Hemolytic uremic syndrome and death in persons with Escherichia coli O157:H7 infection, foodborne diseases active surveillance network sites, 2000-2006.
BACKGROUND
Hemolytic uremic syndrome (HUS) is a life-threatening illness usually caused by infection with Shiga toxin-producing Escherichia coli O157 (STEC O157). We evaluated the age-specific rate of HUS and death among persons with STEC O157 infection and the risk factors associated with developing HUS.


METHODS
STEC O157 infections and HUS cases were reported from 8 sites participating in the Foodborne Diseases Active Surveillance Network during 2000-2006. For each case of STEC O157 infection and HUS, demographic and clinical outcomes were reported. The proportion of STEC O157 infections resulting in HUS was determined.


RESULTS
A total of 3464 STEC O157 infections were ascertained; 218 persons (6.3%) developed HUS. The highest proportion of HUS cases (15.3%) occurred among children aged <5 years. Death occurred in 0.6% of all patients with STEC O157 infection and in 4.6% of those with HUS. With or without HUS, persons aged 60 years had the highest rate of death due to STEC O157 infection. Twelve (3.1%) of 390 persons aged 60 years died, including 5 (33.3%) of 15 persons with HUS and 7 (1.9%) of 375 without. Among children aged <5 years, death occurred in 4 (3.0%) of those with HUS and 2 (0.3%) of those without.


CONCLUSIONS
Young children and females had an increased risk of HUS after STEC O157 infection. With or without HUS, elderly persons had the highest proportion of deaths associated with STEC O157 infection. These data support recommendations for aggressive supportive care of young children and the elderly early during illness due to STEC O157.
Gould
L Hannah
LH
Enteric Diseases Epidemiology Branch, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. lgould@cdc.gov
Demma
Linda
L
Jones
Timothy F
TF
Hurd
Sharon
S
Vugia
Duc J
DJ
Smith
Kirk
K
Shiferaw
Beletshachew
B
Segler
Suzanne
S
Palmer
Amanda
A
Zansky
Shelley
S
Griffin
Patricia M
PM
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003643:Death; D004926:Escherichia coli; D004927:Escherichia coli Infections; D019453:Escherichia coli O157 / Q000302:isolation & purification*; D005260:Female; D005517:Foodborne Diseases; D006463:Hemolytic-Uremic Syndrome; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D055815:Young Adult