The news out of Germany on Saturday is mostly a mix of two or three key points: EHEC probably comes from meat, not vegetables; a May festival in Hamburg, and a restaurant in Lübeck, are the most likely venues for the first infections; and new infections seem to be decreasing. This is all encouraging.
But the news for those already infected is increasingly bad. Via Ärzte Zeitung: EHEC recommended: Early neurological therapy. Excerpt from a computer translation, with my editing:
The current wave of EHEC is special - not only because of the rare pathogen and the size of the outbreak, but also because of the neurological consequences for patients.
The German Society of Neurology (DGN) has reported that about half of patients with hemolytic-uremic syndrome (HUS) may also suffer from severe and sometimes irreversible neurological disorders.
Two Hamburg neurologists, Professor Joachim Roether and Professor Christian Gerloff, say that is is alarming that the neurological condition in spite of early plasmapheresis does not improve or even deteriorates.
Gerloff is director of neurology at the University Hospital Hamburg-Eppendorf (UKE), Roether is Chief of Neurology at the Asklepios Clinic Altona.
Espeically striking is the early appearance of neurological symptoms, says Gerloff. "It can develop simultaneously with renal and gastroenterological symptoms."
Crucial features of HUS are bloody diarrhea, hemolysis, and renal dysfunction. In the neurological symptom complex in HUS, the first are confusion, reduced vigilance, irritability and delirium. There are also many cases of aphasia and apraxia, and disturbances of the brain stem functions. In severe cases, patients develop myoclonic seizures and sometimes that can lead to coma.
The neurologists suspect the cause of these symptoms is Shiga toxin 2, which EHEC releases. In addition to the hemolytic effect, the toxin leads to a swelling of the vascular endothelium. As a result, the toxin could also lead to a widening of the intracranial vessels and a disturbance of autoregulation in the kidneys.
