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Title: Importance of case age in the purported association between phylogenetics and hemolytic uremic syndrome in Escherichia coli O157:H7 infections.

Authors: Tarr, G A M; Shringi, S; Oltean, H N; Mayer, J; Rabinowitz, P; Wakefield, J; Tarr, P I; Besser, T E; Phipps, A I

Published In Epidemiol Infect, (2018 09)

Abstract: Escherichia coli O157:H7 is the largest cause of hemolytic uremic syndrome (HUS). Previous studies proposed that HUS risk varies across the E. coli O157:H7 phylogenetic tree (hypervirulent clade 8), but the role of age in the association is unknown. We determined phylogenetic lineage of E. coli O157:H7 isolates from 1160 culture-confirmed E. coli O157:H7 cases reported in Washington State, 2004-2015. Using generalised estimating equations, we tested the association between phylogenetic lineage and HUS. Age was evaluated as an effect modifier. Among 1082 E. coli O157:H7 cases with both phylogenetic lineage and HUS status (HUS n = 76), stratified analysis suggested effect modification by age. Lineages IIa and IIb, relative to Ib, did not appear associated with HUS in children 0-9-years-old. For cases 10-59-years-old, lineages IIa and IIb appeared to confer increased risk of HUS, relative to lineage Ib. The association reversed in ⩾60-year-olds. Results were similar for clade 8. Phylogenetic lineage appears to be associated with HUS risk only among those ⩾10-years-old. Among children <10, the age group most frequently affected, lineage does not explain progression to HUS. However, lineage frequency varied across age groups, suggesting differences in exposure and/or early disease manifestation.

PubMed ID: 29914582 Exiting the NIEHS site

MeSH Terms: Adolescent; Adult; Age Factors; Child; Child, Preschool; Escherichia coli Infections/epidemiology; Escherichia coli Infections/microbiology*; Escherichia coli O157/isolation & purification*; Female; Hemolytic-Uremic Syndrome/epidemiology; Hemolytic-Uremic Syndrome/microbiology*; Humans; Infant; Infant, Newborn; Male; Middle Aged; Phylogeny; Retrospective Studies; Washington/epidemiology

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