Sabine Jordan

Epidemic Profile of Shiga-Toxin–Producing Escherichia coli O104:H4 Outbreak in Germany

BACKGROUND We describe an outbreak of gastroenteritis and the hemolytic-uremic syndrome caused by Shiga-toxin-producing Escherichia coli in Germany in May, June, and July, 2011. The consumption of sprouts was identified as the most likely vehicle of infection. METHODS We analyzed data from reports in Germany of Shiga-toxin-producing E. coli gastroenteritis and the hemolytic-uremic syndrome and clinical information on patients presenting to Hamburg University Medical Center (HUMC). An outbreak case was defined as a reported case of the hemolytic-uremic syndrome or of gastroenteritis in a patient infected by Shiga-toxin-producing E. coli, serogroup O104 or serogroup unknown, with an onset of disease during the period from May 1 through July 4, 2011, in Germany. RESULTS A total of 3816 cases (including 54 deaths) were reported in Germany, 845 of which (22%) involved the hemolytic-uremic syndrome. The outbreak was centered in northern Germany and peaked around May 21 to 22. Most of the patients in whom the hemolytic-uremic syndrome developed were adults (88%; median age, 42 years), and women were overrepresented (68%). The estimated median incubation period was 8 days, with a median of 5 days from the onset of diarrhea to the development of the hemolytic-uremic syndrome. Among 59 patients prospectively followed at HUMC, the hemolytic-uremic syndrome developed in 12 (20%), with no significant differences according to sex or reported initial symptoms and signs. The outbreak strain was typed as an enteroaggregative Shiga-toxin-producing E. coli O104:H4, producing extended-spectrum beta-lactamase. CONCLUSIONS In this outbreak, caused by an unusual E. coli strain, cases of the hemolytic-uremic syndrome occurred predominantly in adults, with a preponderance of cases occurring in women. The hemolytic-uremic syndrome developed in more than 20% of the identified cases.

Auffällige Zunahme des Lymphogranuloma venereum unter homosexuellen Männern in Hamburg

Nachdem in den letzten Jahren ein auffälliger Anstieg der klassischen Geschlechtskrankheiten, wie Lues und Gonorrhoe, im homosexuellen Patientenkollektiv zu beobachten war, zeigte sich im Jahr 2003 am ifi‐Institut in Hamburg erstmals eine Zunahme des seltenen Lymphogranuloma venereum. Insgesamt wurden in diesem Zeitraum vier homosexuelle Patienten mit unterschiedlichen Erscheinungsformen des Lymphogranuloma venereum identifiziert. Ein Auslandsaufenthalt lag bei keinem Patienten vor. Bei drei Patienten bestand gleichzeitig eine HIV‐Infektion. In allen Fällen konnte eine Chlamydia‐trachomatis‐Infektion mittels SDA (strand displacement amplification) in genitalen Abstrichproben oder Lymphknotenpunktat nachgewiesen werden. In 3 der 4 Fälle erfolgte eine Typisierung durch Sequenzanalyse von ompA‐PCR‐Produkten, wobei jeweils der C.‐trachomatis‐Serovar‐L2 identifiziert wurde. Weitere differentialdiagnostisch relevante genitale Infektionen wurden mit Hilfe erregerspezifischer PCR‐Analysen, bakteriologischen und serologischen Untersuchungsmethoden ausgeschlossen.

Risk Factors for Development of Hemolytic Uremic Syndrome in a Cohort of Adult Patients with STEC 0104:H4 Infection

The outbreak of Shiga toxin producing E.coli O104:H4 in northern Germany in 2011 was one of the largest worldwide and involved mainly adults. Post-diarrheal hemolytic uremic syndrome (HUS) occurred in 22% of STEC positive patients. This study’s aim was to assess risk factors for HUS in STEC-infected patients and to develop a score from routine hospital parameters to estimate patient risks for developing HUS. In a cohort analysis, adult patients with STEC infection were included in five participating hospitals in northern Germany between May and July 2011. Clinical data were obtained from questionnaires and medical records, laboratory data were extracted from hospitals’ electronic data systems. HUS was defined as thrombocytopenia, hemolytic anemia and acute renal dysfunction. Random forests and multivariate logistic regression were used to identify risk factors for HUS and develop a score using the estimated coefficients as weights. Among 259 adults with STEC infection, vomiting (OR 3.48,95%CI 1.88–6.53), visible blood in stools (OR 3.91,95%CI1.20–16.01), age above 75 years (OR 3.27, 95%CI 1.12–9.70) and elevated leukocyte counts (OR 1.20, 95%CI 1.10–1.31, per 1000 cells/mm3) were identified as independent risk factors for HUS. A score using these variables has an area under the ROC curve of 0.74 (95%CI 0.68–0.80). Vomiting, visible blood in stools, higher leukocyte counts, and higher age indicate increased risk for developing HUS. A score using these variables might help to identify high risk patients who potentially benefit from aggressive pre-emptive treatment to prevent or mitigate the devastating consequences of HUS.

Efficacy and safety of sofosbuvir-based triple therapy in hepatitis C genotype 4 infection

BACKGROUND There are only limited data on sofosbuvir-based treatment regimens in hepatitis C virus (HCV) genotype 4-infected patients. AIMS To evaluate safety and efficacy of sofosbuvir-based triple-therapy in HCV genotype 4 infection. METHODS All HCV genotype 4-infected patients who started sofosbuvir-based triple-therapy at our two centres between January and June 2014 were prospectively included (N=24) and compared to genotype 4 patients treated with peginterferon/ribavirin between January 2001 and December 2012 (N=63). RESULTS The demographics in the sofosbuvir group and the controls were comparable (males 87.5% and 82.5%; mean age 46.7±9.0 years and 42.0±9.8 years, respectively). Sustained virological response was achieved in 83.3% in the sofosbuvir group and in 47.6% of controls (P=0.003). Fatigue (P=0.007), flu-like (P=0.015), gastrointestinal (P<0.001), dermatologic (P<0.001) and psychiatric symptoms (P=0.022) were more common in the control group. CONCLUSIONS In our real-life cohort, sofosbuvir-based triple therapy confirmed its high efficacy and safety for chronic genotype 4 hepatitis C.

P0831 : Safety and efficacy of Sofosbuvir-based treatment regimens for chronic hepatitis C virus infection: A “Real-Life”, single-center experience in 117 patients

polymorphism in NS3 or NS5A, while two patients with the polymorphism experienced viral breakthrough. Except for the two patients, patients with NS5A Y93H/N or L31M showed similar viral response until 4 weeks of the therapy. The frequently reported adverse events were mild headache, fever, or elevations of ALT, g-GTP or ALP and one patient stopped the therapy because of the onset of brain infarction. There were no further serious adverse events during early course of the treatment. Conclusions: The response of HCV-RNA was favorable enough during the DCV+ASV therapy, even for women, aged patients, patients with liver cirrhosis or patients with intractable IL-28B polymorphism. However, resistance-associated polymorphism of HCV could affect treatment response, and further examination for absolute quantity of the resistance-associated polymorphism is desired to evaluate the effectiveness for the DCV+ASV treatment.