title: Two cases of non-O157:H7 Escherichia coli hemolytic uremic syndrome caused by urinary tract infection.
abstract: Escherichia coli serotype O157:H7 is a leading cause of diarrhea and hemolytic uremic syndrome (HUS). Because of the limitations of current diagnostic techniques, the prevalence of non-O157:H7 Shiga toxin-producing E coli strains is not known. We describe two patients with HUS in whom no E coli O157:H7 was demonstrable in stool cultures. On culture of the urine, the first patient was found to have E coli O113:H21 strain, and the second patient had E coli O6:H1 serotype. Shiga toxin production (stx2) by the O113:H21 isolate was confirmed. The first patient required 15 days of peritoneal dialysis and subsequently recovered renal function. At last follow-up, serum creatinine was 0.9 mg/dL. The second patient had preservation of renal function throughout the acute illness with serum creatinine of 0.5 mg/dL. The clinical presentation, bacteriology, course, and outcome as well as epidemiologic implications of the increasing number of patients with E coli urinary tract infections associated with HUS are discussed. These cases illustrate the need to investigate patients with nondiarrheal HUS for infection with Shiga toxin-producing E coli of the non-O157 strain variety.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Mayo Clinic, Rochester, MN 55905, USA. hogan.marie@mayo.edu
authors.forename: M C
authors.initials: MC
authors.lastname: Hogan
authors.forename: J M
authors.initials: JM
authors.lastname: Gloor
authors.forename: J R
authors.initials: JR
authors.lastname: Uhl
authors.forename: F R
authors.initials: FR
authors.lastname: Cockerill
authors.forename: D S
authors.initials: DS
authors.lastname: Milliner
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004926:Escherichia coli / Q000145:classification; D004927:Escherichia coli Infections / Q000150:complications* / Q000382:microbiology; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000382:microbiology*; D006801:Humans; D008297:Male