The Epidemiology and Clinical Aspects of the Hemolytic Uremic Syndrome in Minnesota

Martin, David T.; MacDonald, Kristine L.; White, Karen E.; Soler, John T.; Osterholm, Michael T.

doi:10.1056/nejm199010253231703

Cited by 194 publications

(107 citation statements)

References 19 publications

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“…Indeed, salt loading protects against presumably nonthrombotic nephrotoxicity, such as that caused by amphotericin, 28 and isotonic saline prevents nephropathy caused by radiocontrast media better than does hypotonic saline. 29 It is interesting that unlike a Minnesota study that suggested that antibiotic administration was related to a milder course of HUS, 30 we detected no statistically significant association between antibiotic administration and development of either oligoanuria or nonoligoanuria. However, in our study, children who received antibiotics generally also received less intravenous sodium and fluids.…”

Section: Discussioncontrasting

confidence: 51%

Relative Nephroprotection DuringEscherichia coliO157:H7 Infections: Association With Intravenous Volume Expansion

et al. 2005

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ABSTRACT. Objective. The hemolytic uremic syndrome (HUS) consists of hemolytic anemia, thrombocytopenia, and renal failure. HUS is often precipitated by gastrointestinal infection with Shiga toxin-producing Escherichia coli and is characterized by a variety of prothrombotic host abnormalities. In much of the world, E coli O157:H7 is the major cause of HUS. HUS can be categorized as either oligoanuric (which probably signifies acute tubular necrosis) or nonoligoanuric. Children with oligoanuric renal failure during HUS generally require dialysis, have more complicated courses, and are probably at increased risk for chronic sequelae than are children who experience nonoligoanuric HUS. Oligoanuric HUS should be avoided, if possible. The presentation to medical care of a child with definite or possible E coli O157:H7 infections but before HUS ensues affords a potential opportunity to ameliorate the course of the subsequent renal failure. However, it is not known whether events that occur early in E coli O157:H7 infections, particularly measures to expand circulating volume, affect the likelihood of experiencing oligoanuric HUS if renal failure develops. We attempted to assess whether pre-HUS interventions and events, especially the volume and sodium content of intravenous fluids administered early in illness, affect the risk for developing oligoanuric HUS after E coli O157:H7 infections.Methods. We performed a prospective cohort study of 29 children with HUS that was confirmed microbiologically to be caused by E coli O157:H7. Infected children were enrolled when they presented with acute bloody diarrhea or as contacts of patients who were known to be infected with E coli O157:H7, or if they had cultureconfirmed infection, or if they presented with HUS. HUS was defined as hemolytic anemia (hematocrit <30%, with fragmented erythrocytes on peripheral-blood smear), thrombocytopenia (platelet count of <150 000/mm 3 ), and renal insufficiency (serum creatinine concentration that exceeded the upper limit of normal for age). A wide range of pre-HUS variables, including demographic factors, clinical history, medications given, initial laboratory values, and volume and content of parenteral fluid administered, were recorded and entered into analysis. Estimates of odds ratios were adjusted for possible confounding effects using logistic regression analysis. Twenty-nine children who were <10 years old, had HUS confirmed to be caused by E coli O157:H7, and were hospitalized at the Children's Hospital and Regional Medical Center, Seattle, were studied. The main outcome measured was development of oligoanuric renal failure. Oligoanuria was defined as a urine output <0.5 mL/kg per hour for at least 24 consecutive hours.Results. As a group, the children with oligoanuric renal failure presented to medical attention and were evaluated with laboratory testing later than the children with nonoligoanuric renal failure. On initial assessments, the children with oligoanuric outcomes had higher white blood cell counts, lower platelet counts...

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Section: Discussioncontrasting

confidence: 51%

Relative Nephroprotection DuringEscherichia coliO157:H7 Infections: Association With Intravenous Volume Expansion

et al. 2005

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“…The large number of patients who needed simultaneous treatment was challenging, especially on resources, but the initial rate of complications was not unusual. Especially when looking at the published pediatric series from the US [5], Australia [6], Great Britain [7], and Germany [8], it seems that most pediatric patients with STEC O104:H4 HUS had a comparable course compared to historic controls. Two special features compared to the past, however, were the fact that patients were from a high socioeconomic status and that age at presentation was relatively high.…”

Section: Specific Pediatric Details In Comparison To Published Seriesmentioning

confidence: 99%

Outbreak of hemolytic uremic syndrome caused by E. coli O104:H4 in Germany: a pediatric perspective

Kemper

2011

Pediatr Nephrol

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In May-June 2011, an unprecedented outbreak of hemolytic uremic syndrome (HUS) caused by Shiga toxinproducing E. coli (STEC) O104:H4 affected >800 adults, in whom this disorder is usually rarely seen. Over 90 children were also affected in the largest STEC-associated HUS outbreak in children to date. Despite high patient numbers and chronic staff shortages in pediatric institutions, almost all patients were treated locally, mainly because of maximally increased staff input. Epidemiologic features were characterized by relatively high age at presentation, possibly related to the isolated etiologic agent, raw bean sprouts. Fortunately, in children, other clinical features, including neurological complications, dialysis requirement, and short-term outcome, were comparable to previous historical series. Only one child died, compared to 35 adults. Differences in treatment recommendations and approaches between adults and children were noted. Treatment with eculizumab was available, but handled more restrictively in children. Despite treatment differences, children and adult clinical outcomes were comparable, pending a final analysis. In summary the STEC O104:H4 HUS outbreak was challenging for pediatric resources but clinical presentation and complications were comparable to previous experience. Acute outbreak onset made structured approaches to treatments impossible, however, ongoing analysis may provide evidence for improving care of children with STEC HUS.

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“…In population-based studies of HUS, age-specific incidence was highest among children Ͻ5 years of age, but these studies did not evaluate risk factors for progression of diarrhea or hemorrhagic colitis to HUS. [3][4][5][6] In some studies of children with E coli O157:H7 infection, girls were more likely than boys to develop HUS. 7,8 Patients who are infected with E coli O157:H7 and at the time of presentation to medical care have elevated white blood cell counts, fever, or bloody stools also have been noted to have a higher risk of progression to HUS than patients without these findings.…”

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confidence: 99%

Predictors of Hemolytic Uremic Syndrome in Children During a Large Outbreak of Escherichia coli O157:H7 Infections

et al. 1997

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ABSTRACT. Objective. To evaluate risk factors for progression of Escherichia coli O157:H7 infection to the hemolytic uremic syndrome (HUS).Study Design. We conducted a retrospective cohort study among 278 Washington State children <16 years old who developed symptomatic culture-confirmed E coli O157:H7 infection during a large 1993 outbreak. The purpose of the study was to determine the relative risk (RR) of developing HUS according to demographic characteristics, symptoms, laboratory test results, and medication use in the first 3 days of illness.Results. Thirty-seven (14%) children developed HUS. In univariate analysis, no associations were observed between HUS risk and any demographic characteristic, the presence of bloody diarrhea or of fever, or medication use. In multivariate analysis, HUS risk was associated with, in the first 3 days of illness, use of antimotility agents (odds ratio [OR] ‫؍‬ 2.9; 95% confidence interval [CI] 1.2-7.5) and, among children <5.5 years old, vomiting (OR ‫؍‬ 4.2; 95% CI 1.4 -12.7). Among the 128 children tested, those whose white blood cell (WBC) count was 13 000/L in the first 3 days of illness had a 7-fold increased risk of developing HUS (RR 7.2; 95% CI 2.8 -18.5). Thirteen (38%) of the 34 patients with a WBC count 13 000/L developed HUS, but only 5 (5%) of the 94 children whose initial WBC count was <13 000/L progressed to HUS. Among children who did not develop HUS, use of antimotility agents in the first 3 days of illness was associated with longer duration of bloody diarrhea.Conclusions. Prospective studies are needed to further evaluate measures to prevent the progression of E coli O157:H7 infection to HUS and to assess further clinical and laboratory risk factors. These data argue against the use of antimotility agents in acute childhood diarrhea. Our finding that no intervention decreased HUS risk underscores the importance of preventing E coli O157:H7 infections. Pediatrics 1997;100(1). URL: http:// www.pediatrics.org/cgi/content/full/100/1/e12; antibiotics, antimotility agents, Escherichia coli O157:H7, kidney failure, leukocytosis.ABBREVIATIONS. HUS, hemolytic uremic syndrome; BUN, blood urea nitrogen; RR, relative risk; CI, confidence interval; TMP/SMZ, trimethoprim/sulfamethoxazole; OR, odds ratio; WBC, white blood cell; Stx, Shiga toxin. E scherichia coli O157:H7 causes bloody and nonbloody diarrhea that progresses to hemolytic uremic syndrome (HUS) in a subset of patients.1,2 Though the gastrointestinal manifestations of infection with E coli O157:H7 can be severe, HUS accounts for the major acute and chronic morbidity and mortality caused by this organism.Associations between certain host-specific factors and the risk of progression of enteric infection with E coli O157:H7 to HUS have been reported. In population-based studies of HUS, age-specific incidence was highest among children Ͻ5 years of age, but these studies did not evaluate risk factors for progression of diarrhea or hemorrhagic colitis to HUS. [3][4][5][6] In some studies of children with E coli O...

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The Epidemiology and Clinical Aspects of the Hemolytic Uremic Syndrome in Minnesota

Abstract: This study provides evidence for an increase in the incidence of hemolytic uremic syndrome, which is probably related to an increased incidence of E. coli O157:H7 infections. Hemolytic uremic syndrome has become an important pediatric and public health problem.

Cited by 194 publications

References 19 publications

Relative Nephroprotection DuringEscherichia coliO157:H7 Infections: Association With Intravenous Volume Expansion

Relative Nephroprotection DuringEscherichia coliO157:H7 Infections: Association With Intravenous Volume Expansion

Outbreak of hemolytic uremic syndrome caused by E. coli O104:H4 in Germany: a pediatric perspective

Predictors of Hemolytic Uremic Syndrome in Children During a Large Outbreak of Escherichia coli O157:H7 Infections

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