title: Post-dysenteric hemolytic uremic syndrome in children during an epidemic of Shigella dysentery in Kwazulu/Natal.
abstract: We report 81 of 107 cases of hemolytic uremic syndrome (HUS), admitted between July 1994 and February 1996, following an outbreak of Shigella dysenteriae type 1 dysentery in Kwazulu/Natal. All patients, excluding 1, were black with a mean age of 38 months (range 1-121); 50 (61.7%) were males. The mean duration of dysentery was 11.3 days (range 1-41) and HUS 15 days (range 1-91). Most patients had acute oliguric renal failure (90.1%), 42 (51.6%) required peritoneal dialysis. Complications included encephalopathy 30 (37.0%), convulsions 12 (14.8%) and hemiplegia 2 (2.3%), gastrointestinal perforation 8 (9.9%), protein losing enteropathy 26 (32.1%), toxic megacolon 4 (4.9%), rectal prolapse 5 (6.2%), hepatitis 11 (13.6%), myocarditis 5 (6.2%), congestive cardiac failure 3 (3.7%), cardiomyopathy 3 (3.7%), infective endocarditis 1 (1.2%), septicemia 15 (18.5%), disseminated intravascular coagulation 17 (21%). Leukemoid reactions were found in 74 (91.3%) patients, hyponatremia in 56 (69.1%), and hypoalbuminemia in 67 (82.7%). Stool culture for Shigella dysenteriae type I was positive in only 7 (8.6%) patients; Shiga toxin assays were not performed. Outcome was as follows: recovery 32 (39.5%), impaired renal function 8 (9.9%), chronic renal failure 26 (32.1%), end-stage renal disease 1 (1.2%), and death 14 (17.3%) patients.
authors.affiliation: Department of Pediatrics and Child Health, University of Natal, Faculty of Medicine, South Africa.
authors.forename: R
authors.initials: R
authors.lastname: Bhimma
authors.forename: N C
authors.initials: NC
authors.lastname: Rollins
authors.forename: H M
authors.initials: HM
authors.lastname: Coovadia
authors.forename: M
authors.initials: M
authors.lastname: Adhikari
mesh_terms: D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D004405:Dysentery, Bacillary / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology / Q000209:etiology* / Q000378:metabolism; D006801:Humans; D007223:Infant; D008297:Male; D012762:Shigella dysenteriae; D013019:South Africa / Q000453:epidemiology