Following EHEC outbreaks in Northern Germany: DGVS urges diligence in pathogen diagnostics.
29.09.2025 17:43
Following over 100 suspected cases of EHEC in Mecklenburg-Western Pomerania, public uncertainty is growing. The German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS) urges a sober assessment of the figures. The reason: With the increasing use of highly sensitive PCR diagnostics, the risk rises that clinically irrelevant findings will also be interpreted as EHEC infections. In accordance with its guidelines on gastrointestinal infections, the DGVS explicitly advises that PCR confirmation of EHEC should always be followed up with a culture.
Of the more than 100 suspected cases, the health authorities in Mecklenburg-Western Pomerania had confirmed only 50 cases of EHEC – Enterohemorrhagic Escherichia coli – through laboratory diagnostics and assigned them to the current outbreak strain as of last Thursday. Twelve of those infected, all children, developed hemolytic uremic syndrome (HUS), which can lead to severe blood clotting disorders or kidney dysfunction. "EHEC infections can manifest in very different ways – from harmless diarrhea to life-threatening complications such as HUS," explains Professor Dr. Ansgar W. Lohse, Director of the Department of Gastroenterology (with sections for Infectious Diseases and Tropical Medicine) at the University Medical Center Hamburg-Eppendorf. Children are particularly vulnerable, as the current outbreak demonstrates that they are more likely than adults to develop an EHEC-related illness. „If an EHEC infection is suspected, rapid but also careful diagnostics are required,“ said Lohse.
In light of the current case numbers, the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS) urges a critical evaluation of test results. The reason: PCR diagnostics are being used with increasing frequency. "PCR tests can detect even minute traces of bacterial genetic material – even when the pathogens are no longer alive and can no longer cause disease," explains Professor Dr. Sebastian Suerbaum, Director of the Max von Pettenkofer Institute and Professor of Medical Microbiology and Hospital Hygiene at LMU Munich. A positive result, therefore, does not automatically mean that an acute infection is actually present, the expert emphasizes.
„This can lead to the number of reported cases appearing higher than the actual number of infected individuals,“ Professor Lohse emphasizes. „Only culture allows for reliable confirmation, subtype determination, and important resistance testing. Only then can we reliably assess the course of the infection,“ adds Professor Suerbaum. This approach is also recommended by the current DGVS guideline on gastrointestinal infections.
For the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS), it is crucial to avoid unnecessary alarm and provide targeted care to patients. "In the current situation, we advise caution," says Professor Dr. Birgit Terjung, media spokesperson for the DGVS in Bonn. "PCR results should always be confirmed by a culture. This is the only way to reliably determine the actual significance of the findings, the virulence of the pathogen, and the necessary treatment."„
Further sources
- Manthey CF, Epple HJ, Keller KM, Lübbert C, Posovszky C, Ramharter M, Reuken P, Suerbaum S, Vehreschild M, Weinke T, Addo MM, Stallmach A, Lohse AW; Collaborators. S2k Guideline Gastrointestinal Infections of the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS). Z Gastroenterol. 2024 Jul;62(7):1090-1149. German. doi: 10.1055/a-2240-1428. Epub 2024 Jul 8. PMID: 38976986. Gastrointestinal infections – DGVS – German Society for Gastroenterology, Digestive and Metabolic Diseases
- News – LAGuS