Although rare, cases of hemolytic uremic syndrome (HUS) from E. coli infections in adults more frequently result in severe illness and death than pediatric cases, according to a new study. Published in the most recent issue of the Center’s for Disease Control and Prevention’s (CDC’s) publication Emerging Infectious Disease, the study called “Shiga Toxin–Associated Hemolytic Uremic Syndrome in Adults, France, 2009–2017” was conducted by researchers in France.

The retrospective study looked at HUS cases caused by Shiga toxin-producing E. coli (STEC) in 96 adults from 2009 to 2017. Because HUS most often affects children, France has been tracking STEC-associated HUS in children under the age of 15 since 1996, but no national tracking program exists for cases of adult E. coli HUS. Despite the significantly lower incidence of E. coli HUS among adults than in children, researchers found that the 60+ age group was associated with the most fatalities.

Most of the patients, 72 percent, had some kind of underlying condition, 28 percent had an underlying immunodeficiency, 42 patients had high blood pressure at admission.

E.coli lawyer - patient in hospital bed with monitor in finger

Symptoms of Adult E. coli HUS

The adult E. coli HUS patients in this study experienced the following symptoms:

  • 82 percent had diarrhea,
  • 49 percent had bloody diarrhea.
  • 11 patients had severe colitis, 4 of whom required emergency surgery
  • 100 percent of patients had renal impairment
  • 64 percent  required dialysis
  • 76 percent had had neurologic symptoms such as confusion and headache
  • 52 percent had a serious neurologic complication such as seizure, coma, or focal deficiency
  • 35 percent required mechanical ventilation
  • 43 percent had cardiac events

Study Conclusions

The researchers found that underlying conditions were a major factor in survival rates. Specifically, immunodeficiency was strongly associated with decreased survival among adults with HUS. They also concluded that the prevalence of these cases is likely underestimated and surveillance should be expanded.


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