Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome.
Most cases of diarrhoea-associated haemolytic uraemic syndrome (HUS) are caused by Shiga-toxin-producing bacteria; the pathophysiology differs from that of thrombotic thrombocytopenic purpura. Among Shiga-toxin-producing Escherichia coli (STEC), O157:H7 has the strongest association worldwide with HUS. Many different vehicles, in addition to the commonly suspected ground (minced) beef, can transmit this pathogen to people. Antibiotics, antimotility agents, narcotics, and non-steroidal anti-inflammatory drugs should not be given to acutely infected patients, and we advise hospital admission and administration of intravenous fluids. Management of HUS remains supportive; there are no specific therapies to ameliorate the course. The vascular injury leading to HUS is likely to be well under way by the time infected patients seek medical attention for diarrhoea. The best way to prevent HUS is to prevent primary infection with Shiga-toxin-producing bacteria.
Tarr
Phillip I
PI
Division of Gastroenterology, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, Campus Box 8208, 660 South Euclid Avenue, St Louis, MO 63110, USA. tarr@wustl.edu
Gordon
Carrie A
CA
Chandler
Wayne L
WL
D003937:Diagnosis, Differential; D003967:Diarrhea / Q000382:microbiology; D004196:Disease Outbreaks; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D019453:Escherichia coli O157 / Q000378:metabolism*; D006463:Hemolytic-Uremic Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D006801:Humans; D022603:Shiga Toxins / Q000378:metabolism*
D022603:Shiga Toxins