“Children on the Frontline Against E.coli”: Typical Hemolytic-Uremic Syndrome

Heidi Andersen

doi:10.29074/ascls.18.2.90

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Heidi Andersen, MT(ASCP)⇑
1. works at St John's Hospital, Anderson IN and at Indiana University Hospital, Indianapolis IN

Address for correspondence: Heidi Andersen MT(ASCP), 2007 B Parsons Drive, Indianapolis IN 46224. (317) 459-3023. handerse{at}iupui.edu

Extract

A thirteen-month old infant presented with classical hemolytic-uremic syndrome (HUS), but with negative cultures for Escherichia coli (E. coli) 0157:H7. HUS is commonly linked to infection with E. coli 0157:H7; however, traditional culture has demonstrated poor sensitivity. Pathogenesis of the organism in HUS involves the production of a Shiga-like toxin (STX), resulting in a triad of symptoms. An early and accurate differential diagnosis, based on patient presentation with acute renal failure, hemolytic anemia, and thrombocytopenia, is critical for supportive treatment and improved prognosis. Patient prognosis is related to the duration of renal failure and dialysis treatment. Research is aimed at improved detection of E. coli 0157:H7 or the STX produced, and future vaccination to eliminate typical HUS.

CASE STUDY In January, a thirteen-month-old Caucasian male presented with progressive diarrhea over a period of two weeks. During this time, medical attention was sought, and the infant was diagnosed with a common childhood diarrhea, suspected to be due to a rotavirus. However, the infant continued with progressive diarrhea and began showing signs of pallor, dehydration, petechiae on his thighs, and decreased appetite. The infant began experiencing episodes of acute abdominal pain with intermittent periods of lethargy. As the diarrhea worsened, one sixteenth of a tablet of Imodium® was given to the infant and he was brought to the local emergency department (ED).

The infant presented in the ED with signs of edema in the extremities from oliguria and acute renal failure. He was catheterized, treated with Lasix® to stimulate kidney function, and…

ABBREVIATIONS: CDC = Centers for Disease Control and Prevention; HUS = hemolytic-uremic syndrome; STX = shiga-like toxin; TTP = thrombotic thrombocytopenic purpura.