Haemolytic uraemic syndromes in the British Isles 1985-8: association with Verocytotoxin producing Escherichia coli

Article Abstract:

Hemolytic-uremic syndrome (HUS) occurs primarily in infants and young children, and is characterized by hemolytic anemia (the breakdown of red blood cells), thrombocytopenia (a decreased number of platelets, blood cells important for clotting), and acute kidney failure. Two subtypes of HUS have been identified: D+ HUS and D-HUS. HUS preceded by diarrheal illnesses, the so-called D+ HUS, is more common and has a better-than-80 percent recovery rate. D+ HUS is associated with Verocytotoxin (a toxin), which is produced by strains of the common intestinal bacteria Escherichia coli. (Hence, the name VTEC infection, caused by Verocytotoxin producing Escherichia coli.) The occurrence of HUS in the British Isles between 1985 and 1988 is described. Of 273 patients with HUS, 95 percent had D+ HUS. These cases tended to occur more frequently in the summer, and usually affected children aged one to two years. Among children more than 10 years of age, many more girls than boys developed D+ HUS. Common symptoms of this illness included: decreased urine output, abnormal hydration, high blood pressure, and seizures. Children with higher levels of neutrophils (a type of white blood cell) tended to do poorly. Patients with D-HUS suffered significantly more severe illness and higher mortality. In addition, the age- and season-related patterns and neutrophil-related prognosis observed with D+ HUS were not observed in the cases of D-HUS. VTEC infection was identified in 33 percent of stool samples collected from 178 patients with D+ HUS; VTEC were also identified in 62 percent of D+ HUS cases when stool samples were collected within three days of the onset of diarrhea (5 of 8 cases). No evidence of VTEC infection was found in the D-HUS cases. These results confirm the subclassification of HUS D+ and D-. Further studies of children with HUS are needed to determine the long-term complications of this disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects, Escherichia coli, Bacterial toxins

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Trends in the incidence of Reye's syndrome and the use of aspirin

Article Abstract:

The cause of Reye's syndrome is not known, but researchers believe there may be many factors at work. Reye's syndrome is a serious disease affecting children and characterized by acute brain damage and fatty deposits in the liver and other organs. There seems to be a link between Reye's syndrome and the use of aspirin. Public education programs in the United Kingdom have warned parents against the use of aspirin in children under the age of 12 years. Warnings labels have also been placed on bottles of aspirin. A study was conducted to determine what drugs were being used to treat fever in children. This study also compared the use of medications for fever in the study group with medications used by an earlier group that had been studied before the aspirin warning was issued. A third purpose of the study was to determine if parents had heard of Reye's syndrome and whether it affected their choice of drug. A standard questionnaire was used when interviewing parents of children who were admitted to the hospital because of fever. There was a substantial decrease in the number of children given aspirin yet there was a lack of parental knowledge about Reye's syndrome. The decline in the use of aspirin is believed to be due to the withdrawal of these products and the mandatory warning labels on all preparations containing aspirin. The lack of parental knowledge regarding Reye's syndrome suggests that the effects of the public education campaign were not sustained. Warning labels are still necessary on aspirin preparations and public education efforts must be continued. Parents must be educated of the association between Reye's syndrome and aspirin in order to continue to prevent more cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Complications and side effects, Risk factors, Aspirin, Health education, Reye syndrome

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New insights into the haemolytic uraemic syndromes

Article Abstract:

Hemolytic-uremic syndrome (HUS) occurs primarily in infants and young children, and is characterized by hemolytic anemia (the breakdown of red blood cells), thrombocytopenia (decreased number of platelets, blood cells important for clotting), and acute kidney failure. In the last 10 years, two subgroups of HUS have been identified: D+ HUS and D-HUS. The most common type, D+ HUS, occurs after a diarrheal illness and carries a good prognosis, with an 85 percent rate of recovery. D+ HUS is associated with a toxin, related to that of dysentery, that is released by some strains of Escherichia coli, a common intestinal bacteria. The involvement of this toxin in HUS was confirmed by the authors in a related paper in the July 1990 issue of Archives of Disease in Childhood. The current article reviews the mechanism by which this toxin is thought to work. Because the incidence of HUS is increasing, pediatricians are advised to closely follow children with diarrheal illnesses. To avoid kidney failure, rehydration of a child with diarrhea should be conducted while monitoring kidney function. In addition, examining stool and blood samples for the presence of this toxin, rather than for specific bacterial strains, is recommended. Patients who develop severe disease or D-HUS (without diarrhea) may require the care of a pediatric nephrologist (kidney specialist). (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, editorial

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