ESPN 53rd Annual Meeting

ESPN 2021


 
ESCHERICHIA COLI O55:H7 ASSOCIATED HAEMOLYTIC URAEMIC SYNDROME (HUS): CASE SERIES FROM THE FIRST DOCUMENTED O55:H7 OUTBREAK IN THE UNITED KINGDOM (UK)
Maduri Raja 1 Mushfequr R Haq 1 Arvind Nagra 1 Rodney D Gilbert 1

1- Department of Paediatric Nephrology, Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom
 
Introduction:

Shiga Toxin-producing Escherichia coli (STEC) are a well-established cause of haemolytic uraemic syndrome (HUS) causing acute kidney injury in children. In the UK, the majority of cases of STEC HUS are caused by serotype O157:H7. This series describes 5-year outcomes of ten children with HUS during England’s first documented STEC O55:H7 outbreak. 

Material and methods:

Retrospective review of ten children with HUS following STEC O55:H7 infection diagnosed between July 2014 and September 2015. Acute clinical course, duration of renal replacement therapy (RRT) and extra-renal involvement were reviewed. 12-month and 5-year follow-up data (kidney function, proteinuria, antihypertensive requirement and neurodevelopmental outcomes) were analysed using descriptive statistics and compared to an O15:H7 HUS case cohort.

Results:

Median age at presentation was 3 years; 60% were male. 9 (90%) had bloody diarrhoea. STEC O55:H7 serology positive in 5 (50%); Stool culture positive for STEC O55:H7 in 9 (90%). Mean acute dialysis duration was 17 days with 9 children requiring more than 10 days of RRT. Neurological involvement was seen in 7 (70%); 3 (30%) had cardiac involvement.  

At 12-month follow up, 6 (60%) were on a single antihypertensive agent; 8 (80%) had raised urine albumin/creatinine ratio; the median formal GFR of the O55:H7 cohort was significantly lower (50-92ml/min/1.73m2) than that of the STEC O157:H7 HUS group.  At 5 years post-HUS, 50% of the O55:H7 cohort had formal GFRs corresponding to CKD stage 2 (G3a1/G2).

Conclusions:

From this series it appears that HUS secondary to infection with E. coli O55 tends to be more severe than with O157. Patients spent longer on dialysis, had more severe renal sequelae and had a higher incidence of extra-renal manifestations. With E. coli strains other than O157 increasing in global incidence, it is important that microbiology laboratories are set up to find all Shiga Toxin producing organisms.