Loos, Sebastian ORCID: 0000-0002-8620-042X, Ahlenstiel, Thurid, Kranz, Brigitta, Staude, Hagen, Pape, Lars ORCID: 0000-0002-3635-6418, Haertel, Christoph, Vester, Udo, Buchtala, Laura, Benz, Kerstin, Hoppe, Bernd, Beringer, Ortraud, Krause, Martin, Mueller, Dominik, Pohl, Martin, Lemke, Johanna, Hillebrand, Georg, Kreuzer, Martin, Koenig, Jens, Wigger, Marianne, Konrad, Martin, Haffner, Dieter, Oh, Jun and Kemper, Markus J. (2012). An Outbreak of Shiga Toxin-Producing Escherichia coli O104:H4 Hemolytic Uremic Syndrome in Germany: Presentation and Short-term Outcome in Children. Clin. Infect. Dis., 55 (6). S. 753 - 760. CARY: OXFORD UNIV PRESS INC. ISSN 1537-6591

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Abstract

Background. In May and June 2011 the largest known outbreak of hemolytic uremic syndrome (HUS) occurred in northern Germany. Because, quite unusually, a large number of adults was affected and the causative Escherichia 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 was unusually high (11.5 years) compared with that in historical series. Only 1 patient (1.1%) died in the acute phase. Most patients (67/90 [74%]) received supportive care only. Renal replacement therapy was required in 64 of 90 (71%) of the children. Neurological complications, mainly seizures and altered mental stage, were present in 23 of 90 (26%) patients. Ten patients received plasmapheresis, 6 eculizumab, and 7 a combination of both. After a median follow-up of 4 months, renal function normalized in 85 of 90 (94%) patients, whereas 3 patients had chronic kidney disease stage 3 or 4, and 1 patient (1.1%) still requires dialysis. Complete neurological recovery occurred in 18 of 23 patients. Mild to moderate and major residual neurological changes were present in 3 patients and 1 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 Shiga toxin-producing E. coli HUS.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Loos, SebastianUNSPECIFIEDorcid.org/0000-0002-8620-042XUNSPECIFIED
Ahlenstiel, ThuridUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kranz, BrigittaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Staude, HagenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pape, LarsUNSPECIFIEDorcid.org/0000-0002-3635-6418UNSPECIFIED
Haertel, ChristophUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vester, UdoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Buchtala, LauraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Benz, KerstinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hoppe, BerndUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Beringer, OrtraudUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Krause, MartinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mueller, DominikUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pohl, MartinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lemke, JohannaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hillebrand, GeorgUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kreuzer, MartinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Koenig, JensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wigger, MarianneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Konrad, MartinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Haffner, DieterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Oh, JunUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kemper, Markus J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-482968
DOI: 10.1093/cid/cis531
Journal or Publication Title: Clin. Infect. Dis.
Volume: 55
Number: 6
Page Range: S. 753 - 760
Date: 2012
Publisher: OXFORD UNIV PRESS INC
Place of Publication: CARY
ISSN: 1537-6591
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
RELATIVE NEPHROPROTECTION; CLINICAL-ASPECTS; DIARRHEA; INFECTION; STRAIN; ASSOCIATION; NATIONWIDE; HUSMultiple languages
Immunology; Infectious Diseases; MicrobiologyMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/48296

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