HUS Risk Factors

After a diagnosis of an infection with shiga-toxin producing E. coli O157:H7 (STEC) is confirmed, careful monitoring is necessary to watch for signs of hemolytic uremic syndrome (HUS). STEC is the leading cause of hemolytic uremic syndrome, and can develop between 3-14 days after the onset of bloody diarrhea (1). Between 3-15% of people who develop a STEC infection will develop hemolytic uremic syndrome, with the highest concentration among children under 10, the elderly, those with compromised immune systems and people that have contact with farm animals (2).

Other risk factors include (3, 4):

• Bloody diarrhea (associated with E. coli O157:H7 infections and other enterohemorrhagic E. coli (EHEC) strains)
• Fever (develops in only 10-20% of STEC infections)
• Elevated white blood cell count (indicates infection)
• Elevated C-reactive protein levels (an acute phase protein that activates complement and aids in opsonization, a signal of infection)
• Use of antibiotics
• Use of antimotility/antidiarrheal drugs (to help abdominal pain in STEC infection)

Sources:

1. Walker, W. Pediatric Gastrointestinal Disease: Pathophysiology, Diagnosis, and Management. 4th ed. Hamilton, Ontario: BC Decker, 2004.

2. Chang HG, Tserenpuntsag B, Kacica M, Smith PF, Morse DL. 2004. Hemolytic uremic syndrome incidence in New York. Emerg Infect Dis. 10:928-31.

3. Kawamura N, Yamazaki T, Tamai H. 1999. Risk factors for the development of Escherichia coli O157:H7 associated with hemolytic uremic syndrome. Pediatr Int. 41:218-22.

4. Panos GZ, Betsi GI, Falagas ME. 2006. Systematic review: are antibiotics detrimental or beneficial for the treatment of patients with Escherichia coli O157:H7 infection. Aliment Pharmacol & Ther. 24:731-742.

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