A new study published in Emerging Infectious Diseases has found that adult STEC HUS disease is more serious and fatal than the same disease in children, even though children are far more likely to develop this complication after an E. coli infection. The retrospective study looked at Shiga toxin-associated hemolytic uremic syndrome in 96 adults who lived in France from 2009 to 2017.
The researchers found that 20% of adults in France who had STEC HUS disease died during hospitalization, while less than one percent of children who had STEC-associated HUS died during the same years. The deaths were concentrated in the age group of 60+ years. Furthermore, adults had cerebral involvement three times more often than children. More than 52% of adult patients had severe neurologic manifestations, and renal recovery among that group was slow and inconsistent.
Adult STEC HUS is a severe systemic disease that can cause multiple organ failure. STEC-associated HUS has a U curve from birth to old age. The risk for death from STEC-associated HUS increases for people who are over the age of 40. There is a strong association between underlying conditions and decreased survival, especially among patients who have immune deficiencies. Seventy-two percent of the adult patients who developed STEC HUS had some type of underlying condition, while 28% had immune deficiency problems.
The study showed that 100% of patients had renal impairment, and 76% had serious complications such as coma or seizures. Thirty-five percent needed mechanical ventilation, and 43% suffered cardiac events. Sixty-four percent required dialysis because of damage to their kidneys, and 11 patients developed severe colitis.
The researchers say that more studies are needed to see if the use of antimicrobial drugs, which are contraindicated before hemolytic uremic syndrome develops, may reduce the duration of STEC carriage. They also state that adult HUS cases are most likely underestimated, so active epidemiologic and microbiological surveillance of this disease in adults should be implemented.
