[How is hemolytic-uremic syndrome in childhood acquired in Switzerland?]. / Wie wird das hämolytisch-urämische Syndrom des Kindesalters in der Schweiz erworben?

Intestinal infections with shigatoxin-producing Escherichia coli or Shigella dysenteriae type I play a major role in the pathogenesis of the hemolytic-uremic syndrome in childhood. Escherichia coli has been repeatedly detected in the intestines of healthy cattle. Twenty-seven children with hemolytic-uremic syndrome were treated at our hospital between June 1990 and March 1997. Factors indicating a possible previous contact with bovine intestinal content were found in 18 out of the 27 patients: parents stockbreeders (n = 7), recent visit to a cowshed or contact with cowdung or manure (n = 5), residence in a rural cattle-breeding area (n = 5), or consumption of raw milk (n = 1). The factors mentioned were found in 5 out of 27 control patients (p < 0.01). Two children experienced hemolytic-uremic syndrome after a stay respectively in Egypt and Tunisia. Our results indicate an important source for acquisition of hemolytic-uremic syndrome in childhood. Observing simple hygienic rules such as washing of hands and pasteurization of milk is likely to have a positive influence on the incidence of this illness. There are also grounds to consider adding the hemolytic-uremic syndrome to the list of travel-related diseases.