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Volume 27, Number 7—July 2021

Shiga Toxin–Associated Hemolytic Uremic Syndrome in Adults, France, 2009–2017

Benoît Travert1, Antoine Dossier1, Matthieu Jamme, Aurélie Cointe, Yahsou Delmas, Sandrine Malot, Alain Wynckel, Amélie Seguin, Claire Presne, Miguel Hie, Ygal Benhamou, David Ribes, Gabriel Choukroun, Steven Grangé, Alexandre Hertig, Emilie Cornec Le Gall, Lionel Galicier, Eric Daugas, Lila Bouadma, François-Xavier Weill, Elie Azoulay, Fadi Fakhouri, Agnès Veyradier, Stéphane Bonacorsi, Julien Hogan, Véronique Frémeaux-Bacchi, Eric Rondeau, Patricia Mariani-Kurkdjian, Paul CoppoComments to Author , and Centre de Référence des Microangiopathies Thrombotiques2
Author affiliations: Centre de Référence des Microangiopathies Thrombotiques, Paris, France (B. Travert, A. Dossier, M. Jamme, Y. Delmas, S. Malot, A. Wynckel, A. Seguin, C. Presne, M. Hie, Y. Benhamou, G. Choukroun, S. Grangé, A. Hertig, L. Galicier, E. Azoulay, F. Fakhouri, A. Veyradier, V. Frémeaux-Bacchi, E. Rondeau, P. Coppo); Université de Paris, Paris (B. Travert, A. Dossier, A. Cointe, L. Galicier, E. Daugas, L. Bouadma, E. Azoulay, A. Veyradier, S. Bonacorsi, J. Hogan, V. Frémeaux-Bacchi, P. Mariani-Kurkdjian); Hôpital Bichat—Claude Bernard, Paris (B. Travert, A. Dossier, E. Daugas, L. Bouadma); Sorbonne-Université, Paris (M. Jamme, M. Hie, A. Hertig, E. Rondeau, P. Coppo); Hôpital Tenon, Paris (M. Jamme, E. Rondeau); Hôpital Robert-Debré, Paris (A. Cointe, S. Bonacorsi, J. Hogan, P. Mariani-Kurkdjian); Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France (Y. Delmas); Hôpital Maison Blanche, Reims, France (A. Wynckel); Centre Hospitalier Universitaire de Caen, Caen, France (A. Seguin); Centre Hospitalier Universitaire d’Amiens, Amiens, France (C. Presne, G. Choukroun); Groupement Hospitalier Pitié-Salpêtrière, Paris (M. Hie, A. Hertig); Centre Hospitalier Universitaire de Rouen, Rouen, France (Y. Benhamou, S. Grangé); Centre Hospitalier Universitaire de Toulouse, Toulouse, France (D. Ribes); Centre Hospitalier Universitaire de Brest, Brest, France (E. Cornec-Le Gall); Hôpital Saint-Louis, Paris (L. Galicier, E. Azoulay); I; nstitut Pasteur, Paris (F.-X. Weill); Centre Hospitalier Universitaire de Nantes, Nantes, France (F. Fakhouri); Hôpital Lariboisière, Paris (A. Veyradier); Hôpital Européen Georges Pompidou, Paris (V. Frémeaux-Bacchi); Hôpital Saint Antoine, Paris (P. Coppo)

Main Article

Table 2

Clinical and biological characteristics of adults with Shiga toxin–associated hemolytic uremic syndrome, France, 2009–2017*

Characteristic Value
Clinical features
Fever 16/78 (20.5)
Diarrhea 80/96 (83.3)
Bloody diarrhea 47/96 (49.0)
Median time between symptom onset and hospitalization, d (IQR)†
4 (1–9)
Renal manifestations
Median serum creatinine level, μmol/L (IQR)‡ 221.5 (145–391)
Acute kidney injury§ 96/96 (100.0)
KDIGO stage 1 3/96 (3.1)
KDIGO stage 2 17/96 (17.7)
KDIGO stage 3 74/96 (77.1)
Hemodialysis 61/96 (63.5)
Median time before dialysis, d¶ 3 (1–6)
Oligoanuria 47/96 (49.0)
Proteinuria (i.e., >0.5 g/L)
33/42 (78.6)
Neurologic events
Any neurologic sign 73/96 (76.0)
Headache 18/96 (18.8)
Confusion 54/96 (56.3)
Seizure 30/96 (31.3)
Coma 36/96 (37.5)
Focal deficiency 25/96 (26.0)
Abnormal brain imaging# 23/58 (39.7)
Abnormal computed tomographic scan 5/38 (13.2)
Abnormal magnetic resonance imaging 20/42 (47.6)
Stroke, coma, or seizure
50/96 (52.1)
Required mechanical ventilation
34/96 (35.4)
Cardiac events
Any cardiac event 41/96 (42.7)
High troponin level 26/43 (60.5)
Acute coronary syndrome 4/96 (4.2)
New onset of heart arrhythmia 4/96 (4.2)
Acute heart failure 16/96 (16.7)
Recovered from cardiac arrest
1/96 (1.0)
Laboratory features
Median leukocyte count, 109 cells/L (IQR) 10.5 (8.05–13.8)
Median platelet count, 109 cells/L (IQR)** 56 (36–120)
Platelet count <30, 109 cells/L** 19/96 (19.8)
Platelet count <30, 109 cells/L and serum creatinine <200 μmol/L** 5/96 (5.2)
Median hemoglobin, g/dL (IQR)** 10.4 (8.90–12.4)
Elevated lactate deshydrogenase (i.e., >250 IU/L) 78/79 (98.7)
C-reactive protein, mg/L (IQR)†† 48 (22–120)
Elevated lipase (i.e., >210 U/L) 5/32 (15.6)
Low CH50 (i.e., <70%) 26/67 (38.8)
Low C3 (i.e., <0.660 g/L) 5/69 (7.2)
Low C4 (i.e., <0.093 g/L) 3/69 (4.3)
Low complement factor H (i.e., <70%) 3/69 (4.3)
Low complement factor I (i.e., <70%) 1/69 (1.4)
Low CD46 (i.e., <13 µg/L) 23/35 (65.7)
Anti-FH antibody (>150 arbitrary units)‡‡
2/69 (2.9)
Microbiological findings
Shiga toxin genotype 96/96 (100)
stx1+/stx2 12/84 (14.3)
stx2+/stx1 63/84 (75.0)
stx1+/stx2+ 9/84 (10.7)
Escherichia coli serogroup
O157 10/67 (14.9)
O104 8/67 (11.9)
O91 12/67 (17.9)
O80 4/67 (6.0)
O26 4/67 (6.0)
O103 3/67 (4.5)
O111 1/67 (1.5)
Minor serogroups§§ 25/67 (37.3)
Isolation site
Stool 90/96 (93.8)
Urine 7/96 (7.3)
Blood culture 4/96 (4.2)
Multisite¶¶ 5/96 (5.2)

*Values are no. with characteristic/total no. patients (%) except as indicated. KDIGO, Kidney Disease Improving Global Outcomes (15). †Time of symptom onset was the first reported day of diarrhea (for patients with diarrhea) or fever, confusion, abdominal pain, or nausea/vomiting (for patients without diarrhea). ‡Out of 90 patients; samples taken at admission. §Two patients had proteinuria (i.e., >1 g/L) but not elevation of serum creatinine. ¶Out of 60 patients requiring dialysis. #Recent brain lesions on magnetic resonance imaging, computed tomographic scan, or both. Fourteen patients had stroke lesions, 3 had posterior reversible encephalopathy syndrome lesions, 4 had intracerebral bleeds, and 12 had white matter lesions consistent with thrombotic microangiopathies. **Samples taken at admission. ††Out of 52 patients. ‡‡One patient had 242 arbitrary units and 1 had 800 arbitrary units. §§Four patients had strains belonging to O106, 3 to O128, 3 to O174, 2 to O113, 1 to O100, 1 to O126, 1 to O148, 1 to O177, 1 to O78, 1 to O84, and 7 to an O serogroup not typable at the time of identification. ¶¶Two patients had E. coli in urine and stool samples, 2 had E. coli in stool and blood samples, and 1 had E. coli in blood and urine samples.

Main Article

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Main Article

1These first authors contributed equally to this article.

2Members of this group are listed at the end of this article.

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