Outbreak of Escherichia coli and diabetes mellitus.

Sir,

The present global public health issue on the outbreak of Escherichia coli is the world's focus. The infection started in Germany and spread widely in Europe.[1] The pathogenic E. coli infection can cause severe diarrhea as well as other more serious presentations. In some severe cases, infected with E. coli, O157: H7, renal complications such as hemolytic uremic (HUS) syndrome can be expected.

HUS is known for its relationship with diabetes mellitus. Due to pancreatic injury,[2] the increased incidence of insulin-dependent diabetes mellitus in pediatric patients infected with O157: H7 E. coli is reported.[13] It usually accompanies renal failure, which is a complication of HUS.[1-5] Suri et al. mentioned that “Survivors with diarrhea-associated HUS have a significantly increased incidence of diabetes due to complete insulin deficiency, which may recur several years after the initial infection.”[1] As a conclusion, Suri et al. proposed following up for diabetes among the affected patients during acute illness and in long term after severe infection.[4]

In addition to the copresentation with HUS, E. coli is also reported for its relationship to development of peritonitis in diabetic patients. In an animal model study, it is proved that endothelin-1 played important role in development of peritonitis, and increased plasma endothelin-1 concentrations was common in E. coli septic peritonitis.[6]

In conclusion, a certain relationship between diabetes mellitus and E. coli infection is evidenced. In the present E. coli outbreak, the importance of diabetes mellitus, as a possible comorbidity, should not be forgotten.