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Hemolytic-Uremic Syndrome Following Urinary Tract Infection with Enterohemorrhagic Escherichia coli

Hemolytic-Uremic Syndrome Following Urinary Tract Infection with Enterohemorrhagic Escherichia coli: Case Report and Review. Starr M, Bennett-Wood V, Bigham AK, de Koning-Ward TF, Bordun AM, Lightfoot D, Bettelheim KA, Jones CL, Robins-Browne RM. Clinical Infectious Diseases 1998;27:310-315.

ABSTRACT:

Most cases of hemolytic uremic syndrome (HUS) follow enteric infection with Shiga toxin (Stx), in particular Stx-producing Escherichia coli (STEC). Symptomatic intestinal infections with enterohemorrhagic E. coli (EHEC) usually result in diarrhea, thus HUS most often has as a diarrhea prodrome. Nondiarrheal HUS is generally regarded as being due to something other than EHEC. This paper describes an unusual case of HUS involving a urinary tract infection. A 6-week-old child with acute urinary tract infection caused by STEC O5:H0 developed HUS. Molecular and phenotypic analysis of the urinary isolate indicated that it lacked uropathic properties and that it was probably of intestinal origin. Nevertheless, the patient did not experience a diarrheal prodrome, nor was STEC or Stx toxin detected in his feces at any time. Examination of the patient’s serum pointed to recent infection with E. coli O5, with no evidence of exposure to E. coli O157, O111, or O26. He was treated with several antibiotics throughout the course of his illness, peritoneal dialysis, and plasma filtration. By age 15 months, he had become increasingly hypertensive. A review of 13 previously reported cases of HUS associated with acute urinary tract infection indicated that this was the first case of nondiarrheal HUS in which infection with the most common STEC serogroups was specifically excluded. This case illustrates the need to investigate patients with nondiarrheal HUS for infection with STEC, particularly infants and young children.