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

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

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

Tiia Virkkala
Xiangning Bai
Jani Halkilahti
Ruska Rimhanen-Finne
Laura Linkosalo
Hannu Jalanko
Harri Saxén
Timo Jahnukainen
Saara Salmenlinna
Elisa Ylinen
Janne Kataja
Linda Korhonen
Matti Nuutinen
Andreas Matussek
Pekka Arikoski
Katso/Avaa
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SPRINGER
doi:10.1007/s00467-020-04560-0
URI
https://link.springer.com/article/10.1007/s00467-020-04560-0
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Julkaisun pysyvä osoite on:
https://urn.fi/URN:NBN:fi-fe2021042821796
Tiivistelmä

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 x 10(9)/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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