HEMOLYTIC UREMIC SYNDROMES IN THE BRITISH-ISLES 1985-8 - ASSOCIATION WITH VEROCYTOTOXIN PRODUCING ESCHERICHIA-COLI .1. CLINICAL AND EPIDEMIOLOGIC ASPECTS

A prospective study of the clinical and epidemiological features of the haemolytic uraemic syndromes was conducted over a three year period in the British Isles. Two hundred and ninety eight children were reported. In two thirds of cases stool samples were analysed for the presence of Verocytotoxin producing Escherichia coli (VTEC) and neutralisable Verocytotoxin. A total of 273 (95%) patients had a prodrome of diarrhoea. In these a seasonal variation in the incidence of haemolytic uraemic syndrome was demonstrated, the 1-2 year age range was most often affected, and the peripheral blood neutrophil count correlated positively with an adverse outcome. Patients presenting without diarrhoea showed none of these associations and had a significantly greater morbidity and mortality. Evidence for VTEC infection was found in 58 (33%) of 178 diarrhoea associated cases whose stools were analysed, although VTEC were identified in five of eight (62%) patients whose stools were collected within three days of the onset of diarrhoea. Most isolates produced VT2 either alone, or together with VT1. There was no evidence of VTEC infection in patients without prodromal diarrhoea.