Blood–cerebrospinal fluid barrier dysfunction in patients with neurological symptoms during the 2011 Northern German E. coli serotype O104:H4 outbreak

ARTICLE Sir, we read with great interest the recently published article by Magnus et al. (2012) describing the neurological symptoms in patients with a complicated Shiga toxin–producing Escherichia coli infection. This article is of great relevance owing to the large number of 104 cases with neurological sequelae out of a cohort of 217 patients of this rare disease. These 104 patients were subjected to neurological, neuroradiological, neurophysiological, CSF and neuropathological examinations. CSF analysis was performed in 10 patients due to haemolytic uremic syndrome–associated thrombocytopaenia in many others. The only CSF abnormality reported was a slight protein elevation (600–1200 mg/l) in three patients. During the outbreak of Shiga toxin–producing E. coli in 2011, we also had the opportunity to be involved in the treatment of 52 patients (Weissenborn et al. , 2012). Five female patients with severe neurological symptoms (Table 1) were subjected to CSF analysis. In contrast to the report of Magnus et al. …