title: Postdiarrheal Shiga toxin-mediated hemolytic uremic syndrome similar to septic shock.
abstract: The inflammatory response of host endothelial cells is included in the development of vascular damage observed in enterohemorrhagic Escherichia coli (EHEC) infection, resulting in hemolytic uremic syndrome (HUS). The response to a non-conventional treatment for a group of D+ HUS (diarrhea positive HUS) patients, with clinical hemodynamic parameters of septic shock was evaluated in this prospective study (1999-2003). Twelve children 2.8 +/- 0.6 years old, with D+ HUS produced by E. coli infection with serological evidence of Shiga toxin, presenting severe unstable hemodynamic parameters and neurological dysfunction at onset, were studied. The protocol included fresh frozen plasma infusions, methylprednisolone pulses (10mg/k/day) for three consecutive days and plasma exchange for five days, starting after admission to the intensive care unit (ICU). The twelve patients with increased pediatric risk of mortality (PRISM) score: 18 +/- 2 after admission to intensive care unit (ICU), required dialysis for 17.4 +/- 4 days, mechanical ventilator assistance for 10 +/- 1 days and early inotropic drugs support for 10.5 +/- 1 days. Neurological dysfunction included generalized tonic-clonic seizures lasting for 5.4 +/- 1 days, n:8. Focal seizures were present in the remaining patients. Dilated cardiomyopathy was present in 6 children. Eight children suffered hemorrhagic colitis. Nine patients survived. Within one year of the injury, neurological sequelae, Glasgow outcome scale (GOS) 3 and 4, were present in two patients, chronic renal failure in one patient. We suggest that early introduction of this protocol could benefit D+ HUS patients with hemodynamic instability and neurological dysfunction at onset. Further studies are likely to elucidate the mechanisms involved in this early adverse clinical presentation of D+ HUS patients.
authors.affiliation: Sección de Nefrología Pediátrica, Departamento de Pediatría, Hospital de Niños Dr. Humberto Notti, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, Mendoza. pvalles@fcm.uncu.edu.ar
authors.forename: Patricia G
authors.initials: PG
authors.lastname: Valles
authors.forename: Silvia
authors.initials: S
authors.lastname: Pesle
authors.forename: Laura
authors.initials: L
authors.lastname: Piovano
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Davila
authors.forename: Mirta
authors.initials: M
authors.lastname: Peralta
authors.forename: Iliana
authors.initials: I
authors.lastname: Principi
authors.forename: Patricia
authors.initials: P
authors.lastname: Lo Giudice
mesh_terms: D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D004927:Escherichia coli Infections / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D019453:Escherichia coli O157 / Q000302:isolation & purification; D006463:Hemolytic-Uremic Syndrome / Q000382:microbiology / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D007223:Infant; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D022622:Shiga Toxin 1 / Q000302:isolation & purification; D022641:Shiga Toxin 2 / Q000302:isolation & purification; D012772:Shock, Septic / Q000503:physiopathology*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D022622:Shiga Toxin 1; D022641:Shiga Toxin 2