Hemolytic-Uremic Syndrome Following Urinary Tract Infection with Enterohemorrhagic Escherichia coli : Case Report and Review

• Published in: Clinical infectious diseases Vol. 27; no. 2; pp. 310 - 315
• Main Authors: Starr, M., Wood, V. Bennett, Bigham, A. K., Ward, T. F. de Koning, Bordun, A. M., Lightfoot, D., Bettelheim, K. A., Jones, C. L., Browne, R. M. Robins
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01.08.1998; University of Chicago Press
• Subjects: Bacterial diseases; Bacterial diseases of the urinary system; Biological and medical sciences; Clinical Articles; Diarrhea; DNA probes; DNA, Bacterial - analysis; Electrophoresis, Gel, Pulsed-Field; Escherichia coli; Escherichia coli - genetics; Escherichia coli - isolation & purification; Escherichia coli Infections - complications; Escherichia coli Infections - diagnosis; Escherichia coli O157; Feces; Hemolytic uremic syndrome; Hemolytic-Uremic Syndrome - diagnosis; Hemolytic-Uremic Syndrome - etiology; Human bacterial diseases; Humans; Infant; Infections; Infectious diseases; Male; Medical sciences; Shiga toxins; Urinary tract infections; Urinary Tract Infections - complications; Urinary Tract Infections - microbiology; Urine; Human; Kidney disease; Urinary system disease; Typing; Hemolytic uremic syndrome; Colibacillosis; Escherichia coli; Hemopathy; Urinary tract disease; Urinary tract; Infection; Case study; Hemolytic anemia; Microbiological investigation; Renal failure; Bacteriosis; Bacteria; Complication; Child; Bibliographic review; Enterobacteriaceae
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/514656

A 6-week-old child with acute urinary tract infection caused by Shiga toxin—producing Escherichia coli (STEC) O5:H—developed hemolytic-uremic syndrome (HUS). Molecular and phenotypic analysis of the urinary isolate indicated that it lacked uropathic properties and that it was probably of intestinal origin. Nevertheless, the patient did not experience a diarrheal prodrome, nor was STEC or Shiga toxin detected in his feces at any time. Examination of the patient's serum pointed to recent infection with E. coli O5, with no evidence of exposure to E. coli O157, O111, or O26. A review of 13 previously reported cases of HUS associated with acute urinary tract infection indicated that this was the first case of nondiarrheal HUS in which infection with the most common STEC serogroups was specifically excluded. This case illustrates the need to investigate patients with nondiarrheal HUS for infection with STEC.