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Gastrointestinal involvement in STEC-associated hemolytic uremic syndrome: 10 years in a pediatric center

Mario Giordano1, Onofrio Iacoviello2, Luisa Santangelo3

  • 1Pediatric Nephrology and Dialysis Unit, Pediatric Hospital Giovanni XXIII - AOU Consorziale Policlinico, Bari, Italy. mariogiordanobari@fastwebnet.it.

Pediatric Nephrology (Berlin, Germany)
|January 8, 2024
PubMed

Insights

Gastrointestinal complications, including severe bowel issues, are common in Shiga toxin-producing E. coli hemolytic uremic syndrome (STEC-HUS) in children. Hepatopancreatic involvement is frequent but typically resolves without specific E. coli or Shiga toxin correlations.

Area of Science:

  • Pediatric Nephrology
  • Gastroenterology
  • Infectious Diseases

Background:

  • The gastrointestinal tract is a primary target in pediatric Shiga toxin-producing Escherichia coli hemolytic uremic syndrome (STEC-HUS).
  • Understanding the spectrum of GI complications and hepatopancreatic involvement is crucial for managing STEC-HUS.

Purpose of the Study:

  • To characterize gastrointestinal complications in children with STEC-HUS.
  • To investigate the association between specific E. coli serotypes/Shiga toxin variants and hepatopancreatic involvement.

Main Methods:

  • Observational study of 79 pediatric STEC-HUS patients from January 2012 to June 2021.
  • Detailed recording of demographic, clinical, laboratory, intestinal, hepatobiliary, and pancreatic data.
  • Analysis of gastrointestinal complication frequency based on E. coli serotypes and Stx variants.

Main Results:

  • Six patients experienced bowel complications, including rectal prolapse and life-threatening bowel perforation (3/6 deaths).
  • Acute pancreatitis occurred in 13 patients; elevated pancreatic enzymes and liver transaminases were common.
  • Hepatopancreatic involvement showed no correlation with specific E. coli serotypes or Shiga toxin variants.

Conclusions:

  • Gastrointestinal complications in STEC-HUS range from mild laboratory abnormalities to severe, fatal events like bowel perforation.
  • Hepatopancreatic involvement is a frequent finding in STEC-HUS, generally presenting as a self-limiting condition.
Abstract

Keywords:
Acute pancreatitisBowel perforationExtrarenal involvementSTEC HUS

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