Clinical course and the role of shiga toxin-producing Escherichia coli infection in the hemolytic-uremic syndrome in pediatric patients, 1997-2000, in Germany and Austria: a prospective study.
Hemolytic-uremic syndrome (HUS) is mainly associated with foodborne infections by Shiga toxin-producing Escherichia coli (STEC). From January 1997 through December 2000, 394 children with HUS were evaluated in a prospective multicenter surveillance study in Germany and Austria (incidences, 0.7/100,000 and 0.4/100,000 children <15 years old, respectively). Blood leukocytosis was associated with increased detection of STEC in stool cultures (P<.01) and a more severe disease course. Risk of death was associated with cerebral involvement (P<.01). Most strikingly, non-O157:H7 STEC were detected in 43% of stool cultures of patients with HUS: O26 was detected in 15%, sorbitol-fermenting O157:H(-) in 10%, O145 in 9%, O103 in 3%, and O111 in 43%. Patients with O157:H7 serotypes required dialysis for a longer time and had bloody diarrhea detected more frequently, compared with patients with non-O157:H7 serotypes (P<.05). This large study in children with HUS underlines the rising importance of non-O157:H7 serotypes, and, despite increased public awareness, the number of patients remained unchanged.
Gerber
Angela
A
Zentrum für Kinderheilkunde und Jugendmedizin, Universität Freiburg, Freiburg, Germany.
Karch
Helge
H
Allerberger
Franz
F
Verweyen
Hege M
HM
Zimmerhackl
Lothar B
LB
D001317:Austria / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003470:Culture Media; D004926:Escherichia coli / Q000145:classification / Q000302:isolation & purification / Q000378:metabolism*; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology*; D019453:Escherichia coli O157 / Q000145:classification / Q000378:metabolism; D005243:Feces / Q000382:microbiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011446:Prospective Studies; D018571:Sentinel Surveillance; D012703:Serotyping; D022603:Shiga Toxins / Q000096:biosynthesis*
D003470:Culture Media; D022603:Shiga Toxins