OBJECTIVES: Children with acute bloody diarrhea are at risk of being infected with Shiga toxin-producing Escherichia coli (STEC) and of progression to hemolytic uremic syndrome. Our objective was to identify clinical and laboratory factors associated with STEC infection in children who present with acute bloody diarrhea. METHODS: We performed a prospective cohort study of consecutive children younger than 18 years who presented with acute (<2-week duration) bloody diarrhea between August 1, 2013, and August 1, 2014. We excluded patients with a chronic gastrointestinal illness and/or an obvious noninfectious source of bloody stool. We obtained a standardized history and study laboratory tests, performed physical examinations, and recorded patient outcomes. RESULTS: Of the 135 eligible patients, 108 were enrolled; 27 declined consent. The median patient age was 3 years, and 56% were male. Ten (9%) patients tested positive for STEC (E coli O157:H7, n = 8; E coli O111, n = 1; E coli O103, n = 1), and 62 had negative stool culture results. Children infected with STEC were older (8.5 vs 3 years, respectively) (P < .001) and more likely to have abdominal tenderness (83% vs 17%, respectively) than those in the other groups. D-Dimer concentrations had a 70% sensitivity and 55% specificity for differentiating children with STEC from those with another cause of bloody diarrhea and 75% sensitivity and 70% specificity in differentiating children with a bacterial etiology from those with negative stool culture results. CONCLUSION: Clinical assessment and laboratory data cannot reliably exclude the possibility that children with bloody diarrhea have an STEC infection and are at consequent risk of developing hemolytic uremic syndrome. Abnormal D-dimer concentrations (>0.5 μg/mL) were insufficiently sensitive and specific for distinguishing patients with STEC from those with another bacterial cause of bloody diarrhea. However, this marker might be useful in identifying children whose bloody diarrhea is caused by a bacterial enteric pathogen.
OBJECTIVES: Children with acute bloody diarrhea are at risk of being infected with Shiga toxin-producing Escherichia coli (STEC) and of progression to hemolytic uremic syndrome. Our objective was to identify clinical and laboratory factors associated with STEC infection in children who present with acute bloody diarrhea. METHODS: We performed a prospective cohort study of consecutive children younger than 18 years who presented with acute (<2-week duration) bloody diarrhea between August 1, 2013, and August 1, 2014. We excluded patients with a chronic gastrointestinal illness and/or an obvious noninfectious source of bloody stool. We obtained a standardized history and study laboratory tests, performed physical examinations, and recorded patient outcomes. RESULTS: Of the 135 eligible patients, 108 were enrolled; 27 declined consent. The median patient age was 3 years, and 56% were male. Ten (9%) patients tested positive for STEC (E coli O157:H7, n = 8; E coli O111, n = 1; E coli O103, n = 1), and 62 had negative stool culture results. Children infected with STEC were older (8.5 vs 3 years, respectively) (P < .001) and more likely to have abdominal tenderness (83% vs 17%, respectively) than those in the other groups. D-Dimer concentrations had a 70% sensitivity and 55% specificity for differentiating children with STEC from those with another cause of bloody diarrhea and 75% sensitivity and 70% specificity in differentiating children with a bacterial etiology from those with negative stool culture results. CONCLUSION: Clinical assessment and laboratory data cannot reliably exclude the possibility that children with bloody diarrhea have an STEC infection and are at consequent risk of developing hemolytic uremic syndrome. Abnormal D-dimer concentrations (>0.5 μg/mL) were insufficiently sensitive and specific for distinguishing patients with STEC from those with another bacterial cause of bloody diarrhea. However, this marker might be useful in identifying children whose bloody diarrhea is caused by a bacterial enteric pathogen.
Authors: Stephen B Freedman; Mohamed Eltorki; Linda Chui; Jianling Xie; Sharon Feng; Judy MacDonald; Andrew Dixon; Samina Ali; Marie Louie; Bonita E Lee; Lara Osterreicher; Jennifer Thull-Freedman Journal: J Pediatr Date: 2016-10-10 Impact factor: 4.406
Authors: Silviu Grisaru; Jianling Xie; Susan Samuel; Lisa Hartling; Phillip I Tarr; David Schnadower; Stephen B Freedman Journal: JAMA Pediatr Date: 2017-01-01 Impact factor: 16.193
Authors: Wayne L Chandler; Srdjan Jelacic; Daniel R Boster; Marcia A Ciol; Glyn D Williams; Sandra L Watkins; Takashi Igarashi; Phillip I Tarr Journal: N Engl J Med Date: 2002-01-03 Impact factor: 91.245
Authors: Eileen J Klein; Jennifer R Stapp; Carla R Clausen; Daniel R Boster; Joy G Wells; Xuan Qin; David L Swerdlow; Phillip I Tarr Journal: J Pediatr Date: 2002-08 Impact factor: 4.406
Authors: Chris Stockmann; Andrew T Pavia; Brad Graham; Mike Vaughn; Rob Crisp; Mark A Poritz; Stephanie Thatcher; E Kent Korgenski; Trenda Barney; Judy Daly; Margarita Rogatcheva Journal: J Pediatric Infect Dis Soc Date: 2017-09-01 Impact factor: 3.164
Authors: Luis Hernán Llano López; Pablo Melonari; Stephan Gehring; Daniel Schreiner; Sandra Grucci; Sofía Pérez Araujo; Lorena Di Pauli; Christina Oetzmann von Sochaczewski; Arne Schröder; Laura Piovano Journal: Eur J Clin Microbiol Infect Dis Date: 2020-10-04 Impact factor: 3.267