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Hemolytic uremic syndrome in Belgium: Incidence and association with verocytotoxin-producing Escherichia coli infection

par Pierard, Denis;Cornu, G.;Proesmans, Willem;Dediste, Anne ;Jacobs, Frédérique ;Van De Walle, Johan;Mertens, Antje;Ramet, José;Lauwers, Sabine;Boelaert, Johan R.;Chantraine, Jean Marie;Cuvelier, Antoine;De Beenhouwer, Hans;Delmée, Michel;Duyckx, M.C.;Hansen, Valérie;Jordens, Paul;Lessire, M.N.;Masschelin, B.;Nulens, Eric;Peetermans, Willy;Struelens, Marc ;Surmont, Ignace;Thys, Jean-Pierre ;Trippaerts, Marc;Vandemarliere, M.;Van Landuyt, Herman;Verschraegen, Gerda;Vogelaers, Dirk;Verbist, Ludo;Verhaegen, Jan;Beckers, Jan;Boven, Katia;Brouillard, J.;Devaster, Jeanne-Marie ;Ghysen, M.S.;Glupczynski, Gérald ;Ieven, Margareta;Levy, Jack ;Madhoun, Philippe;Matthys, D.;Melin, Pierrette;Meunier, Françoise ;Vos, Jaap
Référence Clinical microbiology and infection, 5, 1, page (16-22)
Publication Publié, 1999-01

Article révisé par les pairs

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Résumé :

Objective: To evaluate the incidence of hemolytic uremic syndrome (HUS) in Belgium and to determine the role of verocytotoxin-producing Escherichia coli 0157:H7 and other serotypes (non-0157 VTEC). Methods: Twenty-two centers, including the seven university hospitals, registered prospectively all cases of HUS; they collected clinical samples for isolation of VTEC strains and serum for detection of specific O-lipopolysaccharide antibodies. Results: Forty-seven cases of HUS (including five incomplete cases) were recorded. Three cases were seen in nonresidents. The incidence of complete HUS in Belgian residents was 4.3 cases/100,000 in children < 5 years old, 1.8 cases/100,000 when all children < 15 years were considered, and 0.42/100,000 when patients of all ages were taken into account. By combining bacteriologic and serologic results, evidence of VTEC infection was obtained in 64% of the patients, mainly but not exclusively in children with prodromal diarrhea. The 13 VTEC isolates belonged to serotypes 0157:H7 (nine isolates), 026:H11, 0121:H-, 0145:H- and 0172:H- (one each) and all produced VT2 (+VT2vh-a in three 0157 strains) and were positive for the eaeA gene. Conclusions: The incidence rate found in this study and the high mortality and morbidity linked with this syndrome warrant further registration of pediatric and post-diarrheic adult HUS cases and also examination of stools for both 0157 and non-0157 VTEC strains. For effective prevention of this disease, further study of the serotypes and accessory virulence factors associated with HUS is needed.