In the midst of the largest outbreak of food poisoning caused by bacteria enterohemorrhagic Escherichia coli (EHEC) which Germany has never seen a group of doctors may have found a way to treat the most severe cases. The finding appears today in The New England Journal of Medicine ( NEJM ).
At least four people died in the outbreak, which was caused by the consumption of contaminated vegetables. To date, 276 patients developed hemolytic uremic syndrome (HUS). The potentially fatal syndrome characterized by destruction of red blood cells and severe kidney problems caused by the toxin of the bacteria, is the most serious complication of EHEC infection.
The article Franz Schaefer, pediatric nephrologist at the Centre and Adolescent Medicine in Heidelberg, Germany, and other doctors describe how they successfully treated three children suffering from EHEC infection SHU with a new approach. They used monoclonal antibody eculizumab, which has been on the market since 07 to treat a disease rare blood. Eculizumab inhibits part of the human immune system called the complement system, which usually destroys invading cells that were marked for destruction by other parts of the immune system.
The complement system has been involved for some time in some patients who develop HUS no EHEC infection, known as atypical HUS patients, eculizumab has been successfully used to treat them. Recent research suggests that the complement system may also be involved in cases of HUS caused by EHEC.
last fall, Schaefer saw a girl suffering from HUS due to EHEC infection. He tried the first most common treatment, the substitution of blood plasma of patients with donor plasma to rid the body of toxins. (HUS patients are usually treated with antibiotics because antibiotics can worsen symptoms by releasing Shiga toxin of bacteria in large amounts.)
When the health of the girl has not improved Schaefer tried the antibody. "We had no other option. It has serious neurological symptoms, paralysis of one side of the body, cramps, then slipped into a coma," recalls Schaefer. "But when we finally gave her the antibody has improved tremendously within 24 hours," Schaefer said. "It was not a controlled experiment, of course," he said. "But the improvements were highly suggestive of be due to the treatment. "
Schaefer was apparently not the only one with this idea. When he wrote a case report NEJM , the publishers notified that two other groups had sent similar reports at the same time. "so we wrote something together and it was accepted for publication 14 days ago," said Schaefer. A few days later, the HUS cases began to appear en masse in northern Germany.
"I could not believe it," said Schaefer. "Cases of HUS with severe neurological symptoms are very rare, but now they are everywhere." He also informed his colleagues elsewhere. "Many of them asked about the new treatment, and some patients have been treated with it. "
at the university clinic in Essen, Andreas Kribben two HUS patients treated with the antibody. "We have seven HUS patients altogether, but we use only eculizumab on two patients who do not respond to plasmapheresis," he said. Kribben wrote the original document on the use of eculizumab to treat aHUS, so he had experience with drugs. "We started treating the first patient Wednesday before the Schaefer paper output. Unfortunately, we have not seen the kind of response that Schaefer described and we know atypical HUS patients, "he said.
Jens Nürnberger, a nephrologist in Schwerin Clinic is a little skeptical about treatment. "There is no real evidence for this treatment," he said. "It might work or it might not." The cases described in Schaefer document could also be spontaneous remissions, he warns. "The other problem is that this drug is extremely expensive, costing at least € 15,000 per patient, and Medicare is not going to pay for it."
However, in cases where no other option is, doctors have reason to try the new drug anyway, Nürnberger said. "But we should really be defining groups of patients who receive the drug and groups who are not and make a kind of controlled study, "he said. "Instead, many people will be treated in this way, some will get better, some will not. Ultimately, we will not have learned anything." But he, like everyone else, always hoping that it will prove to be the right treatment at the right time
0 Komentar