26 cases of haemolytic uremic syndrome (HUS) linked to E.coli bacteria have been identified in children in France since the beginning of the year. Two deaths are confirmed. What is that ? How to avoid it? Symptoms, diagnosis, treatment, pediatrics: definition and advice.
A increase in the number of cases of hemolytic-uremic syndrome (SHU) and serious Escherichia coli infection, reported since the beginning of February 2022, is observed in France. At March 11, 2022according to communicated from the Ministry of Health, 26 cases of HUS or severe infection have been identified. These cases occurred in 9 regions of France Metropolitan: New Aquitaine (6 cases), Hauts-de-France (5 cases), Ile-de-France (4 cases), Pays de la Loire (4 cases), Brittany (3 cases), Bourgogne-Franche-Comté ( 1 case), Grand Est (1 case), Provence-Alpes-Côte-D’azur (1 case) and Auvergne-Rhône-Alpes (1 case). The sick children, ages 1 to 15 with a median age of 8 years, presented symptoms between January 18, 2022 and February 23, 2022. Two children died. Furthermore, 22 additional cases are under investigation. “At this stagethe epidemiological investigation did not make it possible to incriminate a source of contamination particular Also the health authorities are renewing the general recommendations for the prevention of food risks, especially in children under the age of 16. indicates the ministry. The SHU imposes an immediate consultation of a doctor in case of suggestive symptoms. Definition and advice.
What is hemolytic uremic syndrome?
Hemolytic-uremic syndrome (HUS) is a infectious disease most often of food origin, rare in France, but serious. We talk about a syndromeHemolytic” because it means that there is “a destruction of red blood cells” (responsible for anemia and a drop in platelets) and “uremic“because there isblood urea. Urea is a waste product from the body eliminated by the kidneys in the urine. Increased blood urea and other waste products such as creatinine indicate kidney failure. This syndrome is most often caused by Shiga-toxin producing Escherichia coli bacteria. These bacteria are eliminated through the stool and can contaminate the environment (water, manure, soil) and food. They tolerate cold well (survival of several days in a refrigerator) but not cooking.
What are the warning symptoms of a HUS?
An infection with E. coli bacteria is manifested by diarrhea often with blood, abdominal pain, and sometimes vomiting which can evolve, after a week approximately towards a severe form of the infection. The main characteristics of the SHU are a haemolytic anemia (extreme fatigue, pallor), thrombocytopenia (drop in platelets) and acute renal failure (decrease in urine volume, darker urine sometimes), sometimes seizures.
What are the symptoms of pediatric HUS?
Every year, about 160 children with HUS are notified to Public Health France, which has set up a system for surveillance of this disease since 1996. In children, this syndrome is most commonly caused by infection with bacteria belonging to the E. coli family. This last manifests itself within 3-4 days after contamination (10 days maximum) by diarrhea often accompanied by blood, from abdominal pain and sometimes vomiting which can progress, after about a week, to a severe form of the infection (HUS) in about 10% of children. The young child then presents signs of great fatigue, paleness, a decrease in the volume of urine, which becomes darker, and sometimes convulsions. A doctor should be consulted immediately in the event of suggestive symptoms. Treatment in hospital may include, among other things, blood transfusions and/or dialysis. Most children recover from post-diarrheal HUS.
The diagnosis is confirmed by a blood test and a urine analysis. The bacteria in question are sought by an analysis of the stools in a specialized laboratory.
What are the treatments for HUS?
HUS secondary to an infection with Escherichia coli producing Shiga-toxins imposes a hospital carewhich is mainly based on the treatment of symptoms. Severe forms may require a dialysis treatment and or blood transfusion within a intensive care unit.
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The Escherichia coli responsible for HUS are present in the intestines of many ruminant animals (cows, calves, goats, sheep, deer, etc.) and are eliminated by excrement who can then contaminate the environment (water, manure, soil) and food. Those bacteria tolerate cold well (survival in a fridge or freezer), but are destroyed by cooking. To avoid the transmission of these bacteria and the aggravation towards a HUS, the following actions must be applied (especially in children under 16 and the elderly):
- Hand washing should be systematic before preparing meals;
- meats, and especially minced beef, but also minced meat preparations, must be well cooked through (and not pink through the core);
- raw milk, cheeses made from raw milk and dairy products made from raw milk should not be consumed by children under 5 years old ; prefer cooked pressed cheeses (such as Emmental, Comté, Gruyère, Beaufort), processed cheese spreads and pasteurized milk cheeses;
- flour-based preparations (pizza/cookie dough/cake/pie, etc.) should not be eaten raw or undercooked;
- vegetables, salad, fruit and aromatic herbs, in particular those that are going to be eaten raw, must be carefully washed before consumption, after peeling if necessary;
- raw foods should be kept separate from cooked or ready-to-eat foods;
- cooked meals and leftover food must be quickly put in the refrigerator and sufficiently reheated and consumed quickly;
- kitchen utensils (especially when they have previously been in contact with raw food), as well as work surfaces, must be thoroughly washed;
- children should not drink untreated water (well water, torrent, etc.) and avoid swallowing it when swimming (lake, pond, etc.);
- finally, it is necessary to avoid the contact of very young children (under 5 years old) with cows, calves, sheep, goats, deer, etc., and their environment; in case of contact with these animals, hand washing must be systematic.
“The risk of long-term sequelae is significant”
What is the risk of complications?
HUS secondary to infection with Escherichia coli producers of Shiga-toxins damages the kidneysit’s here leading cause of kidney failure acute in children under 3 years old in France. Other organs may also be affected, including brain and heart, and “the risk of long-term sequelae is significant” indicated Public Health France. However, with proper care, theclinical course is favorable in a majority of patients. the mortality rate described is less than 5% in the scientific literature, in France it is less than 1% based on monitoring data.
Sources:
– Ministry of Health
– Public Health France