title: Immune response to Escherichia coli O157:H7 in hemolytic uremic syndrome following salmonellosis.
abstract: Escherichia coli O157:H7, a Shiga-like toxin (SLT)-producing enteric pathogen, has been implicated in most cases of post-diarrheal hemolytic uremic syndrome (D + HUS). Infection with other bacterial pathogens such as Salmonella has also preceded D + HUS episodes, leading to speculation that these organisms may also be etiological. We present two children with unrelated D + HUS following salmonellosis. Both children had negative stool cultures on sorbitol-MacConkey agar soon after the onset of diarrhea. After the diagnosis of HUS, both patients had repeat stool cultures positive for Salmonella alone. Polymerase chain reactions for SLT I and II gene sequences in Salmonella isolates were negative. Enzyme-linked immunosorbent assay for specific humoral response to E. coli O157:H7 lipopolysaccharide in acute and convalescent serum samples revealed evidence of heretofore undetected E. coli O157:H7 infection contemporaneous with each D + HUS episode. These cases demonstrate that isolation of only non-SLT-producing microbes from children with D + HUS should raise suspicion of concurrent undetected infection with SLT-producing organisms. Assaying specific immune response to E. coli O157:H7 can be an important epidemiological adjunct. Bacterial infection with non-SLT-producing Salmonella may represent concomitant enteric pathology rather than D + HUS-instigating infection.
authors.affiliation: Division of Nephrology, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: F X
authors.initials: FX
authors.lastname: Flores
authors.forename: K
authors.initials: K
authors.lastname: Jabs
authors.forename: G M
authors.initials: GM
authors.lastname: Thorne
authors.forename: J
authors.initials: J
authors.lastname: Jaeger
authors.forename: M A
authors.initials: MA
authors.lastname: Linshaw
authors.forename: M J
authors.initials: MJ
authors.lastname: Somers
mesh_terms: D000907:Antibodies, Bacterial / Q000097:blood; D001427:Bacterial Toxins / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D019453:Escherichia coli O157 / Q000276:immunology*; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000276:immunology*; D006801:Humans; D008297:Male; D012480:Salmonella Infections / Q000276:immunology*; D022622:Shiga Toxin 1; D022641:Shiga Toxin 2
chemical_list: D000907:Antibodies, Bacterial; D001427:Bacterial Toxins; D022622:Shiga Toxin 1; D022641:Shiga Toxin 2