Enterovirulent E. Coli (EEC) (cont.)
Charles Patrick Davis, MD, PhD
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
In this Article
A new EEC group? (update on the E. coli 0104:H4 outbreak in Germany)
As an update to this article, the addition of the newest EEC E. strain will be presented. It recently arose in Germany in early 2011 and has now been documented in 11 European countries; at least four people who traveled to Germany and returned to the US have been infected with this strain. In most people, the exposure to the infection source occurred while people were visiting Germany, most likely through contaminated food (salads).
The strain has been identified as E. coli 0104:H4 (also termed STEC 0104:H4). It is presented in this section because as stated in the previous paragraph, there are unfortunate overlaps in ECC caused disease and this new strain seems to exhibit some of the worst overlap features of the ECC group members. For example, E. coli 0104:H4 is reported to contain about 93% of the genome of EHEC and produces the Shiga (Vero) toxin; however, it also seems to have the ability like EAEC strains to attach well to gastrointestinal cells.
Currently, the outbreak is the third largest ever reported for E. coli (about 2200 infected patients) and the most lethal (at least 22 dead as of 6/6/2011). In addition, most strains isolated are resistant to multiple antibiotics (aminoglycosides, macrolides and Beta-lactams). The source of the infection may be contaminated bean sprouts grown organically and then shipped to many German restaurants. One major difference in E. coli 0104:H4 from other E. coli that cause hemolytic uremic syndrome or HUS (mainly E. coli 0157:H7) is that the organism is causing HUS in young adult females and other adults. Often, HUS caused by E. coli 0157:H7 is seen in children and the elderly, not relatively healthy adults. However, this outbreak of E. coli 0104:H4 is still new and being studied intensively; other differences may become evident as time progresses.
The most recent (June 3, 2011) guidelines from the CDC are as follows:
It is not recommended to give antibiotics to patients with suspected STEC infections until complete diagnostic testing can be performed and STEC infection is ruled out. Some studies have shown that administering antibiotics in patients with STEC infections might increase their risk of developing HUS. However, clinical decision making must be tailored to each individual patient. There may be indications for antibiotics in patients with severe intestinal inflammation if perforation is of concern. Of note, isolates of STEC O104:H4 from patients in Germany have demonstrated resistance to multiple antibiotics.
Guidelines to ensure as complete as possible detection and characterization of STEC infections include the following:
The benefits of adhering to the recommended testing strategy include early diagnosis, improved patient outcome, and detection of all STEC serotypes.
All patients with Shiga toxin-positive diarrheal illness or HUS should be reported to health departments, regardless of a travel history to Germany.
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