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Germany Outbreak Experiences Shared

Among the surprising aspects of the E. coli O104:H4 outbreak that ravaged Germany this spring were the neurological side effects that caused some patients severe panic attacks, seizures and speech or motor impairment.

But fears that some of these outbreak victims might suffer permanent brain injury may be allayed, and there’s also preliminary evidence that some patients with severe kidney damage might not need long-term dialysis.

Those were some of the conclusions shared during Germany’s first clinical symposium on the outbreak, held Sept. 9 in Berlin and summarized online Thursday by Eurosurveillance

The German Society of Nephrology had invited health experts and microbiologists to share what they’ve learned so far about the outbreak, linked to fenugreek sprouts, that killed 50 and sickened 4,321, including 852 who developed the kidney-damaging complication called hemolytic uremic syndrome, or HUS.

Neurologist Karin Weissenborn of Hannover Medical School, described her experiences with 43 patients – 42 who developed hemolytic uremic syndrome (HUS) and cognitive problems.

Most, but not all of the patients, showed “a complete remission of neurological signs within weeks.”

Fourteen HUS patients, assessed with severe kidney damage and treated at Hamburg-Expender University, all recovered better than expected and none will need regular dialysis, according to researcher Udo Helmchen, who said initial histopathological ratings may have been misleading.

In other symposium highlights:

– Helge Karch, Munster University Clinic, said the Shiga toxin E. coli O104:H4 strain was first isolated in Germany 10 years ago, from a child with HUS. Though not identical to the 2011 outbreak strain, it showed similar features. But why the outbreak strain was so aggressive and spread so rapidly remains an open question.

– Winifried Kern, University of Freiburg, said that based on the experience in Germany, antibiotics still cannot be generally recommended for enterohemorrhagic E. coli infections. 

– Rolf Stahl, Hamburg-Eppendorf University Clinic, explained his rationale for the off-license use of Eculizumab (monoclonal antibody therapy, marketed as Soliris) for patients who weren’t responding to standard treatment options, such as plasma exchange therapy. But Stahl did not present results from the analysis of patients’ outcomes, leaving open the question as to whether Eculizumab was effective or not. (Last week, Soliris was approved for limited use in treating atypical HUS by the U.S. Food and Drug Administration.)

– The continued lack of evidence regarding the best treatment options for E. coli infections remains a concern, although some clinicians cited the benefits of using immunoabsorption for patients who went on to experience neurologic symptoms about 5 to 12 days after the onset of gastrointestinal symptoms. 

 – So far the E coli O104:H4 strain doesn’t appear to have become established as an endemic strain in Germany. 

As big as the outbreak was, the illnesses were nevertheless mostly confined to one country. The experts at the symposium expressed an urgent need to share clinical data and experiences “to prepare for a similar event that might be more widespread.”

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