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Acute renal failure associated with Yersinia pseudotuberculosis infection in children
1Department of Pediatrics, College of Medicine, Inje University, Sanggye Paik Hospital, Seoul, Korea.
Insights
Yersinia pseudotuberculosis infection, often linked to untreated water, can cause acute renal failure in children. Prompt diagnosis and recognition are crucial for managing this serious complication.
Area of Science:
- Pediatric Infectious Diseases
- Nephrology
- Environmental Health
Background:
- Yersinia pseudotuberculosis is a bacterial pathogen that can cause various infections in humans.
- Untreated water sources are potential reservoirs for Yersinia species.
- Acute renal failure (ARF) is a serious complication in pediatric infections.
Purpose of the Study:
- To investigate the clinical features and outcomes of pediatric Yersinia pseudotuberculosis infections.
- To identify risk factors associated with the development of ARF in infected children.
- To explore the role of contaminated water in the transmission of Yersinia pseudotuberculosis.
Main Methods:
- Retrospective analysis of 45 pediatric cases of Yersinia pseudotuberculosis infection confirmed by stool culture.
- Epidemiological investigation including patient history of water contact.
- Isolation and serotyping of Yersinia pseudotuberculosis from clinical and environmental samples.
- Clinical monitoring of patients, including renal function assessment and renal biopsy in cases of ARF.
Main Results:
- Yersinia pseudotuberculosis infection was confirmed in 45 pediatric cases, with 91.1% having contact with untreated water.
- Six patients (13.6%) developed acute renal failure (ARF), with a significantly older age distribution compared to non-ARF cases.
- The main symptoms included fever, rash, abdominal pain, and vomiting; ARF typically occurred within 2-14 days of fever onset.
- Renal biopsy revealed tubulointerstitial nephritis, and ARF showed a benign course with complete recovery in most cases.
Conclusions:
- Yersinia pseudotuberculosis infection is a significant cause of acute interstitial nephritis leading to ARF in children.
- Contact with untreated well or mountain water is a major risk factor for infection.
- Early recognition and management are important for favorable outcomes in pediatric Yersinia pseudotuberculosis-associated ARF.
Abstract:
We report 45 pediatric cases of Yersinia pseudotuberculosis infection confirmed by stool culture between May 1993 and June 1994. In 41 (91.1%) cases there had been contact with untreated well or mountain water. Y. pseudotuberculosis was also isolated from 4 samples of mountain spring water thought to be the sources of infection. During the course of the illness, acute renal failure (ARF) developed in 6 patients (13.6%). The age distribution of the ARF group (12.3 +/- 1.2 years) was significantly different from the non-ARF group (8.0 +/- 3.2 years). The serogroups of Y. pseudotuberculosis isolates from stool samples were 5 (n = 30) and 4 (n = 15). Isolates from the water samples were all serogroup 5. The main symptoms of both groups were fever, rash, abdominal pain, and vomiting. ARF developed between the 2nd and 14th days (mean 6 days) after the onset of fever, and oliguria (< 400 ml/m2 per day) developed in 3 patients (3/6, 50%) immediately after their fevers had subsided. ARF underwent a benign course, with complete recovery within a maximum of 4 weeks (mean 10.2 days), with 1 exceptional patient requiring hemodialysis. Renal biopsy showed evidence of tubulointerstitial nephritis. Y. pseudotuberculosis should be included as one of the causes of acute interstitial nephritis causing ARF in children, especially when the children have histories of drinking untreated water in endemic areas.