TY - JOUR
T1 - Hemolytic uremic syndrome caused by Shiga toxin–producing Escherichia coli in children
T2 - incidence, risk factors, and clinical outcome
AU - Ylinen, Elisa
AU - Salmenlinna, Saara
AU - Halkilahti, Jani
AU - Jahnukainen, Timo
AU - Korhonen, Linda
AU - Virkkala, Tiia
AU - Rimhanen-Finne, Ruska
AU - Nuutinen, Matti
AU - Kataja, Janne
AU - Arikoski, Pekka
AU - Linkosalo, Laura
AU - Bai, Xiangning
AU - Matussek, Andreas
AU - Jalanko, Hannu
AU - Saxén, Harri
N1 - Funding Information:
Open access funding provided by University of Helsinki including Helsinki University Central Hospital. This study was supported by the Päivikki and Sakari Sohlberg Foundation, Sigrid Juselius Foundation, the Pediatric Research Foundation, Helsinki University Central Hospital, and Scandinavian Society for Antimicrobial Chemotherapy Foundation research grants.
Publisher Copyright:
© 2020, The Author(s).
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/4/22
Y1 - 2020/4/22
N2 - 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 × 109/L, and need for dialysis were predictive factors for poor renal outcome. 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.
AB - 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 × 109/L, and need for dialysis were predictive factors for poor renal outcome. 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.
KW - Hemolytic uremic syndrome
KW - Kidney failure
KW - Shiga toxin subtypes
KW - Shiga toxins
KW - Shiga toxin–producing E.coli (STEC)
U2 - 10.1007/s00467-020-04560-0
DO - 10.1007/s00467-020-04560-0
M3 - Article
C2 - 32323005
AN - SCOPUS:85083791532
SN - 0931-041X
VL - 35
SP - 1749
EP - 1759
JO - PEDIATRIC NEPHROLOGY
JF - PEDIATRIC NEPHROLOGY
IS - 9
ER -