Hemolytic uremic syndrome caused by Shiga toxin-producing Escherichia coli in children: incidence, risk factors, and clinical outcome.
Adolescent
Age Factors
Child
Child, Preschool
Creatinine
/ blood
Female
Hemolytic-Uremic Syndrome
/ epidemiology
Humans
Incidence
Infant
Infant, Newborn
Male
Renal Dialysis
/ statistics & numerical data
Retrospective Studies
Risk Factors
Severity of Illness Index
Shiga-Toxigenic Escherichia coli
/ isolation & purification
Hemolytic uremic syndrome
Kidney failure
Shiga toxin subtypes
Shiga toxins
Shiga toxin–producing E.coli (STEC)
Journal
Pediatric nephrology (Berlin, Germany)
ISSN: 1432-198X
Titre abrégé: Pediatr Nephrol
Pays: Germany
ID NLM: 8708728
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
11
10
2019
accepted:
30
03
2020
revised:
22
03
2020
pubmed:
24
4
2020
medline:
16
6
2021
entrez:
24
4
2020
Statut:
ppublish
Résumé
Hemolytic uremic syndrome (HUS) is a multisystemic disease. In a nationwide study, we characterized the incidence, clinical course, and prognosis of HUS caused by Shiga toxin (Stx)-producing Escherichia coli (STEC) strains with emphasis on risk factors, disease severity, and long-term outcome. The data on pediatric HUS patients from 2000 to 2016 were collected from the medical records. STEC isolates from fecal cultures of HUS and non-HUS patients were collected from the same time period and characterized by whole genome sequencing analysis. Fifty-eight out of 262 culture-positive cases developed verified (n = 58, 22%) STEC-HUS. Another 29 cases had probable STEC-HUS, the annual incidence of STEC-HUS being 0.5 per 100,000 children. Eleven different serogroups were detected, O157 being the most common (n = 37, 66%). Age under 3 years (OR 2.4), stx2 (OR 9.7), and stx2a (OR 16.6) were found to be risk factors for HUS. Fifty-five patients (63%) needed dialysis. Twenty-nine patients (33%) developed major neurological symptoms. Complete renal recovery was observed in 57 patients after a median 4.0 years of follow-up. Age under 3 years, leukocyte count over 20 × 10 Age under 3 years, stx2, and stx2a were risk factors for HUS in STEC-positive children. However, serogroup or stx types did not predict the renal outcome or major CNS symptoms.
Sections du résumé
BACKGROUND
Hemolytic uremic syndrome (HUS) is a multisystemic disease. In a nationwide study, we characterized the incidence, clinical course, and prognosis of HUS caused by Shiga toxin (Stx)-producing Escherichia coli (STEC) strains with emphasis on risk factors, disease severity, and long-term outcome.
METHODS
The data on pediatric HUS patients from 2000 to 2016 were collected from the medical records. STEC isolates from fecal cultures of HUS and non-HUS patients were collected from the same time period and characterized by whole genome sequencing analysis.
RESULTS
Fifty-eight out of 262 culture-positive cases developed verified (n = 58, 22%) STEC-HUS. Another 29 cases had probable STEC-HUS, the annual incidence of STEC-HUS being 0.5 per 100,000 children. Eleven different serogroups were detected, O157 being the most common (n = 37, 66%). Age under 3 years (OR 2.4), stx2 (OR 9.7), and stx2a (OR 16.6) were found to be risk factors for HUS. Fifty-five patients (63%) needed dialysis. Twenty-nine patients (33%) developed major neurological symptoms. Complete renal recovery was observed in 57 patients after a median 4.0 years of follow-up. Age under 3 years, leukocyte count over 20 × 10
CONCLUSIONS
Age under 3 years, stx2, and stx2a were risk factors for HUS in STEC-positive children. However, serogroup or stx types did not predict the renal outcome or major CNS symptoms.
Identifiants
pubmed: 32323005
doi: 10.1007/s00467-020-04560-0
pii: 10.1007/s00467-020-04560-0
pmc: PMC7385025
doi:
Substances chimiques
Creatinine
AYI8EX34EU
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1749-1759Références
Infect Immun. 2011 Mar;79(3):1329-37
pubmed: 21199911
Pediatr Nephrol. 2013 Nov;28(11):2097-105
pubmed: 23288350
J Infect Dis. 2002 Jan 1;185(1):74-84
pubmed: 11756984
JAMA. 2003 Sep 10;290(10):1360-70
pubmed: 12966129
BMC Infect Dis. 2015 Aug 11;15:324
pubmed: 26259588
J Pediatr. 2015 Apr;166(4):1022-9
pubmed: 25661408
J Clin Microbiol. 2007 Jun;45(6):2020-4
pubmed: 17446326
Pediatr Nephrol. 2018 Dec;33(12):2371-2381
pubmed: 30159625
BMJ Open. 2016 Jan 29;6(1):e009933
pubmed: 26826153
BMC Infect Dis. 2014 May 16;14:265
pubmed: 24884396
Epidemiol Infect. 2015 Dec;143(16):3475-87
pubmed: 25920912
Nat Rev Nephrol. 2012 Nov;8(11):658-69
pubmed: 22986362
Clin Infect Dis. 2013 May;56(10):1373-81
pubmed: 23378282
Arch Dis Child. 2001 Aug;85(2):125-31
pubmed: 11466187
J Pediatr. 1991 Feb;118(2):195-200
pubmed: 1993944
Med Mal Infect. 2018 May;48(3):167-174
pubmed: 29054297
Kidney Int. 2018 Aug;94(2):408-418
pubmed: 29907460
Emerg Infect Dis. 2016 Sep;22(9):1604-12
pubmed: 27533474
Sci Rep. 2019 Apr 4;9(1):5619
pubmed: 30948755
Pediatr Nephrol. 2008 Aug;23(8):1303-8
pubmed: 18465151
Pediatrics. 2017 Sep;140(3):
pubmed: 28827377
J Infect Dis. 1998 Apr;177(4):962-6
pubmed: 9534969
N Engl J Med. 2000 Jun 29;342(26):1930-6
pubmed: 10874060
Clin Infect Dis. 2006 Dec 15;43(12):1587-95
pubmed: 17109294
Euro Surveill. 2018 Aug;23(35):
pubmed: 30180926
Pediatr Nephrol. 2010 Sep;25(9):1693-8
pubmed: 20422224
Lancet. 2005 Mar 19-25;365(9464):1073-86
pubmed: 15781103
Arch Public Health. 2018 Aug 6;76:41
pubmed: 30128150
J Pediatric Infect Dis Soc. 2016 Jun;5(2):147-51
pubmed: 27199470
JAMA. 2002 Aug 28;288(8):996-1001
pubmed: 12190370
Epidemiol Infect. 2018 Sep 5;:1-5
pubmed: 30182864
Emerg Infect Dis. 2005 Apr;11(4):590-6
pubmed: 15829199
J Comput Biol. 2012 May;19(5):455-77
pubmed: 22506599
Eur J Pediatr. 2010 May;169(5):591-8
pubmed: 19830454
Eur J Pediatr. 2010 Jan;169(1):7-13
pubmed: 19707787
Front Cell Infect Microbiol. 2018 May 01;8:125
pubmed: 29765909
N Engl J Med. 2011 Nov 10;365(19):1763-70
pubmed: 22029753
N Engl J Med. 2011 Nov 10;365(19):1771-80
pubmed: 21696328
Clin Infect Dis. 2012 May;54(10):1413-21
pubmed: 22412065
Kidney Int. 2012 Aug;82(4):445-53
pubmed: 22622496
J Infect Dis. 2002 Aug 15;186(4):493-500
pubmed: 12195376
Am J Epidemiol. 2002 May 15;155(10):941-8
pubmed: 11994234
Foodborne Pathog Dis. 2013 May;10(5):453-60
pubmed: 23560425
Bioinformatics. 2014 Jul 15;30(14):2068-9
pubmed: 24642063
BMC Bioinformatics. 2009 Dec 15;10:421
pubmed: 20003500