Haemolytic anaemia after childhoodEscherichia coliO 157.H7 infection: are females at increased risk?

Abstract

SUMMARYWe conducted a 4-year retrospective cohort study to better define the risk of haemolytic anaemia and haemolytic uraemic syndrome (HUS) in children following sporadic gastrointestinal infection with the 0 157. H7 serotype of Escherichia coli. Of the 72 children infected with this organism, 9 (12 5 %) developed haemolytic anaemia, 6 of whom had HUS. No child in a cohort of 72 age-matched controls with Campylobacter jejuni gastroenteritis developed haemolytic anaemia (P = 0 003). Females had a significantly greater risk of developing haemolytic anaemia after E. coli 0 157. H7 infection than did males (8/29 females v. 1/43 males; P = 0003). In a logistic regression model, female gender emerged as the only statistically significant risk factor for haemolytic anaemia (odds ratio 3-85; 95% confidence interval 124-12). These results are consistent with recent reports of a moderate increase in the risk of HUS for females.

Risk Factors for Sporadic Shiga Toxin–producingEscherichia coliInfections in Children, Argentina1

“…However, others have reported female sex as a risk factor for E. coli O157-associated hemolytic anemia (35). The reason for this sex difference is not known.…”

Human Stx2-Specific Monoclonal Antibodies Prevent Systemic Complications of Escherichia coli O157:H7 Infection

“…HUS, characterized by nonimmune microangiopathic hemolytic anemia, thrombocytopenia, and acute renal dysfunction, can develop several days following the onset of diarrhea (15). The risk of an individual child developing HUS following a bout of sporadic Shiga toxin-producing E. coli gastroenteritis has been estimated to be 3 to 26% (26,29,31 EHEC strains produce one or two toxins, designated Shiga toxin 1 (Stx1) and Stx2, of which Stx2 is most frequently associated with HUS (3,21,27). Both Stx1 and Stx2 are cytotoxins comprised of one enzymatically active (A) subunit and five binding (B) subunits.…”

Production and Characterization of Protective Human Antibodies against Shiga Toxin 1

“…In the United States, the O157:H7 serotype is most frequently associated with HUS in children and the elderly (11). The risk of a child developing HUS following a bout of sporadic gastroenteritis is ϳ3 to 26% (18,21,23 Development of HUS following STEC infection is believed to be associated with the activity of two STEC-produced cytotoxins, designated Stx1 and Stx2. Although variants of Stx2 exist, Stx1 is structurally conserved and is homologous to that produced by Shigella dysenteriae type 1 (13).…”