title: Clinical aspects of a nationwide epidemic of severe haemolytic uremic syndrome (HUS) in children.
abstract: BACKGROUND
  Report a nationwide epidemic of Shiga toxin-producing E. coli (STEC) O103:H25 causing hemolytic uremic syndrome (D+HUS) in children.
  
  
  METHODS
  Description of clinical presentation, complications and outcome in a nationwide outbreak.
  
  
  RESULTS
  Ten children (median age 4.3 years) developed HUS during the outbreak. One of these was presumed to be a part of the outbreak without microbiological proof. Eight of the patients were oligoanuric and in need of dialysis. Median need for dialysis was 15 days; one girl did not regain renal function and received a kidney transplant. Four patients had seizures and/or reduced consciousness. Cerebral oedema and herniation caused the death of a 4-year-old boy. Two patients developed necrosis of colon with perforation and one of them developed non-autoimmune diabetes.
  
  
  CONCLUSIONS
  This outbreak of STEC was characterized by a high incidence of HUS among the infected children, and many developed severe renal disease and extrarenal complications. A likely explanation is that the O103:H25 (eae and stx2-positive) strain was highly pathogen, and we suggest that this serotype should be looked for in patients with HUS caused by STEC, especially in severe forms or outbreaks.
authors.affiliation: Department of Paediatrics, Oslo University hospital, Ulleval, 7 Oslo, Norway. lars.krogvold@medisin.uio.no
authors.forename: Lars
authors.initials: L
authors.lastname: Krogvold
authors.forename: Thore
authors.initials: T
authors.lastname: Henrichsen
authors.forename: Anna
authors.initials: A
authors.lastname: Bjerre
authors.forename: Damien
authors.initials: D
authors.lastname: Brackman
authors.forename: Henrik
authors.initials: H
authors.lastname: Dollner
authors.forename: Helga
authors.initials: H
authors.lastname: Gudmundsdottir
authors.forename: Gaute
authors.initials: G
authors.lastname: Syversen
authors.forename: Pål Aksel
authors.initials: PA
authors.lastname: Næss
authors.forename: Hans Jacob
authors.initials: HJ
authors.lastname: Bangstad
mesh_terms: D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D004927:Escherichia coli Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D006801:Humans; D007223:Infant; D008297:Male; D009664:Norway / Q000453:epidemiology; D011159:Population Surveillance; D011379:Prognosis; D054323:Shiga-Toxigenic Escherichia coli / Q000302:isolation & purification*