Epidemiology and Infection

Predictors for the development of haemolytic uraemic syndrome with Escherichia coli O157[ratio]H7 infections: with focus on the day of illness

K. IKEDA a1c1, O. IDA a1, K. KIMOTO a1, T. TAKATORIGE a1, N. NAKANISHI a1 and K. TATARA a1
a1 Osaka University, Graduate School of Medicine, Course of Social Medicine, Department of Social and Environmental Medicine, 2-2, Yamadaoka, Suita-City, Osaka 565-0871, Japan


A large outbreak of Escherichia coli O157 infections via school lunches occurred at primary schools in 1996 in Sakai City, Japan. As many as 10000 patients suffered from diarrhoea, haemorrhagic colitis and haemolytic uraemic syndrome (HUS). Using data on 288 inpatient school children affected by this outbreak, of whom 36 presented complete HUS and the remaining 252 tested positive for E. coli O157 culture, we attempted to identify predictors for the progression to HUS. Within the first 5 days of illness, clinical features associated with inpatients who developed HUS compared with those without HUS included a C reactive protein (CRP) level higher than 1·2 mg/dl (OR 44·26; 95% CI 5·83–336·23), a white blood cell (WBC) count greater than 11·0 × 109/1 (OR 5·03; 95% CI 27·13–11·87) and a temperature higher than 38·0 °C (OR 5·00; 95% CI 2·25–117·08). It can be concluded that these three factors are predictive factors for the development of HUS in patients with E. coli O157 infection, and patients who have two or all of these factors should be observed closely.

(Accepted December 20 1999)

c1 Author for correspondence.