An Outbreak of Shiga Toxin-Producing Escherichia coli O104:H4 Hemolytic Uremic Syndrome in Germany: Presentation and Short-term Outcome in Children

作者：Loos Sebastian^*; Ahlenstiel Thurid; Kranz Brigitta; Staude Hagen; Pape Lars; 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; Kemper Markus J

来源：Clinical Infectious Diseases, 2012, 55(6): 753-759.

DOI：10.1093/cid/cis531

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. %26lt;br%26gt;Methods. Retrospective analysis of medical records of 90 children and comparison to previous outbreak and sporadic case series. %26lt;br%26gt;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. %26lt;br%26gt;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. %26lt;br%26gt;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.

• 出版日期2012-9-15