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[Hemolytic-uremic syndrome in infants due to verotoxin-producing Escherichia coli]
1Institut für Medizinische Mikrobiologie und Immunologie, Universität Hamburg.
Insights
Enterohaemorrhagic E. coli O157:H- caused haemolytic uraemic syndrome in six infants. Early diagnosis is crucial as this pathogen can lead to severe complications like kidney failure and neurological impairment.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- A cluster of six pediatric cases of haemolytic uraemic syndrome (HUS) occurred in Upper Bavaria between September and November 1988.
- All affected children, aged 4-17 months, experienced preceding gastroenteritis, often with haemorrhagic stools.
Purpose of the Study:
- To identify the causative agent of haemolytic uraemic syndrome in a pediatric cluster.
- To highlight the diagnostic challenges and potential severity of infections caused by specific enterohaemorrhagic E. coli strains.
Main Methods:
- Clinical case observation and management, including peritoneal dialysis for acute renal failure.
- Stool examinations for common enteritis-causing microorganisms.
- Specific gene probes to detect enterohaemorrhagic E. coli O157:H- and verotoxin 2 production.
Main Results:
- Five of the six children recovered fully; one 12-month-old girl sustained statomotoric developmental impairment due to cerebral involvement.
- Initial stool examinations in four patients were negative for common pathogens.
- Enterohaemorrhagic E. coli O157:H- producing verotoxin 2 was identified in the remaining two patients using gene probes.
Conclusions:
- Enterohaemorrhagic E. coli O157:H- should be considered in the diagnosis of haemorrhagic enterocolitis.
- This pathogen can cause severe complications, including acute renal failure and neurological sequelae in infants.
- Prompt and accurate diagnosis is essential for managing HUS and preventing severe outcomes.
Abstract:
Between September and November 1988, six children (aged 4-17 months) from a parish in Upper Bavaria fell ill with a haemolytic-uraemic syndrome. The illness had been preceded by a gastroenteritis with at times haemorrhagic stools. All patients needed peritoneal dialysis for acute renal failure. A 12-month-old girl was left with statomotoric developmental impairment due to cerebral involvement, but the other five children were cured. In the first four children to be admitted stool examinations for the common enteritis-causing microorganisms had been negative. But in the following two, specific gene probes demonstrated enterohaemorrhagic E. coli O157: H- with formation of verotoxin 2 (Shiga-like toxin II). This group of microorganisms must be taken into account in the diagnosis of haemorrhagic enterocolitis, because they can cause severe complications.