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Changes in the postenteropathic form of the hemolytic uremic syndrome in children
1Department of Nephrology, Children's Hospital, Birmingham, UK.
Insights
The nature of childhood hemolytic uremic syndrome (HUS) has changed, with a later age of onset and increased bloody diarrhea since 1982. This new form is linked to verocytotoxin-producing Escherichia coli (VTEC) infections.
Area of Science:
- Pediatrics
- Infectious Diseases
- Nephrology
Background:
- Hemolytic uremic syndrome (HUS) is a serious condition affecting children.
- Clinical presentation and epidemiology of HUS may evolve over time.
Purpose of the Study:
- To analyze changes in clinical and laboratory findings of diarrheal HUS in children treated between 1970 and 1987.
- To identify factors associated with HUS and its outcomes over different time periods.
Main Methods:
- Retrospective analysis of clinical and laboratory data from pediatric HUS patients.
- Logistic regression analysis for prognostic scoring.
- Stool sample analysis for verocytotoxin-producing Escherichia coli (VTEC) and verotoxin from July 1983.
Main Results:
- Referral rates increased after 1982, with a mean age at presentation doubling from 2 to 4 years.
- Bloody diarrhea became a more frequent prodromal illness.
- Post-1982, adverse outcomes correlated with neutrophil leukocytosis and higher hemoglobin levels.
- VTEC was identified in 39% of cases analyzed after July 1983.
Conclusions:
- The characteristics of childhood HUS have shifted, with a new form emerging.
- This evolving HUS is associated with VTEC infections, indicating a change in causative agents or pathogen virulence.
Abstract:
An analysis was made of clinical and laboratory findings in children with the diarrheal form of the hemolytic uremic syndrome (HUS) treated at The Children's Hospital, Birmingham between 1970 und 1987. From 1982 the rate of referral increased, the prodromal illness more often consisted of bloody diarrhea, and the mean age at presentation doubled from 2 to 4 years. For patients with a good outcome there was an excess of males in the period 1970-81, and females in the period 1982-87. Moreover, in the years 1982-87 the disorder was distinguished from that of the earlier time by a positive correlation between adverse outcome and both neutrophil leukocytosis and a higher hemoglobin concentration at presentation. Prognostic scores obtained by logistic regression analysis were specific for each period. From July 1983 stool samples were analyzed for verocytotoxin-producing Escherichia coli (VTEC) and neutralizable verotoxin. Positive results were obtained in 39% of cases. The nature of HUS has changed and the new form of the disorder is associated with VTEC infection.