EHECEHEC

By Marie and AliciaBy Marie and Alicia

What is it?What is it?

E. coli is a bacterium that is found in E. coli is a bacterium that is found in the intestine of humansthe intestine of humans

EHEC = enterohaemorrhagic EHEC = enterohaemorrhagic escherichia coliescherichia coli

strain of E. coli strain of E. coli Type : O104:H4Type : O104:H4first recognized in 1982first recognized in 1982 in Germany 2011in Germany 2011

SourcesSources

• reservoir of bacterium in ruminants ( e.g reservoir of bacterium in ruminants ( e.g cattle or camels)cattle or camels)

• contaminated food like raw or uncooked contaminated food like raw or uncooked meatmeat

• person-to-person contact: oral-faecal routeperson-to-person contact: oral-faecal route

(asymptomatic carriers)(asymptomatic carriers)• contaminated water (can survive for contaminated water (can survive for

months)months)• in this case probably contaminated in this case probably contaminated

vegetables which got in contact with vegetables which got in contact with faeces of infected animalsfaeces of infected animals

PathogenesisPathogenesis

• Incubation period: 3-8 days; infectious Incubation period: 3-8 days; infectious dose may be only 10 bacteriadose may be only 10 bacteria

• in the intestines bacteria attach to the in the intestines bacteria attach to the villi and produce Shiga-like toxinsvilli and produce Shiga-like toxins

• toxins block protein synthesis and toxins block protein synthesis and induces cell deathinduces cell death

• also enter blood vessels and attach to also enter blood vessels and attach to their walls causing the breakdown of their walls causing the breakdown of RBCs and plateletsRBCs and platelets

HUSHUS

hemolytic-uremic syndromehemolytic-uremic syndrome closely associated with EHEC and other closely associated with EHEC and other

GIT-infectionsGIT-infections 10-20% of patients with EHEC infections 10-20% of patients with EHEC infections

develop this syndromedevelop this syndrome mortality rate with intensive care is 3-mortality rate with intensive care is 3-

5%5% affects especially people with less affects especially people with less

distinct immune systemdistinct immune system

SymptomsSymptoms

feverfever nausea/ vomittingnausea/ vomitting weaknessweakness abdominal painabdominal pain

patients with HUS:patients with HUS: diarrhea (progresses to bloody diarrhea)diarrhea (progresses to bloody diarrhea) abdominal crampsabdominal cramps

Clinical findingsClinical findings

small blood clotssmall blood clots internal bleedinginternal bleeding anemia and thrombocytopeniaanemia and thrombocytopenia dyspnea (breathing difficulties)dyspnea (breathing difficulties) inflammation of the pancreas inflammation of the pancreas kidney failure kidney failure anuriaanuria neurological disordersneurological disorders

Treatment Treatment

EHECEHEC– most victims most victims

recover within 10 recover within 10 daysdays

– bacterium is killed bacterium is killed at 70°Cat 70°C

– no antibiotics no antibiotics stimulate toxin stimulate toxin productionproduction

– hygienehygiene

HUSHUS– intensive careintensive care– transfusion of RBC transfusion of RBC

and plateletsand platelets– dialysisdialysis– medication like medication like

corticosteroidscorticosteroids

EHEC in GermanyEHEC in Germany

EHEC infections occur worldwideEHEC infections occur worldwide in Germany about 1000 every year, in Germany about 1000 every year,

usually affecting small childrenusually affecting small children big outbreak in summer 2011 from big outbreak in summer 2011 from

may to julymay to july

4335 EHEC infected people, 855 HUS 4335 EHEC infected people, 855 HUS infected people 2987 people with acute infected people 2987 people with acute gastroenteritis, 48 deathsgastroenteritis, 48 deaths

68% of patients were females and most 68% of patients were females and most affected people were adults affected people were adults

fenugreek seeds were identified as source fenugreek seeds were identified as source for the infection for the infection

after the distribution was ceased, there after the distribution was ceased, there were no new infections associated with the were no new infections associated with the vehicle vehicle

Consequences

Affected people:– dialysis throughout life– need of donor organs

Economy:– farmers lost income– European Commission covered the loss

by paying 226 million € to the agricultural market

– another 12 million € for the study of the pathogen

References:References:– http://www.spiegel.de/thema/ehec/– http://www.who.int/mediacentre/factsheets/fs125/en/– http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH000153

9/– http://www.rki.de/DE/Content/InfAZ/E/EHEC/EHEC.html

Pictures:Pictures:– http://mhstatic.de/fm/1/thumbnails/SH_ehec_Bakterien_8

00.jpg.2721709.jpg– http://healthmap.org/en/– http://www.google.de/imgres?imgurl=http://http://www.google.de/imgres?imgurl=http://

www.lgl.bayern.de/gesundheit/pic/www.lgl.bayern.de/gesundheit/pic/ehec_faelle_bayern_250711.gif&imgrefurl=http://ehec_faelle_bayern_250711.gif&imgrefurl=http://www.lgl.bayern.de/gesundheit/ehec.htm&usgwww.lgl.bayern.de/gesundheit/ehec.htm&usg