Sociodemographic and clinical risk factors for paediatric typical haemolytic uraemic syndrome: retrospective cohort study

Adams, Natalie; Byrne, Lisa; Rose, Tanith C.; Adak, B; Jenkins, Claire; Charlett, André; Violato, Mara; O’Brien, Sarah J.; Whitehead, Margaret; Barr, Ben; Taylor-Robinson, David; Hawker, Jeremy

doi:10.1136/bmjpo-2019-000465

Cited by 9 publications

(12 citation statements)

References 27 publications

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“…Adjusted odds of chronic kidney failure in this study were also lower among urban cases compared to rural cases. Several studies have shown that rural populations have higher exposure to STEC ( 21 , 22 ) and consequently are at higher risk of HUS ( 23 ), although these results are not consistent with other studies ( 24 ). While sample size (74 HUS cases from among 71 families) likely limited this study to detecting only large effects, it is notable that the sample size in this study is larger than most cohort studies on LTHOs of HUS which frequently consist of <50 cases ( 4 ).…”

Section: Discussioncontrasting

confidence: 58%

Facilitating Evaluation of Hemolytic Uremic Syndrome Long-Term Health Outcomes Through Social Media Support Groups

Beczkiewicz

Scharff

Kowalcyk

2020

Front. Public Health

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Individual burden and cost of hemolytic uremic syndrome (HUS)—a medical condition characterized by acute kidney failure—can be substantial when accounting for long-term health outcomes (LTHOs). Because of the low incidence of HUS, evaluation of associated LTHOs is often restricted to physician and outbreak cohorts, both of which may not be representative of all HUS cases. This exploratory study recruited participants from private social media support groups for families of HUS cases to identify potential LTHOs and costs of HUS that are not currently measured. Additionally, this study sought to identify case characteristics that may confound or modify these LTHOs and costs of HUS. Respondents self-selected to complete an online cross-sectional survey on acute and chronic illness history, treatments, and public health follow-up for HUS cases. Posttraumatic stress among respondents (typically case parents) was also evaluated. Responses were received for 74 HUS cases from 71 families representing all geographic regions, and levels of urbanicity within the US self-reported symptoms were typical for HUS, while 35.1% of cases reported antibiotic treatment at any point during the acute illness. Hospital transfers were reported by 71.6% of cases introducing possible delays to care. More than 70% of cases reported experiencing at least one LTHO, with 45% of cases reporting renal sequelae. Posttraumatic stress symptoms were frequently reported by respondents indirectly affected by HUS. Potentially large economic costs that are not addressed in existing analyses were identified including both financial and more general welfare losses (lost utility). While biases in the study design limit the generalizability of results to all HUS cases, this study provides new insights into unmeasured LTHOs and costs associated with HUS. These results suggest that robustly designed cohort studies on HUS should include measures of psychosocial impacts on both the affected individual and their family members.

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Section: Discussioncontrasting

confidence: 58%

Facilitating Evaluation of Hemolytic Uremic Syndrome Long-Term Health Outcomes Through Social Media Support Groups

Beczkiewicz

Scharff

Kowalcyk

2020

Front. Public Health

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“…During the surveillance period, <6% of cases detected and diagnosed as STEC-positive developed HUS, which is lower than the 15% reported by Tarr et al and 20% by Adams N et al, although the latter data relate to STEC O157 infections only [2,27]. Not all the patients with STEC infection develop BD, and this finding may partly explain this difference.…”

Section: Discussionmentioning

confidence: 63%

“…Data produced in the present study show that 70% of STEC positive cases in the pediatric population occurred in the 0-4 years age group. In the EU, almost one-third of all confirmed STEC cases have been reported in children aged <4 years, which is the age group with the highest reporting rate (8.9 cases/100,000 population), confirming that very young children are at a higher risk of infection than people of other ages [19,26,27].…”

Section: Discussionmentioning

confidence: 99%

“…Shiga toxins produced by the stx1 and stx2 genes are the main virulence factors of STEC [32], whereas the eae gene, encoding for intimin protein, mediates the attachment of STEC to the enterocytes [33]. It is known that stx2 and eae genes, along with young age, play the roles of risk factors for the development of HUS [11,14,27]. In our study, samples from 32.9% (25/76) of STEC cases harbored the stx2 gene (single and co-infection).…”

Section: Discussionmentioning

confidence: 99%

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Epidemiology of Shiga Toxin-Producing Escherichia coli Infections in Southern Italy after Implementation of Symptom-Based Surveillance of Bloody Diarrhea in the Pediatric Population

Loconsole

Giordano

Centrone

et al. 2020

IJERPH

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Shiga toxin-producing Escherichia coli (STEC) infections result in a significant public health impact because of the severity of the disease that, in young children especially, can lead to hemolytic–uremic syndrome (HUS). A rise in the number of HUS cases was observed in the Apulia region of Italy from 2013 to 2017, and so, in 2018, a symptom-based surveillance system for children with bloody diarrhea (BD) was initiated in order to detect and manage STEC infections. The objective of the study was to describe the epidemiology of STEC infections in children from June 2018 to August 2019. Children <15 years old with BD were hospitalized and tested for STEC. Real-time PCR for virulence genes (stx1, stx2, eae) and serogroup identification tests were performed on stool samples/rectal swabs of cases. STEC infection was detected in 87 (10.6%) BD cases. The median age of STEC cases was 2.7 years, and 60 (68.9%) were <4. Of these 87 cases, 12 (13.8%) came from households with diarrhea. The reporting rate was 14.2/100,000, with the highest incidence in cases from the province of Bari (24.2/100,000). Serogroups O26 and O111 were both detected in 22/87 (25.3%) cases. Co-infections occurred in 12.6% of cases (11/87). Twenty-nine STEC were positive for stx1, stx2, and eae. Five cases (5.7%) caused by O26 (n = 2), O111 (n = 2), and O45 (n = 1) developed into HUS. A risk-oriented approach based on the testing of children with BD during the summer may represent a potentially beneficial option to improve the sensitivity of STEC surveillance, not only in Italy but also in the context of Europe as a whole.

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“…Cumulatively, young children (<5 years) and the older subpopulation (>65 years) accounted for 56.7% (n = 1,563) of confirmed sporadic infections. Both of these subpopulations are known to be immunologically vulnerable and exhibit higher incidence rates of infection and severe sequelae (29,30). Younger cohorts especially are at increased risk of infection caused by frequent contact with other children of a similar age, and also pose a risk as a source of infection associated with increased contact with adults, particularly among the 30-39 year age group (31,32).…”

Section: Discussionmentioning

confidence: 99%

Spatiotemporal Dynamics of Sporadic Shiga Toxin–Producing Escherichia coli Enteritis, Ireland, 2013–2017

Cleary¹,

Boudou²,

Garvey³

et al. 2021

Emerg. Infect. Dis.

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O ver the previous decade, the Republic of Ireland has frequently reported the highest incidence rates of symptomatic Shiga toxin-producing Escherichia coli (STEC) infection in the European Union (EU) (1). The reported national crude incidence rate (CIR) of confi rmed STEC infections in Ireland during 2017 was 923 cases (16.6 cases/100,000 population), equating to ≈10 times the EU average (1.66 cases/100,000 population) (1,2).Shiga toxin-producing E. coli bacteria, of which there are >100 serotypes, were fi rst discovered in 1977; the most well-known STEC strain, E. coli O157:H7, was fi rst recognized as a pathogen in 1982. The Shiga toxin-producing group of E. coli includes serotypes O157, O26, and other enterohemorrhagic E. coli bacteria; serotypes are typically categorized by the presence of stx1 or stx2 genes (3). STEC is associated with a wide range of sequelae, from mild diarrhea to hemorrhagic colitis, hematochezia (bloody diarrhea), thrombotic thrombocytopenic purpura, and hemolytic uremic syndrome (HUS) causing intravascular lysis of red blood cells (2,4). Infection is characterized by several transmission routes, including consumption of contaminated food and water, person-to-person contact, or direct contact with infected animals (4,5). A recent study found the incidence of confi rmed sporadic (i.e., nonoutbreak) STEC O157 infection in Ireland in 2008-2013 signifi cantly elevated in regions characterized by high reliance on private groundwater (odds ratio [OR] 18.727; p<0.001) and high livestock densities (OR 1.001; p = 0.007) (6).Transmission sources, pathways, and sourcepathway interactions associated with STEC infection in Ireland are multifaceted, resulting in a complex exposure profi le (7,8). Sporadic cases of infection are inherently diffi cult to attribute to specifi c risk factors for reasons that include the absence of accurate dateof-onset data, underreporting, misdiagnosis, myriad potential exposures, and surveillance limitations (5,6,7). Of 2,210 confi rmed STEC cases reported in Ireland during 2008-2013, a total of 1,264 (57.2%) were defi ned as sporadic (6).The high proportion of sporadic STEC infections relative to total annual cases in Ireland, and their association with environmental exposures, has made the spatiotemporal occurrence of STEC particularly important in public health. We used a suite of

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Sociodemographic and clinical risk factors for paediatric typical haemolytic uraemic syndrome: retrospective cohort study

Cited by 9 publications

References 27 publications

Facilitating Evaluation of Hemolytic Uremic Syndrome Long-Term Health Outcomes Through Social Media Support Groups

Facilitating Evaluation of Hemolytic Uremic Syndrome Long-Term Health Outcomes Through Social Media Support Groups

Epidemiology of Shiga Toxin-Producing Escherichia coli Infections in Southern Italy after Implementation of Symptom-Based Surveillance of Bloody Diarrhea in the Pediatric Population

Spatiotemporal Dynamics of Sporadic Shiga Toxin–Producing Escherichia coli Enteritis, Ireland, 2013–2017

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