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Open Access 01-09-2020 | Escherichia Coli | Original Article

Hemolytic uremic syndrome caused by Shiga toxin–producing Escherichia coli in children: incidence, risk factors, and clinical outcome

Authors: Elisa Ylinen, Saara Salmenlinna, Jani Halkilahti, Timo Jahnukainen, Linda Korhonen, Tiia Virkkala, Ruska Rimhanen-Finne, Matti Nuutinen, Janne Kataja, Pekka Arikoski, Laura Linkosalo, Xiangning Bai, Andreas Matussek, Hannu Jalanko, Harri Saxén

Published in: Pediatric Nephrology | Issue 9/2020

Abstract

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.

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Title: Hemolytic uremic syndrome caused by Shiga toxin–producing Escherichia coli in children: incidence, risk factors, and clinical outcome
Authors: Elisa Ylinen
Saara Salmenlinna
Jani Halkilahti
Timo Jahnukainen
Linda Korhonen
Tiia Virkkala
Ruska Rimhanen-Finne
Matti Nuutinen
Janne Kataja
Pekka Arikoski
Laura Linkosalo
Xiangning Bai
Andreas Matussek
Hannu Jalanko
Harri Saxén
Publication date: 01-09-2020
Publisher: Springer Berlin Heidelberg
Keywords: Escherichia Coli
Hemolytic Uremic Syndrome
Published in: Pediatric Nephrology / Issue 9/2020
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-020-04560-0

At a glance: The STEP trials

Springer Medicine

Hemolytic uremic syndrome caused by Shiga toxin–producing Escherichia coli in children: incidence, risk factors, and clinical outcome

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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