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Diarrhoea in close contacts as a risk factor for childhood haemolytic uraemic syndrome

Published online by Cambridge University Press:  15 May 2009

P. C. Rowe ,
E. Orrbine ,
H. Lior ,
G. A. Wells  and
P. N. McLaine
P. C. Rowe
Affiliation:
Canadian Pediatric Kidney Disease Reference Centre, Ottawa, and the National Laboratory for Enteric Pathogens, Laboratory Centre for Disease Control, Ottawa, Canada
E. Orrbine
Affiliation:
Canadian Pediatric Kidney Disease Reference Centre, Ottawa, and the National Laboratory for Enteric Pathogens, Laboratory Centre for Disease Control, Ottawa, Canada
H. Lior
Affiliation:
Canadian Pediatric Kidney Disease Reference Centre, Ottawa, and the National Laboratory for Enteric Pathogens, Laboratory Centre for Disease Control, Ottawa, Canada
G. A. Wells
Affiliation:
Canadian Pediatric Kidney Disease Reference Centre, Ottawa, and the National Laboratory for Enteric Pathogens, Laboratory Centre for Disease Control, Ottawa, Canada
P. N. McLaine*
Affiliation:
Canadian Pediatric Kidney Disease Reference Centre, Ottawa, and the National Laboratory for Enteric Pathogens, Laboratory Centre for Disease Control, Ottawa, Canada
*
*Dr Peter N. McLaine. Director. Canadian Pediatric Kidney Disease Reference Centre, 401 Smyth Road, Ottawa, Ontario. Canada K1H 8L1.
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Summary

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To determine whether the risk factors for childhood haemolytic uraemic syndrome (HUS) are similar to risk factors previously reported for Escherichia coli O 157. H7 gastroenteritis, we conducted a case-control study at eight paediatric hospitals in the summer of 1990. Thirty-four consecutive children with HUS were prospectively enrolled; all had diarrhoea and 88% had laboratory evidence of exposure to verotoxin-producing E. coli (VTEC). The 102 controls were otherwise healthy children with minor acute injuries. Parents of all subjects responded to a questionnaire about each child's exposure to various foods, methods of food preparation, sources of water, travel, and individuals with diarrhoea.

Children with HUS were significantly more likely than controls to have had close contact with an individual with diarrhoea in the 2 weeks before the onset of illness (74 υ. 29%, P < 0.00001; odds ratio 7·0. 95% CI 2.7–18.5). The onset of diarrhoea in the contacts occurred a median of 6 days (range, 1− > 14 days) before the onset of diarrhoea in the HUS patients. Exposure to undercooked ground meat was not significantly more common in the patients with HUS (15 υ. 8%; P=0.05). These data provide evidence consistent with person-to-person transmission of VTEC in a substantial proportion of episodes of childhood HUS.

Type
Research Article
Information
Epidemiology & Infection , Volume 110 , Issue 1 , February 1993 , pp. 9 - 16
Copyright
Copyright © Cambridge University Press 1993

References

REFERENCES

1.Levin, M, Walters, MDS, Barrett, TM. Hemolytic uremic syndrome. Adv Pediatr Inf Dis 1989: 4: 51–82.Google ScholarPubMed
2.Karmali, MA. Petrie, M. Steele, BT. Lim, C. Sporadic eases of haemolytie-uraemic syndrome associated with faecal eytotoxin-producing Escherichia coli in stools. Lancet 1983: i: 619–20.CrossRefGoogle Scholar
3.Tarr, PI. Neill, MA. Clausen, CR. Watkins, SL. Christine, DL. Hiekman, RO. Escherichia coli O 157. H7 and the hemolvtic uremic svndrome: importance of early cultures in establishing the etiology. J Inf Dis 1990: 162: 553–6.CrossRefGoogle Scholar
4.Grandsen, WR. Damm, MAS. Anderson, JD. Carter, JE. Lior, H. Further evidence associating hemolvtic uremic svndrome with infection bv verotoxin-producing Escherichia coli O 157. H7. J Inf Dis 1986: 154: 522–4.Google Scholar
5.Kleanthous, H. Smith, HR, Scotland, SM. et al. Haemolvtie uraemic syndromes in the British Isles. 1985–8: assoeiation with verocytotoxin-producing Escherichia coli. Part 2. Microbiological aspects. Arch Dis Child 1990: 65: 722–7.CrossRefGoogle ScholarPubMed
6.Rowe, PC, Orrbine, E, Wells, GA, McLaine, PN. The epidemiology of hemolytic uremic syndrome in Canadian children, 1986–1988. J Pediatr 1991; 119: 218–24.CrossRefGoogle Scholar
7.Riley, LW, Remis, RS, Helgerson, SD, et al. Hemorrhagic colitis associated with a rare Escherichia coli serotype. N Eng J Med 1983; 308: 681–5.CrossRefGoogle ScholarPubMed
8.MacDonald, KL, O'leary, MJ, Cohen, ML, et al. Escherichia coli O 157.H7, an emerging gastrointestinal pathogen. JAMA 1988; 259: 3567–70.CrossRefGoogle Scholar
9.Bryant, HE, Athar, MA, Pai, CH. Risk factors for Escherichia coli O 157.H7 infection in an urban community. J Inf Dis 1989; 160: 858–64.CrossRefGoogle Scholar
10.Ostroff, SM, Griffin, PM, Tauxe, RV, et al. A statewide outbreak of Escherichia coli O 157. H7 infections in Washington State. Am J Epidemiol 1990; 132: 239–47.CrossRefGoogle Scholar
11.Carter, AO, Borczyk, AA, Carlson, JAK. et al. A severe outbreak of E. coli 0 157. H7-associated hemorrhagic colitis in a nursing home. N Eng J Med 1987; 317: 1496–1500.CrossRefGoogle Scholar
12.Ryan, CA, Tauxe, RV, Hosek, GW, et al. Escherichia coli O 157.H7 diarrhea in a nursing home: clinical, epidemiological, and pathological findings. J Inf Dis 1986; 154: 631–8.CrossRefGoogle Scholar
13.Belongia, EA, MacDonald, KL, Parham, GL, et al. An outbreak of Escherichia coli O 157.H7 colitis associated with consumption of precooked meat patties. J Inf Dis 1991; 164: 33843.CrossRefGoogle Scholar
14.Pavia, AT, Nichols, CR, Green, DP. et al. Hemolytic-uremic syndrome during an outbreak of Escherichia coli 0 157. H7 infections in institutions for mentally retarded persons: clinical and epidemiologic observations. J Pediatr 1990; 116: 544–51.CrossRefGoogle Scholar
15.Duncan, L, Mai, V, Carter, A, Carlson, JAK, Borczyk, A, Karmali, MA. Outbreak of gastrointestinal disease in Sarnia, Ontario. Ontario Dis Surveillance Rep 1986; 7: 604–11.Google Scholar
16.Salmon, RL, Farrell, ID, Hutchison, JGP, et al. A christening party outbreak of hemorrhagic colitis and haemolytic uraemic syndrome associated with Escherichia coli O 157. H7. Epidemiol Infect 1989: 103: 249–54.CrossRefGoogle ScholarPubMed
17.Swerdlow, DL. Woodruff, BA. Brady, RC, et al. A large waterborne outbreak of antimicrobial-resistant E. coli 0 157. H7 infections. ICAAC. 1990.Google Scholar
18.Spika, JS, Parsons, JE, Nordenberg, D, Wells, JG. Gunn, RA. Blake, PA. Hemolytic uremic syndrome and diarrhea associated with Escherichia coli O 157. H7 in a day care center. J Pediatr 1986: 109: 287–91.CrossRefGoogle Scholar
19.Rowe, PC. Orrbine, E. Lior, H. Wells, GA. McLaine, PX. and the CPKDRC co-investigators. A prospective study of exposure to verotoxin-producing Escherichia coli among Canadian children with haemolytic uraemic syndrome. Epidemiol Infect 1993; 110: 1–7.CrossRefGoogle ScholarPubMed
20.Walter, SD. The distribution of Levin's measure of attributable risk. Biometrika 1975; 62: 371–4.CrossRefGoogle Scholar
21.Riley, LW. The epidemiologic, clinical, and microbiologic features of hemorrhagic colitis. Ann Rev Microbiol 1987: 41: 383–407.CrossRefGoogle ScholarPubMed
22.Karmali, MA. Arbus, GS. Petric, M. et al. Hospital-acquired Escherichia coli 0 157. H7 associated haemolytic uraemic syndrome in a nurse. Lancet 1988; i: 526.CrossRefGoogle Scholar
23.Karmali, MA. Arbus, GS. Ish-Shalom, N, et al. A family outbreak of hemolytic uremic syndrome associated with verotoxin-producing Escherichia coli serotype O 157. H7. Pediatr Nephrol 1988: 2: 409–14.CrossRefGoogle Scholar
24.Wilson, R. Feldman, RA. Davis, J. LaVenture, M. Salmonellosis in infants: the importance of intrafamilial transmission. Pediatrics 1982; 69: 436–8.CrossRefGoogle ScholarPubMed
25.Blaser, MJ. Waldman, RJ. Barrett, T, Erlandson, AL. Outbreaks of Campylobacter enteritis in two extended families: evidence for person-to-person transmission. J Pediatr 1981: 254–7.CrossRefGoogle ScholarPubMed
26.Mosley, WH. Adams, B. Lyman, ED. Epidemiologic and sociologic features of a large urban outbreak of shigellosis. JAMA 1962; 182: 1307–11.CrossRefGoogle ScholarPubMed
27.Harris, JR. Mariano, J. Wells, JG, Payne, BJ. Donnell, HD. Cohen, ML. Person-to-person transmission in an outbreak of enteroinvasive Escherichia coli. Am J Epidemiol 1985: 122: 245–52.CrossRefGoogle Scholar
28.Lopez, EL. Diaz, M. Grinstein, S. et al. Hemolytic uremic syndrome and diarrhea in Argentine children: the role of Shiga-like toxins. J Inf Dis 1989: 160: 469–75.CrossRefGoogle ScholarPubMed
29.Lopez, EL. Diaz, M. Devoto, S. et al. Evidence of infection with organisms producing Shiga-like toxins in household contacts of children with the hemolytic uremic syndrome. J Pediatr Inf Dis 1991: 10: 20–4.CrossRefGoogle ScholarPubMed
30.Thornberry, OT. An experimental comparison of telephone and personal health interview surveys. Vital and health statistics. 1987. series 2, no. 106.Google Scholar