Context An outbreak of Shiga toxin-producing enteroaggregative Escherichia coli (STEC O104:H4) infection with a high incidence of hemolytic uremic syndrome (HUS) occurred in Germany in May 2011. Antibiotic treatment of STEC infection is discouraged because it might increase the risk of HUS development. However, antibiotic therapy is widely used to treat enteroaggregative E coli infection. In the German outbreak, a substantial number of patients received prophylactic azithromycin treatment as part of a therapeutic regimen with the C5 antibody eculizumab.Objective To analyze the duration of bacterial shedding in patients with STEC infection who did and did not receive oral azithromycin therapy.Design, Setting, and Patients At a single center in Lü beck, Germany, 65 patients with STEC infection, including patients with HUS as well as STEC-infected outpatients without manifestation of HUS, were investigated between May 15 and July 26, 2011, and were monitored for a mean of 39.3 days after onset of clinical symptoms. Main Outcome Measure Carriage of STEC after azithromycin therapy.Results Twenty-two patients received oral azithromycin and 43 patients did not receive antibiotic treatment. Among antibiotic-treated patients, long-term STEC carriage (Ͼ28 days) was observed in 1 of 22 patients (4.5%; 95% CI, 0%-13.3%) compared with 35 of 43 patients (81.4%; 95% CI, 69.8%-93.0%) who were not treated with antibiotics (PϽ.001). All 22 patients receiving azithromycin treatment had at least 3 STECnegative stool specimens after the completion of treatment, and no recurrence of STEC was observed in these patients. As proof of principle, 15 patients who initially were not treated with antibiotics and were long-term STEC carriers were treated with oral azithromycin given for 3 days and subsequently had negative stool specimens. ConclusionTreatment with azithromycin was associated with a lower frequency of long-term STEC O104:H4 carriage.

In 2011, a large outbreak caused by a Shiga toxin producing E. coli (STEC) occurred in Northern Germany, with a satellite outbreak in Western France, including the highest number of hemolytic uremic syndrome (HUS) cases ever encountered during a STEC outbreak. The outbreak strain was characterized as an enteroaggregative E. coli of serotype O104:H4 expressing a phage-encoded Shiga toxin 2. The majority of STEC infections and HUS cases were observed in adults, with a preponderance of the female gender. The outbreak imposed huge challenges on clinicians, microbiologists, and epidemiologists but also provided important new insight for the understanding of STEC infection. Thus, novel therapeutic strategies in the treatment of HUS in adults and for decolonization of long-term STEC carriers were evaluated. This review highlights the unusual features of the recent O104:H4 outbreak and focuses on emerging new strategies in diagnostics and treatment of acute STEC-related disease, as well as STEC long-term carriage.

With newly rising coronavirus disease 2019 (COVID-19) cases, important data gaps remain on (i) long-term dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates in fixed cohorts (ii) identification of risk factors, and (iii) establishment of effective surveillance strategies. By polymerase chain reaction and antibody testing of 1% of the local population and >90,000 app-based datasets, the present study surveilled a catchment area of 300,000 inhabitants from March 2020 to February 2021. Cohort (56% female; mean age, 45.6 years) retention was 75 to 98%. Increased risk for seropositivity was detected in several high-exposure groups, especially nurses. Unreported infections dropped from 92 to 29% during the study. “Contact to COVID-19–affected” was the strongest risk factor, whereas public transportation, having children in school, or tourism did not affect infection rates. With the first SARS-CoV-2 cohort study, we provide a transferable model for effective surveillance, enabling monitoring of reinfection rates and increased preparedness for future pandemics.

Amphibians vary in the degree of pre-metamorphic developmental plasticity in response to risk of predation. Changes in hatching time and development rate can increase egg or tadpole survival respectively by shortening the duration of the more vulnerable stages. The intensity of predator induced developmental response and its direction, i.e. delayed, accelerated, or none, varies considerably between amphibian and predator species. We surveyed freshly deposited clutches of the European common frog Rana temporaria in a population in Braunschweig, Germany and found that 62% (N = 20) of the clutches contained planarians (Schmidtea nova), with an average of 3.94 ± 0.79 and a maximum of 13 planarians per clutch. A laboratory predation experiment confirmed that this planaria preys on R. temporaria eggs and early embryos. We further exposed freshly laid egg masses to either free, caged, or no planarians treatments using floating containers within a breeding pond where the two species co-occur. After 10 days exposure, embryos showed developmental stages 14-25 along the Gosner scale with statistically significant positive effects of both predator treatments. The observed effect was rather slight as predator-exposed individuals showed an increase by a single Gosner stage relative to those raised without planarians. The detected trend suggests that direct and indirect cues from flatworms, rarely considered as anuran predators, might induce a developmental response in R. temporaria early developmental stages.