Outbreak of Shiga toxin-producing Escherichia coli and haemolytic uraemic syndrome

Enterohaemorrhagic Escherichia coli (EHEC) is a group of pathogenic Shiga toxin-producing E. coli that can cause haemorrhagic colitis and haemolytic uraemic syndrome (HUS). The disease usually occurs sporadically, but sometimes also occurs in large outbreaks such as that which recently occurred in northern Germany. EHEC infection is a zoonosis and its reservoir is in ruminant farm animals (cattle, sheep and goats). EHEC infection should be considered in patients with bloody diarrhoea, but in the course of many severe EHEC infections a picture resembling HUS may also occur. Antibiotic treatment is contraindicated because it does not reduce the duration of the disease and may have negative complications. Patients with EHEC infection may spread the bacteria and their care includes contact isolation measures with their own toilet facilities. The E. coli type O104:H4 that occurred in Germany has a combination of specific virulence characteristics. This outbreak affected many people who developed HUS and neurological symptoms following bloody diarrhoea.