Effectiveness of therapeutic plasma exchange in the 1996 Lanarkshire Escherichia coli O157 : H7 outbreak.
Background The largest number of adult cases of haemolytic uraemic syndrome (HUS)/thrombotic thrombocytopenic purpura (TTP) during an Escherichia coli 0157 outbreak occurred in 1996 in central Scotland.
Adults who develop HUS/TTP induced by E coli 0157 tend to be elderly and have a historical mortality rate of almost 90% when treated conservatively.
Therefore the decision was made to treat adults who developed HUS/TTP during this outbreak with therapeutic plasma exchange (TPE).
We report our outcome with this controversial treatment.
Methods A case definition for HUS/TTP was developed at the beginning of the outbreak.
All cases meeting this definition were considered for TPE.
Information on demographics, clinical features, treatment and outcome of patients was obtained by retrospective case note review.
Findings 22 adults developed HUS/TTP.
They had a mean age of 71 years. 16 cases received TPE.
Six cases had contraindications to TPE or died before the procedure could be done.
Ten of the 22 (45%) adults with HUS/TTP died.
Five of the 16 (31%) TPE-treated cases died, four of eight aged over 70 years compared with one of eight aged less than 70 years.
Premorbid illness, neurological features, treatment with ciprofloxacin or prostacyclin, and the laboratory severity of HUS/TTP were not associated with death ; the number of cases, however, was too small to allow statistical conclusion. (...)
Mots-clés Pascal : Purpura thrombocytopénique thrombotique, Urémie, Hémolyse, Gastroentérite, Escherichia coli, Enterobacteriaceae, Bactérie, Bactériose, Infection, Complication, Dialyse, Epidémiologie, Echange plasmatique, Traitement, Efficacité traitement, Homme, Royaume Uni, Europe, Thrombocyte, Pronostic, Hémopathie, Anémie hémolytique, Système nerveux pathologie, Appareil urinaire pathologie, Capillaire sanguin pathologie, Peau pathologie, Vaisseau sanguin peau pathologie, Rein pathologie, Insuffisance rénale, Appareil digestif pathologie, Estomac pathologie, Intestin pathologie
Mots-clés Pascal anglais : Thrombotic thrombocytopenic purpura, Uremia, Hemolysis, Gastroenteritis, Escherichia coli, Enterobacteriaceae, Bacteria, Bacteriosis, Infection, Complication, Dialysis, Epidemiology, Plasma exchange, Treatment, Treatment efficiency, Human, United Kingdom, Europe, Platelet, Prognosis, Hemopathy, Hemolytic anemia, Nervous system diseases, Urinary system disease, Capillary vessel disease, Skin disease, Vascular disorders of the skin, Kidney disease, Renal failure, Digestive diseases, Gastric disease, Intestinal disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0514626
Code Inist : 002B05B02F. Création : 18/05/2000.