Haemolytic-uraemic syndrome outbreak caused by Escherichia coli O111:H-: clinical outcomes

Area of Science:

• Pediatric Nephrology
• Infectious Disease Epidemiology
• Food Safety

Background:

• Escherichia coli O111:H- is a known cause of sporadic hemolytic-uremic syndrome (HUS).
• Foodborne outbreaks of HUS are a significant public health concern, particularly in vulnerable populations like children.
• The consumption of contaminated meat products has been implicated in previous E. coli outbreaks.

Purpose of the Study:

• To report on the clinical features and outcomes of children affected by a large outbreak of HUS.
• To identify the source of the outbreak and implement control measures.
• To assess the long-term renal function in children following HUS.

Main Methods:

• Retrospective case series analysis of 20 children diagnosed with HUS.
• Epidemiological investigation to identify the food vehicle of transmission.
• Clinical data collection on patient demographics, symptoms, complications, and treatment.

Main Results:

• Twenty children developed HUS associated with E. coli O111:H- infection in South Australia in 1995.
• The outbreak was traced to contaminated locally produced semi-dry fermented sausage (mettwurst).
• Complications included renal impairment (18/20 required dialysis, 5/18 with significant impairment at 12 months), colonic necrosis (3), cerebral complications (3), and seizures (4). One child died.

Conclusions:

• This was the first reported large outbreak of E. coli O111:H- associated HUS in Australia.
• Contaminated fermented sausages pose a significant risk for HUS outbreaks.
• Prompt recognition and management are crucial, but long-term sequelae, particularly renal impairment, are common.