Six months after thousands of people in Germany were infected with shiga toxin–producing Escherichia coli O104, many still had poor psychological health, persistent fatigue, and impaired quality of life, according to a follow-up study in the November issue of Clinical Gastroenterology and Hepatology. The researchers identified risk factors that might be targeted to reduce the long-term effects of infections on mental health.
From May through July 2011, people in northern Germany experienced the largest reported outbreak of hemolytic uremic syndrome (HUC), which causes bloody diarrhea. The outbreak was caused by infection of sprouts with shiga toxin–producing E coli O104 (STEC).
Within 4 weeks of infection of 3842 individuals, 2987 developed acute gastroenteritis and 855 developed HUC; 53 patients died.
The experience of STEC infection combined with the neurological dysfunction, fear of death, and sudden dependence on help are traumatic events that are likely to cause severe psychologic distress. In a prospective study, Bernd Löwe et al. followed patients soon after infection, tracking changes in psychologic health and quality of life.
They found that 6 months after the outbreak, infected subjects that developed HUD had significantly greater levels of depression, anxiety, post-traumatic and somatic symptoms, and fatigue than the general population, along with restricted quality of life. Three percent of the patients developed post-traumatic stress disorder, 15% met criteria for major depressive disorder, and 43% had clinically relevant fatigue.
Compared with the baseline assessment, there were no significant improvements in psychologic or somatic symptoms 6 months after STEC infection, except for the physical component of health-related quality of life analyses, which had returned to normal levels.
Baseline factors associated with poor psychological health 6 months after infection were previous traumatic events, neuroticism, and low level of social support.
Löwe et al. noticed that although patients who developed HUD did not have a greater incidence of post-traumatic stress disorder or depression than patients who survived other major illnesses, those with HUD had a much higher incidence of persistent fatigue.
The authors conclude that since neuroticism and prior exposure to traumatic events increased the risk for psychopathology, fatigue, and somatic syndromes, patients at risk should be detected and treated as early as possible.
Löwe et al. propose social support can be facilitated by involving family members and other important peers in the acute treatment phase. They add that it is important to equip physicians and nurses with basic psychodiagnostic and psychotherapeutic skills. The authors are planning longer-term, follow-up studies of the outcomes of STEC infection and HUS.