Re: Europe - 17 dead, 1000+ infected, 470 severe cases of E-coli - EHEC STEC hemolytic uremic syndrome
Re: Europe - 17 dead, 1000+ infected, 470 severe cases of E-coli - EHEC STEC hemolytic uremic syndrome
<TABLE id=apex_layout_271110100662109808 class=formlayout border=0 summary=""><TBODY><TR><TD noWrap align=right>
Archive Number</TD><TD noWrap align=left>20110601.1678</TD></TR><TR><TD noWrap align=right>
Published Date</TD><TD noWrap align=left>01-JUN-2011</TD></TR><TR><TD noWrap align=right>
Subject</TD><TD noWrap align=left>PRO/AH/EDR> E. coli O104 - EU (07) & USA</TD></TR></TBODY></TABLE>
E. COLI O104 - EUROPEAN UNION (07) & USA
</PRE>
Excerpt:
[6] Overall discussion
Date: Tue 31 May 2011
Source: Spiegel Online International [edited]
<
http://www.spiegel.de/international/germany/0,1518,765777,00.html>
Germany's _E. coli_ epidemic, which has killed as many as 15 people
so far [16 now -- see [1] above], has alarmed doctors, who have never
seen such an aggressive intestinal bacterium before. Epidemiologists
are desperately searching for the origin of the deadly bacteria.
The eeriest thing of all, according to Rolf Stahl, is the way
patients change. "Their awareness becomes blurred, they have problems
finding words, and they don't quite know where they are," says Stahl.
And then there is this surprising aggressiveness. "We are dealing with
a completely new clinical picture," he notes.
Stahl, a 62-year-old kidney specialist, has been the head of the
Third Medical Clinic and Polyclinic at the University Medical Center
Hamburg-Eppendorf (UKE) for almost 18 years. "But none of us doctors
has ever experienced anything quite like this," he says. His staff has
been working around the clock for the last week or so. "We decide at
short notice who can go and get some sleep."
But Stahl only sees the most severe cases, those in which EHEC
[enterohemorrhagic _E. coli_] also attacks the blood, kidneys and
brain. These patients suffer from a life-threatening complication
known as hemolytic-uremic syndrome (HUS). About 10 days after the
diarrhea begins, the red blood cells suddenly disintegrate, blood
clotting stops working, and the kidneys fail. In many cases patients
need dialysis to stay alive. "The situation is deteriorating
dramatically for our patients," says Stahl.
In Germany, about 60 people a year contract hemolytic-uremic syndrome
after being infected with EHEC. Last week [week of 23 May 2011], there
were as many cases in a single day. According to the Robert Koch
Institute (RKI), the national German institution responsible for
disease control and prevention, there were 276 HUS patients in German
hospitals by Fri 27 May 2011. By Tue 31 May 2011, there were 373
confirmed cases of HUS across Germany. As many as 15 people [16 -- see
[1] above] may have died from EHEC in Germany so far in the current
outbreak. Cases have also been reported in Sweden, Denmark, Britain,
Austria, and the Netherlands.
The story of the outbreak began in Stahl's clinic. When the 1st
patient suspected of having contracted HUS was admitted there on a
Wednesday evening 2 weeks ago, none of the doctors had any idea what
they were facing. "We weren't even thinking of EHEC at first," says
Stahl, "because it normally only affects children." In adults, on the
other hand, HUS can also be caused by genetic defects and autoimmune
diseases, or as a side effect of cancer treatment. By the next day,
however, there were suddenly 7 or 8 cases on the ward, and the
laboratory reported that they were all infected with EHEC. Hamburg
promptly notified the Robert Koch Institute.
The process that began at that point and reached its preliminary
climax at the end of last week [week of 23 May 2011] with the closing
of 2 vegetable production operations in Spain is an example of
impressive epidemiological detective work. It involves close
cooperation among vigilant doctors, epidemiologists thinking
practically, and detail-oriented laboratory scientists.
For the disease control experts at the RKI, it was primarily a matter
of addressing 2 tasks simultaneously and as quickly as possible: to
find the contaminated food products and to determine the type of
bacterium involved.
Helge Karch, the director of the RKI's EHEC consulting laboratory at
the Munster University Hospital in western Germany, has devoted almost
his entire life as a researcher to EHEC bacteria. "But I've never
encountered something like this," he says. The 1st stool sample
arrived in his lab on Monday [23 May 2011]. The 1st cases had already
appeared in the state of North Rhine-Westphalia by then. Karch's staff
members began their analysis right away. The result was clear by
Wednesday evening, 25 May 2011: It was the extremely rare serotype
O104:H4.
After searching through a database for medical journals, Karch found
only one article under the search term "O104:H4": a case study from
Korea. In the Korean case, as in most of the German cases, an adult
woman had contracted EHEC, which is completely atypical for EHEC.
Karch speculated over why the disease wasn't happening in children,
as is normally the case, but only in adults. And why was the infection
striking more people that ever before in Germany? Karch and others
speculate that the problem could lie in the pathogen itself. Perhaps
the genetic material of this rare bacterium has mutated again, so that
its toxin or its bond to the intestinal cells it damages has become
stronger. Doctors hope that a complete sequencing of the genome, which
is now being performed, will offer some answers.
[Byline: Veronika Hackenbroch, Samiha Shafy, Frank Thadeusz]
[...]
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