In addition to today’s resources, please see and review 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. [PubMed Abstract] [Full-Text HTML] [Full-Text PDF]. Clin Infect Dis. 2017 Nov 29;65(12):e45-e80. doi: 10.1093/cid/cix669.
Today, I review, link to, and excerpt from the U.S. Centers For Disease Control And Prevention (CDC)‘s Signs of Hemolytic Uremic Syndrome and from E. coli Infection (Escherichia coli): Information For Clinicians, both accessed 8/2/2024.
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All that follows is from Signs of Hemolytic Uremic Syndrome .
Key points
- Hemolytic uremic syndrome (HUS) is very serious complication of Shiga toxin-producing E. coli (STEC) infection.
- It can lead to kidney failure, permanent health problems, and even death.
- Seek medical care immediately if you notice signs of HUS.
What to look out for
Signs that someone with diarrhea may be developing HUS include:
- Urinating (peeing) less often or not at all
- Losing pink color in cheeks and inside the lower eyelids
- Unexplained bruising or tiny red spots on the skin
- Having blood in the urine (pee)
- Feeling very tired or irritable (cranky)
- Decreased awareness (alertness)
When to seek emergency help
HUS is a medical emergency.
Call the doctor or go to the emergency room immediately.People with HUS should be hospitalized because their kidneys may stop working and they may develop other serious problems. Most people with HUS recover within a few weeks, but some suffer permanent health problems or die.
Other information about HUS
People at risk for HUS
Anyone can develop HUS.
However, among people with diarrhea, HUS is most common among children younger than 5 years.
Causes of HUS
HUS is most often caused by Shiga toxin-producing E. coli (STEC) infection. About 8 in 10 children with HUS have STEC infection.
Other important causes of HUS are
- Other germs that cause diarrhea, vomiting, or intestinal symptoms
- Pneumonia caused by Streptococcus pneumoniae bacteria
- Some medications, including some chemotherapy drugs
Typical and atypical HUS
The information on this page is about typical HUS, which is linked to diarrhea.
Atypical HUS describes all other HUS, which are often the result of a combination of environmental and genetic factors.
People with atypical HUS may develop a chronic (lasting a long time or recurring) form of the condition. Atypical HUS also can lead to more severe symptoms and chronic health problems. These health problems can include high blood pressure, kidney failure, and blood clots that form throughout the bod
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All that follows is from E. coli Infection (Escherichia coli): Information For Clinicians
Key points
- Most intestinal E. coli infections can be managed symptomatically.
- Patients with profuse diarrhea or vomiting should be rehydrated.
- Early use of intravenous fluids may decrease the risk of renal failure in children with STEC infection.
Diagnosis
E. coli infection is diagnosed when the bacteria are identified from the sample of a patient with an acute diarrheal illness.
Testing for STEC
Stool samples should be routinely cultured for E. coli O157 and simultaneously assayed for non-O157 STEC with a test that detects Shiga toxins (or the genes that encode them).
All presumptive E. coli O157 isolates and Shiga toxin-positive specimens should be sent to a public health laboratory for further characterization.
Rapid, accurate diagnosis of STEC infection is important because early clinical management decisions can affect patient outcomes and early detection can help prevent secondary spread.
Testing for other E. coli
Most U.S. clinical laboratories do not use tests that can detect diarrheagenic E. coli other than STEC. Public health laboratories typically test for non-STEC E. coli only during an outbreak of diarrheal illness with an unknown origin.
Keep Reading: Laboratory Testing for E. coli
Treatment
Hydration
Most E. coli infections can be managed symptomatically. Patients with profuse diarrhea or vomiting should be rehydrated.
Evidence from studies of children with STEC O157 infection indicates that early use of intravenous fluids (within the first 4 days of diarrhea onset) may decrease the risk of renal failure.
Antibiotics
Antibiotics used to treat infection with diarrheagenic E. coli other than STEC include fluoroquinolones (such as ciprofloxacin), macrolides (such as azithromycin), and rifaximin.
Clinicians treating a patient whose clinical syndrome suggests STEC infection (see a clinical syndrome table) should be aware that administering antimicrobial agents may increase the risk of hemolytic uremic syndrome.
Resistance to antimicrobials is increasing worldwide. The decision to use an antibiotic should be carefully weighed against the severity of illness, the possibility that the pathogen is resistant, and the risk of adverse reactions, such as rash, antibiotic-associated colitis, and vaginal yeast infection.
Antimotility agents
Antimotility agents should be avoided for patients with bloody diarrhea; treatment should be reassessed if symptoms have not improved in 48 hours. Antimotility agents also should not be given to patients with STEC infection because these agents may increase the risk of complications, including toxic megacolon, HUS, and neurologic complications.
No known data show that kaolin-pectin compounds (e.g., Kaopectate®) or lactobacillus slow diarrhea or relieve abdominal cramping.
Hemolytic uremic syndrome (HUS)
HUS, which can be a complication of STEC infection, is a type of thrombotic microangiopathy, characterized by anemia, kidney injury, and a low platelet count (thrombocytopenia).
HUS can lead to permanent health problems and even death.
The features of HUS, especially in adults, can be similar to thrombotic thrombocytopenic purpura (TTP), in which blood clots form in small blood vessels throughout the body. TTP can lead to strokes, brain damage, and death.
HUS diagnosis
HUS is diagnosed using standard blood chemistry and blood count tests.
HUS treatment
HUS is treated with supportive care, including the management of fluids and electrolytes. In some cases, treatment may involve:
- Dialysis
- Transfusions of red blood cells, platelets, or both
With good supportive care, most people with HUS recover completely. Outcomes are typically better for children than adults.
