ドイツの電脳冊子のSPIEGEL:ONLINEの病原性大腸菌(EHEC)の記事

ドイツの電脳冊子のSPIEGEL:ONLINEの病原性大腸菌(EHEC)の記事

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EHEC therapeutic traials: Full risk agaist destroyers
SPIEGEL ONLINE - 10/06/2011
Why is the rampat EHEC germ so aggressive? The worst Symptoms of HUS's disease have surprised doctors. At some hospitals, they test new therapies. this is risky - but often the last hope fpr those affcted.

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Why the rampant Ehec germ is so aggressive? The worst symptoms of Hus's disease have surprised doctors. At some hospitals, they test new therapies. This is risky - but often the last hope for those affected. 
Speech disorders, epilepsy, Seizure: The Ehec germ that is currently raging in northern Germany and provides for severe disease, has a nasty surprise doctors. Although they are familiar with the annual Ehec outbreaks that occur mainly in the warm summer months, because then the germs can easily multiply. This epidemic, however, is different.

DISPLAY The germ, the enterohemorrhagic Escherichia coli bacterium, subtype O104: H4, is particularly aggressive. "We have observed unexpected disease processes, we have never met before," says Hendrik Lehnert, director of the Medical Clinic I, University Hospital Schleswig-Holstein (UKSH) in Lübeck.
The outbreak is still unknown, despite numerous evidence against an organic farm in Lower Saxony and findings of EHEC pathogens in organic waste Magdeburg. Of the 2648 currently the Robert Koch Institute (RKI) reported Ehec infected it has taken 689 more difficult. They suffer from hemolytic-uremic syndrome (HUS).
Also, this is actually known to the physicians. RKI 2009 counted the 65-Hus cases, two boys aged five and seven years died. This time, adult women are most often affected by Hus, that's one of the surprises for the doctors.
The other is of particular concern: At several hospitals, the doctors report severe neurological complications, many of whom suffer unusually Hus patients. They are confused, no longer find the right words. Some suffer from epileptic seizures, have temporary paralysis or seizures - the range of neurological consequences is great.
Confusion over new strain Ehec
The doctors are stumped. They still have not understood exactly what makes this pathogen Ehec so aggressive and destructive cascades which occur in the body of an infected person. Now doctors at the University Clinics of Greifswald and Bonn, a theory that could explain at least part of that heavy gradients. Thus, it can happen during a Ehec infection that the body develops antibodies against its own tissue structures. These so-called autoantibodies might as well as the Shiga toxin - a poison, which produce the Ehec bacteria - causing damage to the nervous system.
"The severe neurological damage, six to eight days after the first symptoms of EHEC infection. This is a typical time window for the formation of antibodies.'s Why we came up with the idea that autoantibodies could be responsible," says transfusion medicine Andreas Greinacher of the University of Greifswald. Together with colleagues he studied at the Research trigger ZIK Hike the causes of immune diseases, cardiovascular diseases. "We have four Hus patients with marked neurological problems discovered evidence that an autoantibody and to a disordered coagulation factor," says Greinacher.
Why do so is misguided in certain patients Ehec the immune system, doctors do not know. On the one hand, grab those produced by the bacteria Ehec toxins from blood cells. These will be destroyed, cellular debris are deposited in small blood vessels, so that in particular the kidneys, but also the brain damage. On the other hand, the theory of Greinacher and colleagues causes of autoantibodies that is broken down in the cells of the brain and adrenal one responsible for blood clotting protein called von Willebrand factor, not in the normal way into small pieces. This then accumulates and clogs up the capillaries, so the smallest vessels. This would then lead to serious illnesses, so Greinacher.
Some medical tests give hope
The transfusion medicine, and colleagues at the University Clinic in Bonn have therefore started an experimental treatment attempt, four of the seriously ill patients they have treated Hus with a special blood cleansing in which the autoantibodies are filtered from the blood. "After treatment, the laboratory values ​​improved within one day and then also the condition of patients," says Greinacher.
During the presentation of new medical therapies is acting with caution - and four patients are a very small group. But Greinacher gives reasons to make their results public now. "We have decided to present the results of this experiment is now healing, because patients with severe neurological problems Hus and now need therapy."
IN QUESTION, of course it is a healing attempt restricts Greinacher. "We do not know every detail of what happened, for instance, exactly opposite what the body's own structure, the antibody is directed, we simply did not have the time to explore the -. Such trials would take months to complete." But the treatment could be tested immediately at other clinics.
So far, doctors try to patients, in which the HU's syndrome is particularly advanced, and whose blood counts fall below certain values, to help with plasmapheresis. This is also a special type of blood filtration, with which the blood can be cleansed of the dangerous toxin. But also to study the situation is thin. Which patients plasmapheresis actually helps doctors can not say exactly.
At the University Hospital Hamburg-Eppendorf (UKE) and some other hospitals, doctors in particularly severe cases Hus also hopes for an experimental therapy to treat the victims with an antibody called eculizumab. The agent has been authorized since 2007, and is usually used to treat a rare blood disease and a rare hereditary form of Hus. According to initial estimates of the doctors of medicine seems to attempt to run successfully. How successful he is, in fact, will probably show but only in a few weeks. The kidney specialist type carefully: "There is no cure at this time, the patient suddenly makes all healthy," said Hermann Haller, Hannover Medical School (MHH).
Last chance
The condition of some ill patients is so poor that they agree to fight for their lives such therapy trials unconditionally. "I would be comfortable with any kind of treatment have been agreed, if only something would have improved," said a 41-year-old woman who was a week long stationed with severe abdominal cramps and bloody diarrhea in the Asklepios Clinic Altona. Friedrichshagen Mueller, Medical Director, had suggested to her that she should be treated with an antibiotic. "I was glad to hear of this possibility. Even the speech struck me so hard," said the patient.

display antibiotics but can be avoided in the treatment of EHEC infection is usually because they can increase the production of dangerous toxins - and this can lead to dangerous complications. But the doctors are assuming that you can avoid them if we have enough with the antibiotics begins. The idea: As long as only relatively few bacteria in the body, they can kill with an antibiotic before it comes to increased toxin secretion.
Stephen Smith, a microbiologist at Trinity College in Dublin, takes a similar, not all antibiotics have the same effect and would accelerate the production of shigatoxins. "We are dealing with a new strain, which is why we need new therapies." The problem: (subtype O104: H4) The current Ehec Husec041 pathogen is a hybrid of two different E. coli strains, and it is resistant to a range of antibiotics.
But in fact the patient's condition improved in the Asklepios Clinic for a week, that they did not develop HU syndrome, now the 41-year-old housewife, is back home. The clinic has begun to treat any new serious cases with antibiotics. A total of six patients have received since the start of the outbreak of the drug. Although the number of treated patients is too small to draw clear conclusions and claim that antibiotics could prevent the HU's syndrome. For five of the patients was to attempt a blessing - for all the state is improving.