EHEC Infection: Causes, Symptoms & Treatment

EHEC infection, which has also been referred to in the media as EHEC plague, is a bacterial gastrointestinal disease (not a virus! ) that seems symptomatically similar to a common stomach flu or diarrhea with vomiting. However, unlike the stomach flu, it is extremely dangerous and should be examined and treated by a physician as soon as possible. Because of its high risk of infection, it is notifiable in Germany.

What is an EHEC infection?

Enterohemorrhagic Escherichia coli (EHEC) are certain disease-causing strains of the intestinal bacterium Escherichia coli. Click to enlarge. EHEC is an abbreviation for a disease-causing bacterial species that is derived from Escherichia coli, which is necessary for human digestion and is known as enterohemorrhagic Escherichia coli. The disease or infection caused by ingestion of the bacterial strain is a complex of diseases that primarily affect the intestines of humans. In the further untreated course, a so-called hemorrhagic-uremic syndrome can occur, especially in very weakened people, which is a life-threatening disease and in most cases leaves permanent consequential damage throughout life. The EHEC intestinal infection is a hemorrgic diarrhea (diarrhea), which is associated with the appearance of diarrhea mixed with blood. As a colon disease, infection with EHCE represents bacterial enteritis, a disease caused by bacteria.

Causes

The causes of infection with EHEC, which until very recently was known as a traveler’s disease, are poor hygiene, a frequently already weakened immune system predominantly in children and the elderly, contaminated food, and contact with sick farm animals. In addition to sheep, goats and chickens, these are all farm animals that are possible carriers of the disease due to contamination with feces and corresponding excretions. The pathogens can be contained in foodstuffs that are not sufficiently cooked and smoked or are consumed raw. In this context, raw and insufficiently heated milk is the most important source. Skin contact with diseased animals also transmits the EHEC bacteria. Plants wetted with the dung of diseased animals as food and infected water come into question as transmitters, as it were.

Symptoms, complaints, and signs

This infection is a very dangerous infection that must be examined and treated by a physician in every case. If left untreated, EHEC infection can lead to the death of the affected person or significantly reduce the patient’s life expectancy. As a rule, the symptoms of the EHEC infection are very similar to the symptoms of a common gastrointestinal flu. The affected person suffers from bloody stools and very severe diarrhea. The diarrhea often cannot be stopped by medication. Vomiting and permanent nausea may also occur. Most patients also suffer from fever, the EHEC infection is often confused with the stomach flu, so that no early treatment occurs. Similarly, the infection can lead to severe pain and cramps in the abdomen, generally having a very negative impact on the quality of life and daily routine of the affected person. Furthermore, the EHEC infection can spread further and affect the internal organs, causing inflammation of the pancreas in particular. In the worst case, the affected person dies as a result of organ failure. The life expectancy of the affected person is usually limited by the EHEC infection only if it is not treated.

Course

The course of EHEC infection is characterized by initial symptoms resembling an intestinal inflammation or gastroenteritis. Those affected complain of malaise and nausea, nausea and persistent vomiting, and watery diarrhea after about 1 to 8 days of infection and incubation. In addition, fever and abdominal cramps occur due to colitis. As the diarrhea progresses, it contains more or less large amounts of blood due to the destruction of the red blood cells (hemolysis) and the impaired clotting ability of the blood. In the absence of immediate and effective therapy, five to ten percent of patients are affected by a hemolytic uremic syndrome.This means that the function of the kidneys is restricted. This in turn leads to reduced excretion of toxic metabolic waste products and possibly to damage to the brain. Infection with EHEC equally affects the pancreas, so that patients suffer from acute pancreatitis.

Complications

Normally, an infection with EHEC heals without further consequences if treated properly. In a few cases, however, complications can develop, some of them life-threatening. Children are particularly affected. One possible complication is bleeding inflammation of the intestine. The vomiting diarrhea that typically occurs in EHEC infected persons can lead to extreme fluid losses. This can be a great danger, especially for infants and small children. The so-called hemolytic uremic syndrome, or HUS for short, is particularly dangerous. This complication occurs in about five to ten percent of those infected with EHEC. About half of the children who develop this syndrome suffer permanent damage to the kidneys. The result is dialysis treatment that is necessary for a short time, and in rare cases for life. Approximately forty percent of those affected by HUS syndrome develop chronic kidney weakness and/or hypertension within ten to fifteen years of the onset of the disease. This eventually leads to other serious consequences. Hemolytic uremic syndrome is fatal in about four percent of affected patients. Another problem is that infected persons, especially children, continue to excrete the EHEC pathogen for several weeks to months after contracting the disease. This in turn can lead to infection of third parties.

When should you go to the doctor?

If the typical symptoms – including nausea, abdominal pain, vomiting and watery, bloody diarrhea – are detected, there is possibly an EHEC infection. A doctor must clarify whether it is indeed the infectious intestinal disease and, if necessary, take further measures. If the disease remains untreated, further complications such as anemia or even kidney failure may develop. Immediate medical treatment is then required at the latest. In acute emergencies or with pronounced symptoms, the hospital should be visited or the emergency doctor called. This is especially true if the symptoms are due to a possible infection. Thus, people who experience symptoms mentioned after eating raw or unwashed food should consult the doctor immediately. Anyone who feels unwell after swimming in contaminated waters or even shows pronounced symptoms of an EHEC infection should also have this clarified immediately. Medical clarification is necessary simply because of the acute risk of infection. In case of early self-diagnosis, the EHEC infection can be treated by a general practitioner. Other contacts are the gastroenterologist or a specialist in internal medicine.

Treatment and therapy

Treatment of EHEC infection requires immediate intervention and extensive diagnostic testing. In addition, high-dose antibiotics such as trimetoprim-sulfamethoxazole and other belgeit drugs are the mainstay of treatment, but this is controversial because of the side effects that occur during the acute phase of illness. Patients are treated with diuresis and dialysis to prevent cessation of renal function. In addition, therapeutic measures to prevent shock due to the destruction of erythrocytes and reduced blood flow, as well as the supply of fluids and vital electrolytes and various minerals, are of great importance. This is important to replenish the losses of fluid due to the prolonged intense diarrhea and thus stabilize the circulation. Basically, it is so that with the current medical possibilities a causal treatment is not feasible. Only the symptoms of the disease itself can be treated and preventive measures can be used. An infection mt EHEC is reportable and requires inpatient monitoring and treatment in any case.

Outlook and prognosis

Although an EHEC infection is often very severe, there are nevertheless very good prospects of cure. Thus, the disease usually heals without consequences. Some EHEC infections even proceed without symptoms. After the symptoms have subsided, many patients remain carriers of the EHEC pathogen for several weeks.However, complications can also occur, leading to long-term health problems. Major complications include hemolytic uremic syndrome (HUS) and bleeding intestinal inflammation. In addition, the body suffers fluid and electrolyte loss from the severe diarrhea. The loss of fluids can lead to dehydration (exsiccosis) of the organism. Due to these complications, there are also isolated cases of fatal EHEC infections. This is the case in about one to two percent of those affected. Chronic kidney damage often occurs as part of the hemolytic uremic syndrome, which can even lead to fatal kidney failure in two to three percent of cases. However, a large number of affected patients are dependent on dialysis for a time or even for life. In particularly severe cases, however, a kidney transplant may be necessary. Children in particular develop severe kidney damage in up to 50 percent of cases following HUS caused by EHEC infection. They are then permanently dependent on dialysis. After another ten to fifteen years, high blood pressure in turn occurs in 40 percent of patients suffering from HUS.

Prevention

Currently, physicians are researching a successful treatment therapy for EHEC infection. Until suitable drugs and treatment options appear, the following preventive measures should be observed by everyone. First, all fresh vegetables should be washed well with water and cleaned thoroughly. In addition, it is advisable to behave hygienically in general when handling food. This includes regular hand washing and cleanliness in the kitchen. Also pots, cutting boards and other kitchen utensils should be kept very clean. Furthermore, the vegetables or fruits should be boiled so that the germs are killed by the heat. The same applies to meat and dairy dishes.

Aftercare

Many people probably still remember the massive wave of EHEC infections in 2011. Many German patients were dramatically ill at that time. Treatment proved as difficult as follow-up care because the source of the infection was not identified. All suspicions could never be conclusively proven. Blood tests and functional tests of the kidneys are standard practice. But doctors still have to improvise to this day. A not insignificant number of those affected are still suffering from the consequences of the Ehec infection. Many of those affected have had to return to the clinic several times for follow-up examinations. They were given Eculizumab without knowing whether it was actually helping. Some people affected by the EHEC infection developed hemolytic uremic syndrome. This could result in damaged kidneys and brain damage. Other patients suffer from EHEC infections with a different type of pathogen. They remain patients with kidney problems and hypertension. Follow-up of both disorders requires lifelong monitoring and medication. If necessary, dialysis may be required after EHEC infection. It is also precarious that the EGEC virus can sometimes be detected again, even if the blood had already shown no pathogen several times in succession. This makes follow-up care more difficult. Some patients had to undergo follow-up care for six months after an EHEC infection, others sometimes for longer. The aftercare measures depend on the damage left behind and the respective symptoms.

What you can do yourself

Dealing with EHEC is difficult when severe complications have occurred. The option for self-help depends on the severity of the illness and therefore varies from case to case. If diarrhea is mild, affected individuals can compensate for the loss of fluids and salt by drinking enough fluids. If the stool is bloody or purulent, there is no self-help option, and a visit to the doctor is advised. If a hemolytic-uremic syndrome has developed, only intensive care will help. As far as possible, self-help is considered only for combating the symptoms, but not for combating the pathogen. Teas made from certain dried fruits contain tannins that counteract inflammation in the intestinal mucosa. Over-the-counter charcoal tablets are also helpful, but only if the patient does not need to take medications whose effects must not be reduced. If the appetite comes back, a light build-up diet is helpful. The patient should eat the food in small bites or sips and in peace. And allow himself to rest.In any case, the emotional support and assistance of family members are reassuring and can speed the healing process.