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http://link.springer.de/link/service/journals/00467/contents/02/00966/

© IPNA 2002

Laura De Petris^1, , Alessandra Gianviti¹, Daniela Caione², Daniele Innocenzi², Alberto Edefonti³, Giovanni Montini⁴, Tommaso De Palo⁵, Alberto Eugenio Tozzi⁶, Alfredo Caprioli⁷ and Gianfranco Rizzoni¹

The authors wrote this article on behalf of and with the assistance of the members of the Italian HUS Surveillance Group. The members of the group include: Alfonso Ferretti, Division of Nephrology and Dialysis, Santobono Hospital, Naples; Maurizio Gaido, Division of Nephrology and Dialysis, Regina Margherita Hospital, Turin; Francesco Perfumo, Division of Nephrology and Dialysis, G. Gaslini Hospital, Genoa; Nunzia Miglietti, Pediatric Clinic, Spedali Civili, Brescia; Leopoldo Peratoner, Pediatric Division, Civil Hospital, Pordenone; Ivana Pela, Pediatric Clinic, Meyer Hospital, Florence; Ilse Ratsche, Pediatric Clinic, University of Ancona; Elio Salvaggio, Pediatric Clinic, Catholic University, Rome; Giuliana Lama, Pediatric Clinic, University Federico II, Naples; Giovanni Capasso, Division of Nephrology and Dialysis, University of Naples; Rosa Penza, Pediatric Clinic, University of Bari; Silvio Maringhini, Division of Nephrology, Di Cristina Hospital, Palermo; Salvatore Li Volti, Pediatric Clinic, University of Catania; Carmen Setzu, Division of Nephrology, Brotzu Hospital, Cagliari; Marco Pennesi, Burlo Hospital, Trieste; Gianluigi Ardissino, Dialysis Unit, Pediatric Clinic de Marchi Milan, Italy; Alberto Bettinelli, Pediatric Unit, San Leopoldo Mantic Hospital, Merate; Salvatore Maffei, Pediatric Clinic, University of Perugia

Abstract. Verocytotoxin-producing Escherichia coli (VTEC) infections cause most cases of hemolytic uremic syndrome (HUS); 10-30% of patients, however, are negative for VTEC infection. The etiology of HUS in VTEC-negative cases remains poorly understood. Before the association between VTEC infection and HUS was recognized, sporadic cases of HUS with enterovirus infection were reported in the literature. Since May 1988, most cases of HUS in Italy have been reported to the Italian surveillance system, and in 73% of these, evidence of VTEC infection was demonstrated. The aim of this study was to determine whether the frequency of enteroviral infections was different in the acute phase of VTEC-positive and VTEC-negative HUS. Eighty-nine patients were investigated for enteroviral infection, of whom 58 were VTEC positive and 31 VTEC negative. Two serum samples from each patient were examined for seroconversion to enterovirus (coxsackie, echovirus, and picornavirus) by a complement fixation test. Serological evidence of acute infection with non-polio enterovirus was found in 33 patients (37%) [20/58 (34.5%) VTEC positive and 13/31 (41.9%) VTEC negative]. There was no statistically significant difference between the two groups. These results demonstrate that there are no significant differences for enteroviral infection in VTEC-positive and VTEC-negative patients and, therefore, enteroviral infections should not be considered a cause of HUS in VTEC-negative children.

Keywords. Hemolytic uremic syndrome - Verocytotoxin-producing Escherichia coli infection - Enterovirus - Complement fixation test

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