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01-09-2014 | Original Article

Neurological involvement in children with E. coli O104:H4-induced hemolytic uremic syndrome

Authors: Angela Bauer, Sebastian Loos, Carola Wehrmann, Dirk Horstmann, Frank Donnerstag, Johanna Lemke, Georg Hillebrand, Ulrike Löbel, Lars Pape, Dieter Haffner, Carola Bindt, Thurid Ahlenstiel, Anette Melk, Anja Lehnhardt, Markus J. Kemper, Jun Oh, Hans Hartmann

Published in: Pediatric Nephrology | Issue 9/2014

Abstract

Background

The aim of this study was to analyze the neurological involvement and outcome in pediatric patients with hemolytic uremic syndrome (HUS) during the 2011 epidemic caused by Escherichia coli O104:H4.

Methods

Clinical data and data from magnetic resonance imaging (MRI) scans and electroencephalography (EEG) during the acute phase of the disease and during follow-up at 3 and 6 months were analyzed in 50 patients. Twenty-five of these patients underwent neuropsychological testing (WISC IV) during follow-up.

Results

Neurological involvement (stupor or coma, seizures, visual disturbances, paresis, myocloni) was initially observed in 14/50 (28 %) patients. One patient died. EEG abnormalities were more frequent in patients with neurological involvement than in those without (12/14 vs. 13/25, respectively). Cranial MRI scans were analyzed in nine patients with neurological involvement, of whom five showed abnormal findings. At the 3- and 6-month follow-ups, EEG abnormalities were found in 14/40 (35 %) and 7/36 (19 %) patients, respectively, whereas 28/42 (67 %) and 17/39 (44 %) patients, respectively, complained about on-going reduced performance. Neuropsychological testing showed a slightly lower global intelligence quotient in patients with neurological involvement versus those without (113.4 ± 2.8 vs. 119.4 ± 1.8, respectively).

Conclusions

Neurological involvement was frequent in our cohort. Accordingly, the incidence of pathological EEG findings was high, even in patients without clinical signs of neurological involvement. Nevertheless, major neurological sequelae were rare, and neuropsychological outcome was favorable after 6 months.

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Title: Neurological involvement in children with E. coli O104:H4-induced hemolytic uremic syndrome
Authors: Angela Bauer
Sebastian Loos
Carola Wehrmann
Dirk Horstmann
Frank Donnerstag
Johanna Lemke
Georg Hillebrand
Ulrike Löbel
Lars Pape
Dieter Haffner
Carola Bindt
Thurid Ahlenstiel
Anette Melk
Anja Lehnhardt
Markus J. Kemper
Jun Oh
Hans Hartmann
Publication date: 01-09-2014
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Nephrology / Issue 9/2014
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-014-2803-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Neurological involvement in children with E. coli O104:H4-induced hemolytic uremic syndrome

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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