G2-1320. Serologic Testing for Shiga Toxin-Producing Escherichia coli in Pediatric Hemolytic Uremic Syndrome, Foodborne Diseases Active Surveillance Network (FoodNet), 2000-2005
Session: Poster Session: Pediatrics II
Sunday, October 26, 2008: 12:00 AM
Room: Hall C
Background: Hemolytic uremic syndrome (HUS) is a leading cause of acute renal failure in children, with a mortality rate of 5%. Most HUS cases follow diarrheal illness caused by Shiga toxin-producing Escherichia coli (STEC), primarily STEC O157. HUS is often diagnosed when STEC may no longer be detectable in stool. We evaluated the contribution of serologic testing in HUS cases. Methods: FoodNet conducts population-based active surveillance for STEC infections and HUS. Sites are encouraged to submit sera from HUS patients to test for STEC O157 antibodies. Results:
During 2000-2005, 315 pediatric HUS cases were reported. The median age was 3.6 years; 56% were girls. STEC O157 was isolated from the stool of 177 (56%) children. Of 133 culture-negative children, only 44 (33%) had sera tested but 24 (55%) had antibodies to STEC O157. Children with only positive serology (n=24) were older (4.6 versus 3.5 years), reported bloody diarrhea less frequently (67% versus 95%), and had more days between diarrhea onset and stool culture (7.5 versus 3), than those with only positive culture (n=172). Additionally, a larger proportion of seropositive children received antibiotics for diarrhea (42% versus 27%). Conclusions:
Serologic testing increased the proportion of HUS cases attributable to STEC by 8% (24 cases). Children with STEC infection identified by serology alone were slightly older, less likely to report bloody diarrhea, were cultured later, and more frequently received antibiotics. Culture-negative children without serologic testing represent a lost opportunity for diagnosis.
Amanda Palmer1, Beletshachew Shiferaw, MD, MPH2, Deborah Talkington3, Effie Boothe, MSN, RN, Kanyin L. Ong, MPH5, L. Hannah Gould, PhD6, Melissa Viray, MD7, Patricia Griffin, MD7, Sharon Hurd, MPH8, Tameka Hayes, MPH9 and  M. Viray, None., (1)Maryland Department of Health and Mental Hygiene, (2)Oregan Department of Human Services, Portland, OR, (3)Centers for Disease Control and Prevention, (4)Atlanta Research and Education Foundation, Atlanta, GA, (5)Centers for Disease Control and Prevention, Atlanta, GA, (6)CDC, Atlanta, GA, (7)Connecticut EIP, New Haven, CT, (8)Georgia Division of Public Health, Decatur, GA

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