The United States national prospective hemolytic uremic syndrome study: Microbiologic, serologic, clinical, and epidemiologic findings

The frequency of Shiga toxin-producing Escherichia coli (STEC) serotypes as sociated with postdiarrheal hemolytic uremic syndrome (HUS) cases among chi ldren and adults in the United States and the proportion with IgM or IgG li popolysaccharide antibodies to E. coli O157 were determined by use of a nat ionwide sample from January 1987 through December 1991. Among 83 patients, STEC were isolated from 30 (43%) of 70 whose stool cultures yielded bacteri al growth (25 E. coli O157 isolates and 5 non-O157 STEC isolates). Fifty-th ree (80%) of 66 patients with serum samples had positive O157 lipopolysacch aride antibody titers. Of the 83 patients, 60 (72%) had evidence of STEC in fection, including 6 of 8 adults whose illnesses also met criteria for thro mbotic thrombocytopenic purpura. Data from a subset of patients suggest tha t E. coli O157 was the cause of greater than or equal to 80% of the STEC in fections. All 3 women who were postpartum had evidence of E. coli O157 infe ction. STEC infection should be considered the likely cause for all persons with postdiarrheal HUS.