German public health officials have warned of a spike in cases of E. coli among travelers to Egypt.

Experts from the Robert Koch Institut (RKI) said they had also seen a rise in connected cases of hemolytic uremic syndrome (HUS). HUS is a severe complication associated with E. coli infections that causes kidney failure.

Since the beginning of 2023, 31 cases of E. coli and 10 of HUS in people who were likely infected while on holiday in Egypt have been reported.

A large proportion of patients – 12 E. coli cases and six HUS cases – were recorded in May and June. They had stayed in different hotels, mainly in Hurghada, which is also the most frequent travel spot in the country.

General increase
In 2019 there were a similar number of E. coli and HUS cases linked to Egypt in the first half of the year but in all other recent years there were significantly fewer reports.

Of E. coli cases in 2023, 13 are female and 18 male. The median age is 3 with a range from 3 months to 71 years old. Of HUS cases, six are female and four male with an age range of 1 to 30 years old. At least five E. coli and all HUS cases were hospitalized but no one has died.

The E. coli serotype is known for six cases and there are five different types.

Investigations so far have not provided any indications of an outbreak through one source of infection or in a single hotel but pointed to more general food or water hygiene issues.

Such hotels usually offer salad and buffet food making choices, such as only eating well-cooked items and fruit they have peeled themselves, harder for travelers. Where tap water is not designated as drinking water, public health officials say bottled water should be used.

RKI officials warned of an expectation of more cases and said when people come back from Egypt with diarrhea, stool samples should be tested for E. coli and attention should be paid to the symptoms of HUS, especially in young children.

Clinical laboratories were asked to send an isolate or a stool swab of diagnosed E. coli cases in people with a history of travel to Egypt to the National Reference Center for Salmonella and other bacterial pathogens at the RKI for typing. Isolates or stool samples from HUS cases can also be sent to the laboratory for HUS at the University Hospital Münster.

About E. coli
Anyone who has developed symptoms of E. coli infection should seek medical attention and tell their doctor about their possible food poisoning. Specific tests are required to diagnose the infections, which can mimic other illnesses.

The symptoms of E. coli infections vary for each person but often include severe stomach cramps and diarrhea, which is often bloody. Some patients may also have a fever. Most patients recover within five to seven days. Others can develop severe or life-threatening symptoms and complications, according to the Centers for Disease Control and Prevention (CDC).

About 5 to 10 percent of those diagnosed with E. coli infections develop a potentially life-threatening kidney failure complication, known as a hemolytic uremic syndrome (HUS). Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of urination, small unexplained bruises or bleeding, and pallor. 

Many people with HUS recover within a few weeks, but some suffer permanent injuries or death. This condition can occur among people of any age but is most common in children younger than five years old because of their immature immune systems, older adults because of deteriorating immune systems, and people with compromised immune systems such as cancer patients. 

People who experience HUS symptoms should immediately seek emergency medical care. People with HUS will likely be hospitalized because the condition can cause other serious and ongoing problems such as hypertension, chronic kidney disease, brain damage, and neurologic problems.

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