A large outbreak of Escherichia coli O157 infections via school lunches occurred at primary
schools in 1996 in Sakai City, Japan. As many as 10000 patients suffered from diarrhoea,
haemorrhagic colitis and haemolytic uraemic syndrome (HUS). Using data on 288 inpatient
school children affected by this outbreak, of whom 36 presented complete HUS and the
remaining 252 tested positive for E. coli O157 culture, we attempted to identify predictors
for the progression to HUS. Within the first 5 days of illness, clinical features associated with
inpatients who developed HUS compared with those without HUS included a C reactive
protein (CRP) level higher than 1·2 mg/dl (OR 44·26; 95% CI 5·83–336·23),
a white blood cell (WBC) count greater than 11·0 × 109/1
(OR 5·03; 95% CI 27·13–11·87) and a temperature
higher than 38·0 °C (OR 5·00; 95% CI 2·25–117·08).
It can be concluded that these three factors
are predictive factors for the development of HUS in patients with E. coli O157 infection, and
patients who have two or all of these factors should be observed closely.