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Hemolytic uremic syndrome cases mounting in Germany E. coli outbreak

Escherichia coli is the likely cause of a food-borne outbreak in Germany that has led to nine deaths and 470 cases of hemolytic uremic syndrome since the second week of May.

Although the investigation into the source of the outbreak is still under way, the Federal Institute for Risk Assessment in Germany advises against consumption of cucumbers, raw tomatoes and lettuce to prevent further cases.

“This recommendation applies especially to foods acquired in northern Germany and will be upheld while the outbreak investigations continue and as long as the source of the outbreak has not been identified,” according to a Federal Institute for Risk Assessment press release.

Other countries have also been affected, with 10 hemolytic uremic syndrome cases in Sweden. All of those affected recently visited Germany, particularly northern Germany, according to a WHO press release.

“The outbreak has developed very rapidly, and an unusually high number of cases affect adults — 86% are in people aged 18 years or older — particularly women (67%),” WHO officials wrote in the release. “Nevertheless, cases have also been reported in school-aged children. The unusual E. coli serogroup O104 is suspected of being the pathogen likely to be associated with this outbreak.”

WHO has offered technical assistance to assist countries without the capacity to detect the E. coli serogroup O104 and will maintain close contact with the relevant authorities, according to the release.

Those who develop bloody diarrhea and abdominal pain and have recently visited Germany should seek medical advice urgently. Currently, WHO does not recommend any restrictions in travel or trade with Germany.

Shiga toxin-producing E. coli continue to be major threats to public health with produce emerging as an important vehicle of transmission in the US and Europe. The outbreak in Germany is due to an uncommon serotype of E. coli and would be missed by most laboratories in the US that look only for the more common E. coli O157:H7 by culturing stool directly on sorbitol-containing MacConkey agar. To find other serotypes, it is necessary to look for Shiga toxin in stools of those with illness, and if positive, then refer the E. coli to a reference laboratory for serotyping.

Herbert L. DuPont, MD
St. Luke’s Episcopal Hospital, Houston

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