Haemolytic-uraemic syndrome in childhood: surveillance and case-control studies in Italy. Italian HUS Study Group.

Seventy-six cases of haemolytic-uraemic syndrome (HUS) were collected over a 4-year period during a surveillance and case-control study. The annual incidence of 0.2 per 100,000 children aged 0-14 years is lower than in other countries; 34% had no prodromal diarrhoea. Evidence for verocytotoxin-producing Escherichia coli (VTEC) infection was found in 72% of patients and 3% of controls; 88% of patients with bloody diarrhoea, 67% with non-bloody diarrhoea and 55% without diarrhoea were VTEC positive. Seventy-three percent of patients had creatinine clearance > or = 80 ml/min per 1.73 m2, normal blood pressure, no proteinuria and haematuria < 2+ after 1 year of follow-up. One patient died and none had non-renal sequelae. VTEC positivity was significantly correlated with a good outcome, while the absence of diarrhoea and a high total white blood cell count at onset were not predictors of a bad outcome. Household contacts of HUS patients had diarrhoea more frequently than those of the control group, supporting the hypothesis of person-to-person transmission of VTEC infection.