As German health officials sought the source of a deadly enterohemorrhagic Escherichia coli outbreak that has claimed the lives of at least 19 people, the US Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA) has issued a notice to healthcare providers to be on alert for infection among travelers returning from Germany.

While there are some reports of the outbreak stabilizing, the World Health Organization (WHO; Geneva, Switzerland) has confirmed that a total of 1,823 cases of Shiga toxin–producing E. coli O104:H4 (STEC O104:H4) have been reported, including 520 cases of hemolytic uremic syndrome (HUS), a potentially life-threatening complication of the infection that can cause kidney failure. Twelve HUS cases so far have been fatal, and seven deaths were reported among non-HUS cases. The number of countries reporting cases of the STEC O104:H4 poisoning had increased to 11 by June 3, 2011; despite this, all but one of the deaths since the outbreak emerged in May have occurred in Germany. The 18th death was reportedly in Sweden and involved a person who had recently returned from Germany.

In addition to causing particularly severe symptoms, the strain is unusual in that most of the victims appear to be women, and people over the age of 20. The unusual patterns underscore that little is known about the strain's nature, but they could also suggest the source that may be somehow related to the adult female demographic. The duration time from exposure to onset of symptoms is also unique, with incubation times of more than a week and up to 12 days, compared to as little as 5 days commonly seen with other E. coli infections. Most patients' symptoms resolve within 5 to 7 days; HUS, however, can develop a week after diarrhea begins.

"Four suspected cases of the infection have been reported in the United States, all involving people who had recently traveled to Hamburg," said Chris Braden, MD, director of Foodborne, Waterborne, and Environmental Diseases at the CDC. "Three of the 4 cases in the United States involved HUS and the patients were hospitalized. The fourth case did not develop HUS but had bloody diarrhea, and we know there was a Shiga toxin–producing organism involved."

After backtracking on an earlier suggestion that the source of the E. coli strain could be linked to organic Spanish cucumbers, and the possiblility connecting the pathogen to bean sprouts from Saxony, German officials still maintain that cucumbers, tomatoes, and lettuce are top suspects, after 17 of the people affected (one of whom died), were found to have lunched on May 13 at the popular Kartoffel-Keller Lübeck (Germany), all of them ordering side salads.

 

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