Reuters Health

By Anthony J. Brown, MD

Tuesday, September 9, 2003

NEW YORK (Reuters Health) - Children who eat undercooked beef can become infected with a bug that can cause lasting kidney problems, new research shows.

Undercooked beef and other food items can be contaminated with a bacteria called E. coli:O157:H7. Eating tainted foods causes infection with the microbe, resulting in diarrhea and other debilitating symptoms such as vomiting, cramps, and fever. More worrisome, about one in ten children will develop a serious disease called hemolytic uremic syndrome or HUS.

HUS is known to be the most common cause of acute kidney failure in children. Although this type of failure often resolves, findings from the new study indicate many children who've survived HUS still have long-term kidney problems.

Dr. Amit X. Garg, from the London Health Sciences Centre in Ontario, Canada, and others reviewed 49 studies that looked at the long-term kidney outcomes of nearly 3500 children with HUS. The patients ranged in age from 1 month to 18 years and the average follow-up period was just over 4 years.

The new findings are reported in this week's Journal of the American Medical Association (JAMA).
Death or permanent kidney disease occurred in about 12 percent of patients, the authors note. In addition, 25 percent of HUS survivors demonstrated long-term kidney problems.

The more severe the initial illness, the greater was the risk of long-term problems. For example, children whose illness involved serious conditions like coma or seizures were at increased risk of dying or having permanent kidney disease. Also, requiring dialysis for the initial illness was tied to a worse long-term outlook.

So what can be done to help these kids with HUS?

In another study reported in the journal, Dr. Howard Trachtman, from Schneider Children's Hospital in New Hyde Park, New York, and colleagues tested a new drug designed to bind to Shiga toxin, the chemical produced by E. Coli that causes HUS.

SYNSORB Pk, which is produced by Canadian company SYNSORB Biotech, Inc, is thought to work by blocking the toxin's ability to be absorbed into the body from the intestines.

The study involved 145 children with HUS who received SYNSORB Pk or inactive placebo pills for 7 days.

Treatment with SYNSORB did not lessen the severity of HUS. The percentage of patients who died or had serious non-kidney problems was nearly the same in both groups -- about 19 percent. Similarly, close to 40 percent of patients in each group required dialysis, an indicator that their kidneys were not working well.

According to a related editorial, drugs that try to control HUS once it has occurred may not be the best treatment strategy.

"I think the focus needs to be on preventing HUS," Dr. Richard L. Siegler, author of the editorial, told Reuters Health. For example, E. coli-infected patients could be given infusions of antibodies that neutralize Shiga toxin in the blood and reduce its ability to cause HUS.