About HUS and German E.coli outbreak

1. Hamburg - 1.8 million people - Germany's second largest city - founded in 88o C.E. - Hamburg is Europe's second largest port. - Hamburg has 2300 bridges, more than both Amsterdam and Venice combined - St. Pauli district is largest adult entertainment district in Europe UKE Universitätsklinikum Hamburg-Eppendorf 80 clinics and institutes organized in 15 medical centers 1396 beds 1,300 doctors and scientists 3,000 nurses and therapists 2,100 technicians and administrative personnel 3,700 medical students

2. Rolf Stahl, a 62-year-old kidney specialist, has been the head of the Third Medical Clinic and Polyclinic at the University Medical Center Hamburg-Eppendorf (UKE) for almost 18 years. "But none of us doctors has ever experienced anything quite like this," The story of the outbreak began in Stahl's clinic. When the first patient suspected of having contracted HUS was admitted there on a Wednesday evening two weeks ago (11.05) , none of the doctors had any idea what they were facing. "We weren't even thinking of EHEC at first," says Stahl, "because it normally only affects children." In adults, on the other hand, HUS can also be caused by genetic defects and autoimmune diseases, or as a side effect of cancer treatment. By the next day, however, there were suddenly seven or eight cases in the ward, and the laboratory reported that they were all infected with EHEC. Hamburg promptly notified the Robert Koch Institute. http://www.spiegel.de/international/germany/0,1518,765777-2,00.html

3. The first stool sample arrived to Helge Karch, the director of the RKI's EHEC consulting laboratory at the Münster University Hospital in western Germany on Monday (16.05) . The result was clear by Wednesday (18.05) evening: It was the extremely rare serotype O104:H4. After searching through a database for medical journals, Karch found only one article under the search term "O104:H4": a case study from Korea. On the morning (20.05) after the RKI learned of the bizarre cases in Hamburg, four members made their way to the epicenter of the outbreak, Rolf Stahl's clinic in Hamburg. They brought along the epidemiologist's tool of choice: the questionnaire. The researchers sat patiently at the bedsides of 25 female patients. Hardly any of the patients had eaten raw meat or raw milk, the causes of almost all previous EHEC outbreaks, but almost all of them had eaten uncooked vegetables. By Wednesday morning, RKI was able to present the results: Tomatoes, lettuce or cucumbers were the most likely sources of the infection. The bacteria found on two of the four cucumber samples did not match up with the type of EHEC bacteria from the stool samples of patients, "These initial results mean that our hope that we had discovered the source of the (outbreak) has unfortunately not been fulfilled,"

4. I n UKE (02.06.2011) More than 100 patients with HUS 27 children 5 pregnant women 20 are in ICU http://www.wochenblatt.de/

5. 2 June 2011 10:00hrs The HPA can confirm one new case of HUS and three new cases of bloody diarrhoea in England. All are suspected to be related to this outbreak. Three of the four new cases, including the HUS case, are in UK residents with a recent travel history to Germany and one new case is in a German national on holiday in England. This brings the total number of cases in England to seven three HUS and four bloody diarrhoea. There are no reports of any secondary infections in England. http://www.hpa.org.uk/

7. EHEC O104:H4 Shigatoxin 2 (vtx2a) : + (positive) ESBL: CTX-M-15 + (positive) Other ß-Lactamases: TEM-1 + (positive) Ampicillin R Amoxicillin/Clavulanic acid R Piperacillin/Sulbactam R Piperacillin/Tazobactam R* Cefuroxim R Cefuroxim-Axetil R Cefoxitin R Cefotaxim R Cetfazidim R Cefpodoxim R Streptomycin R Nalidixinsäure R Trimethoprim/Sulfamethoxazol R Tetracyclin R Imipenem S Meropenem S Amikacin S Gentamicin S Kanamycin S Tobramycin S Ciprofloxacin S Norfloxacin S Nitrofurantoin S Chloramphenicol S Fosfomycin S

8. Germany's national health agency said 1,534 people in the country had been infected by EHEC with 17 deaths (plus 1 in Sweden). The Robert Koch Institute said 470 people in Germany were suffering from hemolytic uremic syndrome, or HUS, a number that independent experts called unprecedented in modern medical history. HUS normally occurs in 10 percent of EHEC infections, meaning the number seen in Germany could be expected in an outbreak three times the size being currently reported. Germany typically sees a maximum of 50 to 60 annual cases of HUS, which has up to a 5 percent fatality rate according to the World Health Organization. More than 60 percent of the EHEC cases in Germany have been women - 88 percent over the age of 20 - and nearly 90 percent of the HUS cases have been women over the age of 20 . 86 percent of those sickened in the current outbreak were adults Breaking news 2.06.2011

10. Haemolytic Uraemic Syndrome Gasser Syndrome Hamburger disease (USA) Cucumber disease (DE)