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Hemolytic-uremic syndrome in Switzerland: a nationwide surveillance 1997–2003

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Abstract

Hemolytic-uremic syndrome (HUS) is a leading cause of acute renal failure in childhood. In its typical presentation, it is preceded by an episode of diarrhea mostly due to Shiga-toxin-producing Escherichia coli. There is important geographical variation of many aspects of this syndrome. Nationwide data on childhood HUS in Switzerland have not been available so far. In a prospective national study through the Swiss Pediatric Surveillance Unit 114 cases (median age 21 months, 50% boys) were reported between April 1997 and March 2003 by 38 pediatric units (annual incidence 1.42 per 105 children ≤16 years). Shiga-toxin-producing E. coli were isolated in 32 (60%) of tested stool samples, serotype O157:H7 in eight. Sixteen children presented with only minimal renal involvement, including three with underlying urinary tract infection. Six patients presented with atypical hemolytic-uremic syndrome, and six with HUS due to invasive Streptococcus pneumoniae infection. Mortality was 5.3%, including two out of six children with S. pneumoniae infection. The severity of thrombocytopenia and the presence of central nervous system involvement significantly correlated with mortality. In conclusion, childhood HUS is not rare in Switzerland. Contrasting other countries, E. coli O157:H7 play only a minor role in the etiology. Incomplete manifestation is not uncommon.

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Abbreviations

HUS:

hemolytic-uremic syndrome

D+ HUS:

typical HUS (enteropathic or non-enteropathic)

D− HUS:

atypical HUS

cHUS:

complete HUS

iHUS:

incomplete HUS

Stx:

Shiga toxin

EHEC:

enterohemorrhagic Escherichia coli

NENT:

Swiss National Centre for Enteropathogenic Bacteria

SPSU:

Swiss Pediatric Surveillance Unit

STEC:

Shiga-toxin-producing Escherichia coli

UTI:

urinary tract infection

CI:

confidence interval

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Acknowledgment

National Centre for Enteropathogenic Bacteria (NENT), Lucerne: A. Burnens, P. Boerlin, and H. Hächler

Conflicts of interest

The authors declare that they have no conflicts of interest

Author information

Authors and Affiliations

  1. University Children’s Hospital UKBB, Roemergasse, 8, CH4058, Basel, Switzerland

    Alexandra Schifferli, Matteo Fontana & Christoph Rudin

  2. University Children’s Hospital, Berne, Switzerland

    Rodo O. von Vigier

  3. University Children’s Hospital, Zurich, Switzerland

    Giuseppina Spartà

  4. Federal Office of Public Health (FOPH), Berne, Switzerland

    Hans Schmid

  5. Division of Pediatrics, Ospedale San Giovanni, Bellinzona, Switzerland

    Mario G. Bianchetti

Authors
  1. Alexandra Schifferli
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  2. Rodo O. von Vigier
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  3. Matteo Fontana
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  4. Giuseppina Spartà
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  5. Hans Schmid
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  6. Mario G. Bianchetti
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  7. Christoph Rudin
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Consortia

The Swiss Pediatric Surveillance Unit (SPSU)

Corresponding author

Correspondence to Christoph Rudin.

Additional information

Swiss Pediatric Surveillance Unit Committee: Ch. Aebi, Berne (President); V. Bernet-Büttiker, Zurich; P. Hüppi, Geneva; B. Laubscher, Neuchâtel; Ch. Rudin, Basel; H. Zimmermann, Berne; D. Beeli, Berne.

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Schifferli, A., von Vigier, R.O., Fontana, M. et al. Hemolytic-uremic syndrome in Switzerland: a nationwide surveillance 1997–2003. Eur J Pediatr 169, 591–598 (2010). https://doi.org/10.1007/s00431-009-1079-9

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  • DOI: https://doi.org/10.1007/s00431-009-1079-9

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