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BioMed Research International
Volume 2015, Article ID 480680, 8 pages
Research Article

Management of Food-Related Diarrhea Outbreak in the Emergency Department: Lessons Learned from the German STEC O104:H4 Epidemic

1Department of Internal Medicine II/Emergency Department, University Hospital of Schleswig-Holstein, Campus Lübeck, 23560 Lübeck, Germany
2Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Campus Lübeck, 23560 Lübeck, Germany
3Institute for Clinical Epidemiology, University of Lübeck, 23560 Lübeck, Germany
4Emergency Department, Sana-Kliniken, 23560 Lübeck, Germany
5Institute of Medical Microbiology and Hygiene, University Hospital of Schleswig-Holstein, Campus Lübeck, 23560 Lübeck, Germany

Received 31 January 2015; Accepted 22 June 2015

Academic Editor: Miguel Prieto

Copyright © 2015 Friedhelm Sayk et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Emergency department (ED) management of the German STEC O104:H4 outbreak in 2011 was not limited to patients being truly infected with STEC. In parallel to spread of alarming news in public media, patients suffering from diarrhea due to other reasons fearfully presented, equally. We retrospectively characterized these two cohorts for anamnestic, clinical, and laboratory findings at their first ED contact. From 15th of May to July 2011, 302 adult patients with diarrheal complaint presented at the EDs of two tertiary hospitals in Lubeck, northern Germany. Fecal testing for STEC was obtained in 245 (81%) patients: 105 were STEC-positive and 140 were STEC-negative. Anamnestic characteristics (defecation rate, visible bloody diarrhea, and lower abdominal pain), abdominal tenderness, and some laboratory findings were significantly different between both cohorts but not reliable to exclude STEC. In >90% of STEC-positive patients diarrheal symptoms had started in May, reflecting the retrospective nationwide peak of infections, whereas the majority of STEC-negative patients became symptomatic in June 2011. During the German STEC O104:H4 outbreak a definite distinction at initial ED contact between STEC-positive versus STEC-negative patients by clinical judgment alone was not reliable. Fecal testing in the ED, however, might survey the outbreak of foodborne infections with the utmost precision.