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Toxigenic E. coli outbreak in Europe: Information for health professionals

A significant outbreak of Enterohaemorrhagic Escherichia coli (EHEC) O104:H4, a highly pathogenic bacterium subgroup of Shiga-toxin producing E. coli (STEC) is occurring in Europe. The O104:H4 strain causes bloody diarrhoea and a percentage of cases are presenting with complications including haemolytic uraemic syndrome (HUS), a condition characterised by renal failure, microangiopathic haemolytic anaemia, and thrombocytopenia.

In this section:

HUS has been previously noted to affect approximately 6%-9% of those with EHEC overall with young children and the elderly the most commonly affected. The most commonly implicated strain in the past has been 0157:H7 and most available information relates to this serotype.

In the outbreak in Germany due to O104:H4, the groups most commonly affected are young and middle aged adults (over 80%) and 60% of the EHEC cases and 71% of the HUS cases are female.

The incubation period is usually about 48 to 72 hours, but can range from 1–10 days.

Symptoms of disease include abdominal cramps and diarrhoea, which may be bloody. Fever and vomiting may also occur. Most patients recover within 10 days although a proportion will develop HUS.

Any patients with a history of travel to Europe and onset of diarrhoea in the last 2 weeks should have a stool sample collected and sent for testing for bacterial pathogens including STEC. Any positive samples can be forwarded to a reference laboratory for H and O antigen identification.

Treatment is supportive and antibiotics and antimotility agents are not recommended as they may increase the risk of development of HUS.

All cases should be reported to the local public health authorities
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Haemolytic uraemic syndrome (HUS)

HUS occurs after a prodrome of gastroenteritis or haemorrhagic colitis. Patients may present with abdominal pain, vomiting and diarrhoea. Laboratory testing can reveal haemolytic anemia, thrombocytopaenia, haematuria and proteinuria and signs of renal failure.

The central nervous system may be affected with the development of irritability seizures and altered mental status. Treatment is supportive and may include blood transfusion, control of fluid and electrolytes, control of hypertension and dialysis.

Prevention

The food source of the current outbreak has not been identified however consumption of salad items, such as bean sprouts, has been implicated. Human to human spread has not been described with this outbreak. However, while uncommon, person to person contamination can occur. Those caring for persons should adhere to good hand hygiene and other contact precautions.

Useful links

For a list of the countries involved in the outbreak in Europe and further information see the World Health Organization’s website

http://www.euro.who.int/en/what-we-do/health-topics/emergencies/international-health-regulations/outbreaks-of-e.coli-o104h4-infection

http://www.euro.who.int/en/what-we-do/health-topics/emergencies/international-health-regulations/outbreaks-of-e.coli-o104h4-infection/frequently-asked-questions-on-the-ehec-infection-outbreak-in-germany

http://www.euro.who.int/en/what-we-do/health-topics/emergencies/international-health-regulations/outbreaks-of-e.coli-o104h4-infection/frequently-asked-questions-on-the-ehec-infection-outbreak-in-germany/faq-epidemiology

http://www.euro.who.int/en/home

http://www.hpa.org.uk/web/HPAweb&Page&HPAwebAutoListName/Page/1296687744200