Neuropsychological Outcome after Complicated Shiga Toxin–Producing Escherichia coli Infection

Abstract

BackgroundThe diarrhea associated hemolytic uremic syndrome (HUS) is a major cause of acute uremic failure in children, but not very common in adults. The enterohaemorrhagic Escherichia coli -epidemic in Germany in 2011 affected mostly young and healthy adults. While their immediate deficits have been published, not much is known about the time course and degree of recovery concerning cognitive and behavioral impairment.Methods and FindingsTwenty patients with Shiga toxin –producing Escherichia coli infection and neurological symptoms underwent comprehensive neuropsychological assessment 3 months and 1 year after the acute disease. Overall, there was an excellent recovery of cognitive functions. In a detailed neuropsychological analysis no significant deficits could be noticed 1 year after the infection in terms of cognitive function, alertness, executive functions and speech. Interestingly there were no correlations between different indicators for severity of disease (hemoglobin and creatinin levels, days of hospitalization, neurological symptoms and MRI changes) and neuropsychological outcome. However, there were a small number of patients with limitations in every day and professional life even one year after the acute disease.ConclusionsOur study does not provide definitive answers regarding risk factors for these limitations. Still since Shiga toxin –producing Escherichia coli infection is a rare condition in adults, the information this study provides is important for the clinical practice. On one hand for consulting patients and on the other to raise the awareness of the physicians to possible long term complains and the consideration of neuropsychological assessment and supportive psychological treatment.

Recovery of thalamic microstructural damage after Shiga toxin 2-associated hemolytic–uremic syndrome

“…Therefore, numerous deficits of patients with Stx2-associated HUS can be explained by its dysfunction. Consequentially, patients' relatively good neurological and neuropsychological outcome can be clarified by the thalamic recovery [11,13,14,34]. Neurological and neuropsychological impairments of our patients are however enormous in comparison to their subtle microstructural thalamic alterations.…”

Intermediate Follow-up of Pediatric Patients With Hemolytic Uremic Syndrome During the 2011 Outbreak Caused by E. coli O104:H4

“…However, additional detailed neuropsychological and neuromotor performance tests might reveal further impairment after HUS [13,31,32]. A neuropsychological analysis of adults affected during the 2011 outbreak did not show significant deficits 1 year after STEC infection [33].…”

Neurological Sequelae in Adults After E coli O104

“…A recent study that assessed 20 adult patients ∼3 months and 1 year after the acute disease, reported cognitive impairment in almost half of the patients 1 year after infection. 27 Here again fatigue, psychomotor slowing, and concentration problems were reported frequently. Of note, the neuropsychological assessment was performed at 1 year only in those patients and in those tests where results below average had been observed in the first follow-up 10 to 30 weeks after disease onset.…”