title: Hemolytic uremic syndrome due to Escherichia coli O157: H7 in a child with multiple infections.
abstract: Hemolytic uremic syndrome (HUS) is characterized by hemolytic anemia, thrombocytopenia, and uremia; it is a common cause of acute renal failure in children. Although many microbial agents have been associated with HUS, only Escherichia coli O157: H7 has been clearly demonstrated to be a major cause of this illness. A case is presented of a healthy 4-year-old boy who had a recent varicella infection; when evaluated for HUS his blood and stool cultures both grew Salmonella montevideo and blood cultures grew group A beta-hemolytic streptococci. A stool cultured on MacConkey-sorbitol agar also grew E. coli O157: H7. An eightfold rise in serum antibodies to E. coli O157: H7 lipopolysaccharide was also demonstrated. The child recovered completely and was healthy 3 years later. Although this child had several infectious agents anecdotally associated with HUS, appropriate culture of stool showed that he also had E. coli O157: H7 infection. Previous cases thought to be due to other pathogens may similarly have been caused by co-infection with E. coli O157: H7.
authors.affiliation: Department of Medicine, University of Rochester, New York 14642.
authors.forename: D B
authors.initials: DB
authors.lastname: Ornt
authors.forename: P M
authors.initials: PM
authors.lastname: Griffin
authors.forename: J G
authors.initials: JG
authors.lastname: Wells
authors.forename: K R
authors.initials: KR
authors.lastname: Powell
mesh_terms: D000907:Antibodies, Bacterial / Q000032:analysis; D002675:Child, Preschool; D004926:Escherichia coli / Q000302:isolation & purification / Q000502:physiology*; D004927:Escherichia coli Infections / Q000097:blood / Q000150:complications*; D005243:Feces / Q000382:microbiology; D006463:Hemolytic-Uremic Syndrome / Q000097:blood / Q000209:etiology*; D006801:Humans; D008297:Male; D012475:Salmonella / Q000302:isolation & purification
chemical_list: D000907:Antibodies, Bacterial