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

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

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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.

Original languageEnglish
Pages (from-to)1550-1555
Number of pages6
JournalEpidemiology and infection
Volume146
Issue number12
DOIs
StatePublished - Sep 1 2018

Keywords

  • Epidemiology
  • Escherichia coli (E. coli)
  • Shiga toxin-producing E. coli
  • phylogenetics

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    Tarr, G. A. M., Shringi, S., Oltean, H. N., Mayer, J., Rabinowitz, P., Wakefield, J., Tarr, P. I., Besser, T. E., & Phipps, A. I. (2018). Importance of case age in the purported association between phylogenetics and hemolytic uremic syndrome in Escherichia coli O157:H7 infections. Epidemiology and infection, 146(12), 1550-1555. https://doi.org/10.1017/S0950268818001632