Lessons Learned From Outbreaks of Shiga Toxin Producing Escherichia coli

Susanne Hauswaldt; Martin Nitschke; Friedhelm Sayk; Werner Solbach; Johannes K-M Knobloch

doi:10.1007/s11908-012-0302-4

Lessons Learned From Outbreaks of Shiga Toxin Producing Escherichia coli

Curr Infect Dis Rep. 2013 Feb;15(1):4-9. doi: 10.1007/s11908-012-0302-4.

Authors

Susanne Hauswaldt¹, Martin Nitschke, Friedhelm Sayk, Werner Solbach, Johannes K-M Knobloch

Affiliation

¹ Campus Lübeck, Department of Medical Microbiology and Hygiene, University Hospital of Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany.

Abstract

In 2011, a large outbreak caused by a Shiga toxin producing E. coli (STEC) occurred in Northern Germany, with a satellite outbreak in Western France, including the highest number of hemolytic uremic syndrome (HUS) cases ever encountered during a STEC outbreak. The outbreak strain was characterized as an enteroaggregative E. coli of serotype O104:H4 expressing a phage-encoded Shiga toxin 2. The majority of STEC infections and HUS cases were observed in adults, with a preponderance of the female gender. The outbreak imposed huge challenges on clinicians, microbiologists, and epidemiologists but also provided important new insight for the understanding of STEC infection. Thus, novel therapeutic strategies in the treatment of HUS in adults and for decolonization of long-term STEC carriers were evaluated. This review highlights the unusual features of the recent O104:H4 outbreak and focuses on emerging new strategies in diagnostics and treatment of acute STEC-related disease, as well as STEC long-term carriage.