Biology Reference
In-Depth Information
Treatment
Like other STEC strains, the use of antibiotics is not recommended because there
is no evidence that antibiotics improve the course of disease, and it is thought that
treatment with some antibiotics may precipitate kidney complications because of
increased toxin expression. Because no causal therapy for HUS exists, and pooled
analysis of previous data showed no benefit of antibiotics, alternative treatments
have been utilized or developed. In this outbreak, novel strategies for treating
patients with HUS were applied (i.e. antibody treatment with eculizumab, a
monoclonal antibody inhibiting the terminal complement cascade, was associ-
ated with resolution of the severe neurological symptoms of three children with
HUS) ( Lapeyraque et al., 2011 ). Despite the fact that potential benefit in STEC-
associated HUS has not been proven, therapeutic plasma exchange was used
extensively on the basis of uncontrolled reports ( Dundas et al., 1999 ).
Another approach for a prospective treatment was developed thanks to the pub-
lic availability of the genome sequence of E. coli O104:H4, allowing the identi-
fication of the bacteriophage tail spike protein responsible for specific O-antigen
binding encoded in the genome. The gene was fused to the tail fiber gene of an
R-type pyocin, a phage tail-like bacteriocin. Upon binding to a receptor on the target
bacterium, R-type pyocin are able to form a channel across the bacterial envelope
and produce cell death. The novel bacteriocin containing the fusion to the phage
tail fiber fusion from O104:H4 has bactericidal activity specifically against E. coli
strains that produce the O104 lipopolysaccharide antigen ( Scholl et al., 2012 ).
Immune response
No information is currently available regarding the protective host mechanisms,
including immune response, and the role of commensal microbiota during E. coli
O104:H4 infection. However, while searching for a therapeutic alternative treatment
(especially for the neurological signs), the characteristic timespan between onset of
gastroenteritis and the neurological complications (5-12 days) was a key clinical
finding, because it indicated that additional auto-antibodies might be involved in the
pathogenesis of the severe neurological complications ( Lapeyraque et al., 2011 ).
The intravascular reduction of these auto-antibodies by immunoabsorption should
be considered one possible reason for the success of this therapy with regard to the
neurological complications of HUS patients ( Lapeyraque et al., 2011 ).
Control and prevention
Recommendations from the World Health Organization during the outbreak
indicated that regular hand-washing, particularly before food preparation or
consumption and after toilet contact, is highly recommended. These recommen-
dations are particularly important for people who care for small children or are
immunocompromised, as the bacterium could be passed from person to person,
as well as through food and water.
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