Clinical management of children with suspected or confirmed E. coli O157 infection

Scotland continues to report higher rates of infection with Escherichia coli O157 than elsewhere in the UK. Infection with E. coli O157 usually manifests as acute, afebrile, painful, bloody diarrhoea and is the commonest cause of Haemolytic Uraemic Syndrome (HUS), an important cause of childhood renal failure. In 1996 an outbreak of E. coli O157 infection in Central Scotland, resulted in over 500 cases and 17 deaths. Ten years on, high-profile outbreaks of E. coli O157 infection in Scotland still result in cases of HUS and fatalities. We sought to identify outcomes and describe pre-hospital clinical management strategies using prospective, national surveillance of paediatric HUS cases, from 2003 to 2006 inclusive. We recommend that children who present with acute, afebrile, and painful bloody diarrhoea be referred to hospital as early as possible for appropriate clinical management.