Clinical features and treatment of children with hemolytic uremic syndrome caused by EHEC
Clinical features and treatment of children with hemolytic uremic syndrome caused by enterohemorrhagic Escherichia coli O157:H7 infection: experience of an outbreak in Sakai City, 1996. Yoshioka K, Yagi K, Moriguchi N. Pediatrics International 1999;41(2):223-227.
Presented is a study of 15 pediatric patients with hemolytic uremic syndrome (HUS) associated with hemorrhagic colitis caused by enterohemorrhagic Escherichia coli (EHEC) O157:H7. These cases were encountered during the 1996 outbreak in Sakai, Osaka, Japan. The complete form of HUS, which includes the three characteristics hemolytic anemia, thrombocytopenia and acute renal dysfunction, was noted in eight patients, while an incomplete form of HUS, which did not include all three characteristics, was noted in seven patients. The diagnosis and treatment followed the guidelines of the Japanese Society of Pediatric Nephrology, outlined in this paper. Intravenous gamma-globulin (IgG) was administered in nine patients and dialysis was performed in five patients with the complete form of HUS. In three of these five patients, plasma exchange was also performed. Weaning from dialysis was accomplished by the 15th day of disease in all patients. Some patients developed pancreatitis, central nervous system symptoms, fundal hemorrhage (of the eye) and elevation of transaminase (an indicator of liver dysfunction), although these abnormalities subsided uneventfully. Renal biopsy, which was performed in two patients who recovered from acute renal failure but still had mild proteinuria and a decrease in creatinine clearance, showed moderate renal cellular changes. One year after onset of disease, hematological and urological findings were within normal limits in all patients except one with the complete form of HUS, who still had slightly decreased creatinine clearance. Supportive therapy is fundamental in the treatment of HUS. Although there has been controversy about the efficacy of plasma exchange on HUS, CNS symptoms improved quickly in all patients in this study after this therapy. The efficacy of IgG has also not been established but dialysis was not required in any patients who underwent this therapy. These treatments should be evaluated in a controlled study in the future.