Predictors for the development of haemolytic uraemic syndrome with Escherichia coli O157:H7
Predictors for the development of haemolytic uraemic syndrome with Escherichia coli O157:H7 infections: with focus on the day of illness. Ikeda K, Ida O, Kimoto K, Takatorige T, Nakanishi N, Tatara K. Epidemiology and Infection 2000;124(3):343-349.
The association between infection with Escherichia coli O157:H7 and hemolytic uremic syndrome (HUS) has been established, but little is known about whether or which early clinical features can identify patients who are more likely to suffer severe complications. A large outbreak of E. coli O157 infections via school lunches occurred at primary schools in 1996 in Sakai, Osaka, Japan. As many as 10,000 patients suffered from diarrhea, hemorrhagic colitis and HUS. Using data on 288 inpatient school-age children with E. coli O157, of whom 36 presented with complete HUS and the remaining 252 were non-HUS patients, the authors examined the predictors for progression to HUS. Within the first five days of illness, clinical features associated with inpatients who developed HUS compared with those without HUS included a C reactive protein (CRP) level higher than 1.2 mg/dl, a white blood cell (WBC) count greater than 11.0 x 10(9)/1, and a temperature higher than 38.0 degrees Centigrade. The results suggest that these three factors may be predictive for the development of HUS in patients with E. coli O157 infection, and patients who have two or all of these factors should be observed closely for five to 13 days after the onset of illness.