Infallible clinical images

EHEC diagnosis using typical intestinal mucosa characteristics

The scare caused by the Europe wide EHEC epidemic has passed its peak. After two months’ intensive investigations it has been confirmed that the causative agent came from Egypt. But there is no guarantee that future infections won’t take place, despite the fact that the rate of new diagnoses is dropping fast. An aggressive strain of bacteria has broken out in Germany and it remains dangerous. Swift, reliable diagnosis can save lives when a disease breaks out. Employees at Erlangen University Hospital’s Medical Clinic 1 working with experts from Augsburg, Bayreuth and Graz have characterised the new EHEC pathogen O104:H4 using endoscopy and at the cellular level for the first time. The intestinal mucosa itself provides information about how it appears to doctors.

“EHEC infections are accompanied by a range of relatively typical intestinal mucosa characteristics,” explains Prof. Dr. Helmut Neumann from Medical Clinic 1. He said these included, “severely inflamed mucosa with dotted haemorrhages and evident swelling.” The swelling develops in the digestive organ’s cavity (lumen) and can lead to a stenosis, a dangerous narrowing of the intestinal mucosa. The mucosa displays superficial lesions, according to Prof. Neumann, who also holds the W1 Professorship for Molecular Endoscopy at Friedrich-Alexander University Erlangen Nuremberg. Thrombi in many of the tiny capillaries in the intestinal mucosa prevent haemorrhages. The grave clinical images of one patient from Augsburg led doctors to conclude that his condition had to be a case of infection with this new EHEC pathogen. Further diagnostic procedures and, in particular, appropriate treatment depended on this diagnosis being correct.

Endoscopic and cellular (histological) examinations confirmed this. For histological support, the Diako City Clinic in Augsburg turned to the Pathological Institute at Bayreuth Hospital. Pathology at Graz University confirmed the EHEC diagnosis. All of the information came together at Erlangen University Hospital, recognised for its scientists’ expertise in the differential diagnosis of gastro intestinal diseases. The results were collated at the clinic and prepared for first publication in the internationally renowned medical journal Endoscopy in order to provide colleagues around the globe with insight and a basis to offer even more effective diagnosis and treatment. In addition to Prof. Neumann, the authors included Prof. Markus F. Neurath (Erlangen), PD Dr. Michael Vieth (Bayreuth), PD Dr. Cord Langner (Graz) and Dr. Martin Hunstiger (Augsburg). Medical cooperation and communication between these four cities, in two separate countries, had already proven effective in the past. Because of this issue’s explosive and topical nature, Endoscopy’s editors brought forward the publication date for the first article on the subject. Having caused more than 4,000 infections and 49 fatalities, the European EHEC epidemic was one of the most serious ever seen in the world.

As regards new diagnostic methods, Erlangen specialists are continuing to take great strides forward for internal medicine. Prof. Neumann described some of the efforts being made in his specialist area of research: in the future it should be possible to identify pathogens hidden in the organs during the endoscopy. This will considerably accelerate diagnosis and treatment. Tissue samples and complex microbiological examination methods would then no longer be required, saving valuable time and sparing patients from additional interventions.

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uni | press service | research No. 35/2011 on 14.07.2011