regimes. In this issue of Eurosurveillance, Cordesmeyer et al. [4] report about an unusual case of STEC/VTEC O104:H4 infection associated with colonic ischemia, and Kuijper et al. [5] describe a case of household transmission of STEC O104:H4 from a mother to her child. In both cases, neurological symptoms were present, with severe manifestation and as yet unclear neu-rological outcome in the child. From …