An elderly woman needed emergency surgery to remove half her bowel after being infected with E. coli, highlighting a life-threatening risk from the bacterium responsible for a diarrhea outbreak in Germany, doctors said.
Toxins produced by the new O104 E. coli strain cut blood supply to part of the woman’s colon, causing it to become gangrenous, according to a report yesterday in Eurosurveillance, a weekly newsletter on infectious diseases. The woman, in her 80s, also developed confusion and other neurological complications because of the infection, wrote doctors in the West German city of Muenster, where she was treated.
Their findings suggest doctors should watch for unexpected complications caused by the bowel-dwelling bug, and consider examining the gastrointestinal tract with an endoscope to help diagnose cases. Almost 4,000 people in more than a dozen European nations are reported to have been sickened in the outbreak and 43 people have died. Contaminated sprouts have been blamed, raising concern about intensive food production methods.
“We’re more likely to see these things because we’re becoming more reliant on mass-produced, pre-prepared foods,” said James Paton, head of the bacterial pathogenesis laboratory at the University of Adelaide in South Australia, who wasn’t involved in the study. “If you do get failure of process at one point, it can be distributed far and wide.”
The German E. coli epidemic was more deadly than previous outbreaks because the pathogen produced a poisonous by-product called Shiga toxin and had the ability to stack together and stick to the gut, researchers led by Helge Karch, director of the Hygiene Institute at the University of Muenster, said in an article published online this week in the Lancet Infectious Diseases journal.
The unusual combination of traits made it more likely for infected people to develop a potentially fatal kidney complication called hemolytic uremic syndrome, or HUS, the researchers said. The same mechanism responsible for the kidney damage may also cause blockages in the tiny blood vessels supplying the gastrointestinal tract, Paton said.
As of yesterday, the outbreak had sickened 3,792 people in the European Union, including 862 with HUS, and killed 43, according to the European Centre for Disease Prevention and Control in Stockholm.
Severe infection with the bug usually presented as a disease in three phases, the ECDC’s Andreas Jansen wrote in a separate report in Eurosurveillance yesterday. Four out of five patients suffered from bloody diarrhea on hospital admission, with the remainder experiencing watery diarrhea.
A quarter of patients with bloody diarrhea developed signs of HUS three to five days later. Surprisingly, severe neurological symptoms developed after 3 to 10 days in about half of HUS patients, even though their illness appeared to be improving, Jansen wrote.
“These patients who had at first seemed to improve or respond to therapy, deteriorated again,’’ he said. “Some patients even had to be re-hospitalized three to four days after they had been discharged.’’
Neurological symptoms ranged from mild disorientation and cognitive dissociation to stupor and severe, life-threatening seizures, he said. “Worryingly, especially patients with seizures seemed to respond only weakly to standard antibody- based treatment regimes,’’ Jansen said.
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