Psychiatric Symptoms in Patients with Shiga Toxin- Producing E. coli O104:H4 Induced Haemolytic-Uraemic Syndrome

Background: In May 2011 an outbreak of Shiga toxin-producing enterohaemorrhagic E. coli (STEC) O104:H4 in Northern Germany led to a high number of in-patients, suffering from post-enteritis haemolytic-uraemic syndrome (HUS) and often severe affection of the central nervous system. To our knowledge so far only neurological manifestations have been described systematically in literature. Aim: To examine psychiatric symptoms over time and search for specific symptom clusters in affected patients. Methods: 31 in-patients suffering from E. coli O104:H4 associated HUS, were examined and followed up a week during the acute hospital stay. Psychopathology was assessed by clinical interview based on the AMDP Scale, the Brief Symptom Inventory and the Clinical Global Impressions Scale. Results: At baseline mental disorder due to known physiological condition (ICD-10 F06.8) was present in 58 % of the examined patients. Patients suffered from various manifestations of cognitive impairment (n = 27) and hallucinations (n = 4). Disturbances of affect (n = 28) included severe panic attacks (n = 9). Psychiatric disorder was significantly associated with higher age (p,0.0001), higher levels of C-reactive protein (p,0.05), and positive family history of heart disease (p,0.05). Even within the acute hospital stay with a median follow up of 7 days, symptoms improved markedly over time (p,0.0001). Conclusions: Aside from severe neurological symptoms the pathology in E.coli O104:H4 associated HUS frequently include