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Clinical course and the role of Shiga toxin-producing Escherichia coli infection

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. Gerber A, Karch H, Allerberger F, Verweyen HM, Zimmerhackl LB. The Journal of Infectious Diseases 2002;186(4):493-500.


This prospective multicenter surveillance study was performed to determine the prevalence of Shiga toxin-producing E. coli (STEC) in children with HUS in Germany and Austria and to evaluate the association between STEC infection and the clinical course of hemolytic uremic syndrome (HUS). During the four-year study period, 1997 through 2000, 394 cases of pediatric HUS were reported and the number of cases each year remained constant. Prodromal diarrhea was reported in 91% of cases, and 57% of those cases had bloody diarrhea. Neurological symptoms, mainly seizures and stupor, were found in 25% of patients. Hypertension during the acute phase occurred in 15% of children. Acute renal failure required dialysis in 61%, peritoneal dialysis was performed in 42%, hemodialysis in 25%; 9% also received plasmapheresis. Red blood cell transfusions were given to 75% of patients; 16% received platelet transfusions. HUS was associated with STEC infection in 83% of cases. Both O157:H7 and non-O157: H7 were found in the stool cultures of patients with HUS. Those with O157:H7 infection required a longer duration of dialysis and had bloody diarrhea more often than patients with non-O157:H7. Patients without evidence of STEC infection received dialysis for significantly less time than those with STEC infection. Blood leukocytosis was associated with increased detection of STEC in stool cultures and a more severe disease course. Risk of death was associated with cerebral involvement. This large study in children with HUS underlines the rising importance of non-O157:H7 serotypes. The present experience suggests the importance of testing for STEC in stool and serum for each child with bloody diarrhea. If there is evidence of STEC, even young children should be carefully monitored, optimally in a hospital.