A 12-year-old previously healthy girl presented with seizures, bloody diarrhoea and abdominal pain. A diagnosis of haemolytic-uraemic syndrome was made on the basis of the presence of haemolysis, thrombocytopenia and acute renal failure. This case report reviews clinical aspects of the syndrome. Plasma exchange has been used to treat cerebral symptoms in these patients and the dilemma surrounding its use is presented.
FillerG. Acute renal failure in children: aetiology and management. Pediatr Drugs2001;3: 783–92.
2.
European Food Safety Authority. Technical specifications for the monitoring and reporting of verotoxigenic Escherichia coli (VTEC) on animals and food (VTEC surveys on animals and food). EFSA J2009;7: 1366 [43 pp].
3.
KäppeliUHächlerHGiezendannerN. Human infections with non-O157 shiga toxin-producing Escherichia coli, Switzerland, 2000–2009. Emerg Infect Dis2011;17: 180–85.
4.
GerberAKarchHAllerbergerF. Clinical course and the role of shiga toxin-producing Escherichia coli infection in the hemolytic-uremic syndrome in pediatric patients, 1997–2000, in Germany and Austria: A prospective study. J Infect Dis2002;186: 493–500.
BlancoJEBlancoMAlonsoMP. Serotypes, virulence genes and intimin types of shiga toxin (verotoxin)-producing Escherichia coli isolates from human patients: prevalence in Lugo Spain from 1992 through 1999. J Clin Microbiol2004;42: 311–19.
BrooksJTSowersEGWellsJG. Non-0157 shiga toxin-producing Escherichia coli infections in the United States, 1983–2002. J Infect Dis2005;192: 1422–29.
9.
BoyerONiaudetP. Hemolytic uremic syndrome: New developments in pathogenesis and treatment. Int J Nephrol2011;2011: 908407.
10.
KarmaliMASteeleBTPetricMLimC. Sporadic cases of haemolytic uraemic syndrome associated with faecal cytotoxin and cytotocin-producing Escherichia coli in stools. Lancet1983;8584: 619–20.
11.
European Food Safety Agency. Community summary report: Trends and sources of zoonoses and zoonotic agents in the European Union in 2007. EFSA J2009: 223.
12.
JenkinsCJEvansHChartGA. Escherichia coli serogroup O26 – a new look at an old adversary. J Appl Microbiol2008;104: 14–25.
13.
WarwickerPGoodshipTHJ. Haemolytic uraemic syndrome. In: WarrellDACoxTMFirthJD (eds). Oxford Textbook of Medicine, 5th Edition.New York: Oxford University Press; 2010: 4065–69.
14.
ElliottEJRobins-BrowneRMO'LoughlinEV. Nationwide study of haemolytic uraemic syndrome: clinical microbiological, and epidemiological features. Arch Dis Child2001;85: 125–31.
15.
DecludtBBouvetPMariani-KurkdjianP. Haemolytic uraemic syndrome and Shiga toxin-producing Escherichia coli infection in children in France. Epidemiol Infect2000;124: 215–20.
16.
SieglerR. Spectrum of extrarenal involvement in postdiarrheal hemolytic uremic syndrome. J Pediatr1994;125: 511–18.
17.
ButeauCProulxFChaibouM. Leukocytosis in children with Escherichia coli O157:H7 enteritis developing haemolytic uraemic syndrome. Pediatr Infect Dis J2000;19: 642–47.
18.
SernaATBoedekerEC. Pathogenesis and treatment of shiga toxin-producing Escherichia coli infections. Curr Opin Gastroenterol2008;24: 38–47.
19.
BellBPGriffinPMLozanoP. Predictors of hemolytic uremic syndrome in children during a large outbreak of Escherichia coli O157:H7 infections. Pediatrics1997;100: E12.
SieglerRLMilliganMKBurninghamTH. Long-term outcome and prognostic indicators in hemolytic uremic syndrome. J Pediatr1991;118: 195–200.
22.
TönshoffBSammetASandenI. Outcome and prognostic determinants in the hemolytic-uremic syndrome of children. Nephron1994;68: 63–70.
23.
BianchiVRoblesRAlberioL. Von Willebrand factor-cleaving protease (ADAMTS13) in thrombocytopenic disorders: a severely deficient activity is specific for thrombotic thrombocytopenic purpura. Blood2002;100: 710–13.
24.
FurlanMRoblesRGalbuseraM. Von Willebrand factor-cleaving protease in thrombotic thrombocytopenic purpura and the hemolytic uremic syndrome. N Engl J Med1998;339: 1578–84.
25.
TsaiHMLianEC. Antibodies to von Willebrand factor cleaving protease in acute thrombotic thrombocytopenic purpura. N Engl J Med1998;339: 1585–94.
26.
SzczepiorkowskiZMWintersJLBandarenkoN. Guidelines on the use of therapeutic apheresis in clinical practice – evidence-based approach from the apheresis applications committee of the American society for apheresis. J Clinical Apher2010;25: 83–177.
MichaelMElliotEJRidleyGF. Interventions for haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura. Cochrane Database System Revi2009; Issue 1. Art No.: CD003595.
29.
MenneJNitschkeMStingeleR. Validation of treatment strategies for enterohaemorrhagic Escherichia coli O104: H4 induced haemolytic uraemic syndrome: case-control study. BMJ2012;345: e4565.
