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At least one person has died in Germany after contracting a dangerous strain of E. coli. The outbreak, whose cause is currently not known, is concentrated in the north of the country. Over 400 confirmed or suspected cases have already been recorded. Health officials in Germany are in a state of alarm over an outbreak of E. coli infections that has already caused one confirmed death. The health ministry in the northwestern German state of Lower Saxony announced on Tuesday that an 83-year-old woman had died after being infected with E. coli. She was admitted to hospital with bloody diarrhea on May 15 and died on Saturday, the ministry said. Health authorities confirmed that tests had confirmed the woman was infected with the E. coli pathogen. In Bremen, authorities reported that a young woman with symptoms of an E. coli infection had died in the early hours of Tuesday, but laboratory tests have yet to confirm the diagnosis. A third woman infected with E. coli died in Schleswig-Holstein on Sunday, but the cause of death was unclear. The woman was over 80 and was in hospital to have an operation. The current outbreak involves a strain known as enterohemorrhagic E. coli (EHEC). Symptoms of an infection include bloody diarrhea and stomach cramps. In some cases, an infection can cause a disease called haemolytic uraemic syndrome (HUS), which can lead to kidney failure and even death. The outbreak began in the second week of May, and authorities in Germany have so far recorded over 400 confirmed or suspected cases of EHEC infections.
Around 40 cases are said to be very serious. On Monday night, several patients were fighting for their lives, with some having to be artificially ventilated. One patient was in a coma. Around 1,000 people become infected with the pathogen each year in Germany, but experts say the current infection rate is unusually high. "The current trend exceeds any historical comparison," said microbiologist Werner Solbach from the University Hospital Schleswig-Holstein in Kiel. According to Solbach, laboratory tests have shown that the current outbreak involves a bacterial strain that is partially resistant to antibiotics. The source of the outbreak is not known, but it is currently hypothesized that the patients contracted the infection by eating unwashed vegetables. The outbreak is currently concentrated in the north of Germany, and most of the victims are adult women. There are over 200 suspected cases in the northern state of Schleswig-Holstein and almost 100 in Lower Saxony. Other cases have been reported in the states of Hesse, Mecklenburg-Western Pomerania, North Rhine-Westphalia and Saarland, as well as in the city-states of Bremen, Hamburg and Berlin. The German government is concerned about the outbreak. Health Minister Daniel Bahr spoke to the head of the Robert Koch Institute, the central German institution for disease control and prevention, in a telephone call about the situation, a spokesman said Tuesday. Health authorities advised people in Germany to be careful about hygiene, to thoroughly wash fruit and vegetables, and to contact a doctor immediately in the events of symptoms such as bloody diarrhea. E. coli bacteria usually live in the intestines of ruminants and can be transferred to humans who eat uncooked food.
On Tuesday, the German newspaper Süddeutsche Zeitung reported that Karch had discovered that the O104:H4 bacteria responsible for the current outbreak is a so-called chimera that contains genetic materia from various E. coli bacteria. It also contains DNA sequences from plague bacteria, which makes it particularly pathogenic
On the Fly, German Doctors Find Treatment for Deadly E. coli Infections
by Kai Kupferschmidt on 27 May 2011, 6:08 PM
In the middle of the biggest outbreak of food poisoning caused by the bacterium enterohemorrhagic Escherichia coli (EHEC) that Germany has ever seen, a group of doctors may have found a way to treat the most severe cases. The finding appears today in The New England Journal of Medicine (NEJM).
In the article, Franz Schaefer, a nephrologist at the Center for Pediatrics and Adolescent Medicine in Heidelberg, Germany, and other physicians describe how they successfully treated three EHEC-infected children suffering from HUS with a novel approach. They used the monoclonal antibody eculizumab, which has been on the market since 2007, to treat a rare blood disorder. Eculizumab inhibits a part of the human immune system called the complement system that usually destroys invading cells that have been tagged for destruction by other parts of the immune system.
The complement system has been implicated for some time in certain patients who develop HUS without any EHEC infection, known as atypical HUS patients, and eculizumab has been used successfully to treat them. Recent research suggests that the complement system might also be involved in the HUS cases caused by EHEC.
Last autumn, Schaefer saw a young girl suffering from HUS due to an EHEC infection. He first tried the most common treatment, replacing the patients’ blood plasma with donor plasma to rid the body of the toxins. (HUS patients are usually not treated with antibiotics because the antibiotics can aggravate the symptoms by releasing the shiga toxin from the bacteria in large amounts.)
When the girl’s health did not improve, Schaefer tried the antibody. "We did not have any other option. She was showing severe neurological symptoms, paralysis of one side of the body, cramps, and then slipped into a coma," Schaefer remembers. “But when we finally gave her the antibody, she improved immensely within 24 hours,” Schaefer says. “This was not a controlled experiment, of course,” he says. “But the improvements were very suggestive of being due to the treatment.”
Schaefer was apparently not the only one with this idea. When he wrote a case report for NEJM, the editors notified him that two other groups had sent in similar reports around the same time. “So we wrote something all together and it was accepted for publication 14 days ago,“ Schaefer says. A few days later, HUS cases started appearing en masse in northern Germany.
“I could not believe it," Schaefer says. "HUS cases with severe neurological symptoms are very rare, but now they are everywhere." He also informed his colleagues elsewhere. “A lot of them have asked about the new treatment, and a few patients are already being treated with it."
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