title: Hemolytic uremic syndrome in association with typhoid fever.
abstract: BACKGROUND
  Hemolytic uremic syndrome (HUS) has been associated with typhoid fever caused by Salmonella typhi. The pathogenesis of HUS in the context of S typhi infection is not known. The authors report on a patient with typhoid fever in whom HUS and myocarditis developed during the course of his illness and in whom there was no evidence of a Shiga-toxin (Stx)-producing organism.
  
  
  METHODS
  Antibodies directed against the Escherichia coli O157:H7 and S typhi lipopolysaccharide (LPS) were sought in the serum sample taken during the acute phase using line-blot immunoassays. Polymerase chain reaction was performed to detect the presence of stx1 and stx2 genes in the patient's S typhi isolate.
  
  
  RESULTS
  There was no evidence for immunoglobulin (Ig) M and IgA against the LPS of E coli O157:H7, whereas anti-S typhi LPS IgM and IgA were strongly positive. In the polymerase chain reaction, DNA from the Stx-producing E coli controls yielded stx1 and stx2 fragments of the expected sizes on agarose gel electrophoresis, whereas no stx1 and stx2 fragments were obtained from the S typhi isolate. The S typhi did, however, yield a band when amplified with primers specific for viaB, an S typhi gene.
  
  
  CONCLUSIONS
  S typhi may be responsible for some cases of HUS, and the inciting toxin may not be Stx.
authors.affiliation: Department of Internal Medicine, Salmaniya Medical Complex, Manama, Bahrain.
authors.forename: Ali
authors.initials: A
authors.lastname: Albaqali
authors.forename: Adel
authors.initials: A
authors.lastname: Ghuloom
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al Arrayed
authors.forename: Abdulla
authors.initials: A
authors.lastname: Al Ajami
authors.forename: Durjoy K
authors.initials: DK
authors.lastname: Shome
authors.forename: Afaf
authors.initials: A
authors.lastname: Jamsheer
authors.forename: Hyat
authors.initials: H
authors.lastname: Al Mahroos
authors.forename: Srdjan
authors.initials: S
authors.lastname: Jelacic
authors.forename: Phillip I
authors.initials: PI
authors.lastname: Tarr
authors.forename: Bernard S
authors.initials: BS
authors.lastname: Kaplan
authors.forename: Radha K
authors.initials: RK
authors.lastname: Dhiman
mesh_terms: D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood; D004269:DNA, Bacterial / Q000097:blood; D006463:Hemolytic-Uremic Syndrome / Q000097:blood / Q000382:microbiology*; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008070:Lipopolysaccharides / Q000097:blood / Q000276:immunology; D008297:Male; D009205:Myocarditis / Q000382:microbiology; D012485:Salmonella typhi / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D014435:Typhoid Fever / Q000097:blood / Q000150:complications*
chemical_list: D000907:Antibodies, Bacterial; D004269:DNA, Bacterial; D007070:Immunoglobulin A; D007075:Immunoglobulin M; D008070:Lipopolysaccharides