Nationwide study of haemolytic uraemic syndrome: clinical, microbiological, and epidemiological features

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dc.contributor.authorElliott, E.
dc.contributor.authorRobins-Browne, R.
dc.contributor.authorO'Loughlin, E.
dc.contributor.authorBennett-Wood, V.
dc.contributor.authorBourke, J.
dc.contributor.authorHenning, P.
dc.contributor.authorHogg, G.
dc.contributor.authorKnight, J.
dc.contributor.authorPowell, H.
dc.contributor.authorRedmond, D.
dc.date.issued2001
dc.description.abstractAIMS---To establish the incidence and aetiology of haemolytic uraemic syndrome (HUS) in Australia and compare clinical and microbial characteristics of sporadic and outbreak cases. METHODS---National active surveillance through the Australian Paediatric Surveillance Unit with monthly case notification from paediatricians, July 1994 to June 1998. Children under 15 years presenting with microangiopathic haemolytic anaemia, thrombocytopenia, and acute renal impairment were identified. RESULTS---Ninety eight cases were identified (incidence 0.64 per 105 children <15 years/annum and 1.35 per 105 children <5 years/annum). Eighty four were associated with diarrhoea (64 sporadic, 20 constituting an outbreak) and 14 were atypical. Shiga toxin producing Escherichia coli (STEC) O111:H- was the most common isolate in sporadic HUS and caused the outbreak. However O111:H- isolates from outbreak and sporadic cases differed in phage type and subtyping by DNA electrophoresis. STEC isolates from sporadic cases included O26:H-, O113:H21, O130:H11, OR:H9, O157:H-, ONT:H7, and ONT:H-. STEC O157:H7 was not isolated from any case. Only O111:H- isolates produced both Shiga toxins 1 and 2 and possessed genes encoding E coli attaching and effacing gene (intimin) and enterohemolysin. Outbreak cases had worse gastrointestinal and renal disease at presentation and more extrarenal complications. CONCLUSIONS---Linking national surveillance with a specialised laboratory service allowed estimation of HUS incidence and provided information on its aetiology. In contrast to North America, Japan, and the British Isles, STEC O157:H7 is rare in Australia; however, non-O157:H7 STEC cause severe disease including outbreaks. Disease severity in outbreak cases may relate to yet unidentified virulence factors of the O111:H- strain isolated.
dc.description.statementofresponsibilityE J Elliott, R M Robins-Browne, E V O'Loughlin, V Bennett-Wood, J Bourke, P Henning, G G Hogg, J Knight, H Powell, D Redmond, and Contributors to the Australian Paediatric Surveillance Unit
dc.identifier.citationArchives of Disease in Childhood, 2001; 85(2):125-131
dc.identifier.doi10.1136/adc.85.2.125
dc.identifier.issn0003-9888
dc.identifier.issn1468-2044
dc.identifier.urihttp://hdl.handle.net/2440/6968
dc.language.isoen
dc.publisherBritish Med Journal Publ Group
dc.rightsCopyright © 2001 by the BMJ Publishing Group Ltd.
dc.source.urihttps://doi.org/10.1136/adc.85.2.125
dc.subjectContributors to the Australian Paediatric Surveillance Unit
dc.subjectFeces
dc.subjectHumans
dc.subjectEscherichia coli O157
dc.subjectHemolytic-Uremic Syndrome
dc.subjectShiga Toxins
dc.subjectAgglutination Tests
dc.subjectBlotting, Southern
dc.subjectElectrophoresis, Gel, Pulsed-Field
dc.subjectIncidence
dc.subjectStatistics, Nonparametric
dc.subjectFood Microbiology
dc.subjectDisease Outbreaks
dc.subjectVirulence
dc.subjectAdolescent
dc.subjectChild
dc.subjectChild, Preschool
dc.subjectInfant
dc.subjectInfant, Newborn
dc.subjectAustralia
dc.subjectFemale
dc.subjectMale
dc.titleNationwide study of haemolytic uraemic syndrome: clinical, microbiological, and epidemiological features
dc.typeJournal article
pubs.publication-statusPublished

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