RESUMO
OBJECTIVES: To compare the epidemiologic, laboratory, clinical, and outcome variables of atypical (nondiarrheal) hemolytic-uremic syndrome with those of classic postdiarrheal disease. METHODS: A 24-year retrospective review of 28 episodes of atypical HUS that occurred in 22 children compared with 266 episodes of typical postdiarrheal disease in 265 children treated during the same period. RESULTS: Of the 294 episodes of HUS, 9.5% were atypical (nondiarrheal), and 18% of the patients in the atypical disease group had recurrences. Prodromal features (other than the presence or absence of diarrhea) were similar between the groups. White blood cell count and serum creatinine concentration on admission to the hospital and most abnormal blood urea nitrogen values during hospitalization were significantly lower (p = 0.02) in the patients with atypical HUS. Oliguria, anuria, and the need for dialysis were also less common (p = 0.02) in the atypical disease group. There were no deaths in the subset of patients with atypical disease; 3.4% of the patients in the typical disease group died. Although there were no statistically significant differences in the incidence of end-stage renal disease between the atypical and typical disease groups, two of the four patients with atypical disease who had recurrences also had end-stage renal disease. There were no significant differences in chronic renal sequelae between the groups one or more years after HUS. CONCLUSIONS: In contrast to reports from most other regions, patients with atypical disease in our area of the western United States have milder acute nephropathy and, with the exception of those with recurrence, do not experience worse outcomes.
Assuntos
Síndrome Hemolítico-Urêmica , Adolescente , Criança , Pré-Escolar , Feminino , Síndrome Hemolítico-Urêmica/diagnóstico , Síndrome Hemolítico-Urêmica/epidemiologia , Síndrome Hemolítico-Urêmica/fisiopatologia , Humanos , Lactente , Masculino , Prognóstico , Recidiva , Estudos Retrospectivos , Estações do Ano , Utah/epidemiologiaRESUMO
PURPOSE: To describe an outbreak of Escherichia coli O175:H7 infection resulting in a high rate of progression to hemolytic-uremic syndrome, and to attempt to identify predictors of and risk factors for progression. DESIGN: Case-control study among employees and comparison of daily clinical features in two groups: infected residents with subsequent development of HUS and those who had no complications. SETTING: Two institutions for retarded persons in Utah. PATIENTS: Twenty residents with E. coli O157:H7 infection (13 culture confirmed, 2 probable, and 5 possible); HUS developed in 8, and 4 died. Thirty-one infected employees (3 with culture-confirmed, 6 with probable, and 22 with possible infection). MEASUREMENTS AND MAIN RESULTS: In a case-control study among employees, infection was independently associated with eating ground beef from a single lot prepared at several barbecues and with close contact with a resident who had diarrhea. Five of eight residents in whom HUS developed had received trimethoprim-sulfamethoxazole, compared with none of seven who had no subsequent complications (p = 0.026); this finding may reflect antimicrobial treatment of patients with more severe illness. Compared with infected residents without complications, persons with HUS were younger (median age 13 vs 27 years, p = 0.043) and, by the third day of illness, had higher leukocyte counts (median 23.7 X 10(9)/L vs 9.1 X 10(9)/L, p = 0.018) and temperature (median 38.5 degrees C vs 37.0 degrees C, p = 0.016). Leukocytosis peaked on day 4, more than 24 hours before signs of HUS appeared. CONCLUSIONS: Food-borne outbreaks of E. coli O157:H7 in institutions may have devastating effects. Leukocytosis and fever may precede and predict HUS in patients with E. coli O157:H7 infection.