December 1996
SEATTLE — Hemolytic uremic syndrome (HUS) is a well-recognized complication of Escherichia coli O157:H7 and is most common among children, but can affect people of all ages.
In the most recent E. coli O157:H7 outbreaks in Connecticut, the three Pacific Northwestern states and British Columbia, a total of 16 children developed HUS as a result of E. coli. A 16-month-old child died in Denver, according to Cindy Parmeuter, director of communications for the Colorado Department of Public Health and Environment.
HUS occurs in about 10% of children under age 10 who have E. coli O157:H7 according to Phillip I. Tarr, MD, a pediatric gastroenterologist with Children's Hospital and Medical Center, Seattle. HUS cases in most of North America, Europe and Japan are predominately precipitated by E coli O157:H7, which causes approximately two-thirds of all HUS cases, Tarr said.
Although undercooked ground beef is most commonly associated with this virulent form of E. coli, new vehicles such as apple cider, lettuce and salami have been implicated, and many laboratories still don't screen for E. coli O157:H7, according to Tarr.
It is also important, he said, for pediatricians to rapidly report cases to public health authorities because children with E. coli O157:H7 infection could be part of an unrecognized continuing outbreak from a widely disseminated vehicle.
"A vehicle such as apple cider could be overlooked in the absence of careful epidemiologic investigation," according to a 1993 editorial published in the Journal of the American Medical Association (JAMA).
Because young children are particularly susceptible to developing HUS, recognizing infection in children attending day-care facilities is important, according to the JAMA editorial.
Antibiotics for preventing E. coli related HUS are not recommended, because in retrospective analyses, patients who received antibiotics had the same or greater risk of developing HUS than those who received no antibiotics. He urged against the use of agents that slow the gastrointestinal tract.
About half of patients with overt HUS require dialysis, and three-quarters require transfusions of erythrocytes and/or platelets. HUS can be complicated by seizures, coma, hemorrhagic and nonhemorrhagic strokes, colonic perforation, pancreatitis, glucose intolerance, hepatobiliary derangements, hypertension, adult respiratory distress syndrome and cardiomyopathy, Tarr said.
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