Treatment and management of children with haemolytic uraemic syndrome

2017 ◽  
Vol 103 (3) ◽  
pp. 285-291 ◽  
Author(s):  
Patrick R Walsh ◽  
Sally Johnson
Keyword(s):  
Escherichia Coli ◽  
Acute Kidney Injury ◽  
Shiga Toxin ◽  
Haemolytic Uraemic Syndrome ◽  
Pneumococcal Infection ◽  
Kidney Injury ◽  
Complement Cascade ◽  
Alternative Complement ◽  
Invasive Pneumococcal Infection

Haemolytic uraemic syndrome (HUS), comprising microangiopathic haemolytic anaemia, thrombocytopaenia and acute kidney injury, remains the leading cause of paediatric intrinsic acute kidney injury, with peak incidence in children aged under 5 years. HUS most commonly occurs following infection with Shiga toxin-producing Escherichia coli (STEC-HUS). Additionally, HUS can occur as a result of inherited or acquired dysregulation of the alternative complement cascade (atypical HUS or aHUS) and in the setting of invasive pneumococcal infection. The field of HUS has been transformed by the discovery of the central role of complement in aHUS and the dawn of therapeutic complement inhibition. Herein, we address these three major forms of HUS in children, review the latest evidence for their treatment and discuss the management of STEC infection from presentation with bloody diarrhoea, through to development of fulminant HUS.

Haemolytic uraemic syndrome

2020 ◽  
pp. 5027-5032
Author(s):  
Edwin K.S. Wong ◽  
David Kavanagh
Keyword(s):  
Escherichia Coli ◽  
Acute Kidney Injury ◽  
Complement System ◽  
Shiga Toxin ◽  
Thrombotic Microangiopathy ◽  
Initial Treatment ◽  
Haemolytic Uraemic Syndrome ◽  
Kidney Injury ◽  
Adamts13 Activity ◽  
Thrombocytopenic Purpura

Haemolytic uraemic syndrome (HUS) is a thrombotic microangiopathy characterized by the triad of thrombocytopenia, microangiopathic haemolytic anaemia, and acute kidney injury. It is most often caused by Shiga toxin-producing Escherichia coli (STEC-HUS), and any HUS not caused by this is often termed atypical HUS (aHUS). aHUS may be caused by an underlying complement system abnormality (primary aHUS) or by a range of precipitating events, such as infections or drugs (secondary aHUS). Management of STEC-HUS is supportive. In aHUS, plasma exchange is the initial treatment of choice until ADAMTS13 activity is available to exclude thrombotic thrombocytopenic purpura as a diagnosis. Once this has been done, eculizumab should be instigated as soon as possible.

scholarly journals Haemolytic uraemic syndrome and Shiga toxin-producing Escherichia coli infection in children in France

2000 ◽  
Vol 124 (2) ◽  
pp. 215-220 ◽  
Author(s):  
B. DECLUDT ◽  
P. BOUVET ◽  
P. MARIANI-KURKDJIAN ◽  
F. GRIMONT ◽  
P. A. D. GRIMONT ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Prospective Study ◽  
Shiga Toxin ◽  
Haemolytic Uraemic Syndrome ◽  
Serum Samples ◽  
E Coli ◽  
Escherichia Coli Infection ◽  
Stool Samples ◽  
Polymerase Chain

We conducted a study to determine the incidence of haemolytic uraemic syndrome (HUS) in children in France and to assess the role of Shiga-toxin-producing Escherichia coli (STEC) infection in the aetiology of HUS. In collaboration with the Société de Néphrologie Pédiatrique we undertook a retrospective review of all cases of HUS hospitalized from January 1993 to March 1995 and a 1-year prospective study (April 1995–March 1996) of epidemiological and microbiological features of cases of HUS. The polymerase chain reaction (PCR) procedure was used to detect stx, eae, e-hlyA genes directly from case stool samples. Serum samples from cases were examined for antibodies to lipopolysaccharide (LPS) of 26 major STEC serogroups. Two hundred and eighty-six cases were reported. The average incidence per year was 0·7/105 children < 15 years and 1·8/105 children < 5 years. During the prospective study, 122/130 cases were examined for evidence of STEC infection using PCR and/or serological assays and 105 (86%) had evidence of STEC infection. Serum antibodies to E. coli O157 LPS were detected in 79 (67%) cases tested. In conclusion, this study showed that STEC infection is an important cause of HUS in children in France, with a high proportion related to the O157 serogroup.

Haemolytic uraemic syndrome associated with Pseudomonas aeruginosa sepsis

2013 ◽  
Vol 62 (11) ◽  
pp. 1760-1762 ◽  
Author(s):  
Parameswaran Narayanan ◽  
Rashi S. Rustagi ◽  
Prabha Sivaprakasam ◽  
Mahadevan Subramanian ◽  
Sreejith Parameswaran ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Pseudomonas Aeruginosa ◽  
Renal Failure ◽  
Influenza Virus ◽  
Shiga Toxin ◽  
Haemolytic Uraemic Syndrome ◽  
Shigella Dysenteriae ◽  
Micro Organisms

Haemolytic uraemic syndrome (HUS) is a recognized complication of infection with Shiga toxin-producing Escherichia coli (STEC) and Shigella dysenteriae type 1. Infections with other micro-organisms, especially Streptococcus pneumoniae, have been cited as causes of HUS. In addition, influenza virus and other viruses may rarely be associated with this syndrome. A 2-year-old girl presented with severe Pseudomonas aeruginosa sepsis with renal failure and ecthyma gangrenosum. Further investigations revealed features of HUS. She was managed with antibiotics and other supportive measures including peritoneal dialysis, and subsequently made a full recovery. A possible role of neuraminidase in the pathogenesis of P. aeruginosa-associated HUS was proposed. This is the first reported case of P. aeruginosa sepsis leading to HUS.

scholarly journals Influence of socio-economic status on Shiga toxin-producing Escherichia coli (STEC) infection incidence, risk factors and clinical features

2019 ◽  
Vol 147 ◽  
Author(s):  
N. L. Adams ◽  
L. Byrne ◽  
T. C. Rose ◽  
G. K. Adak ◽  
C. Jenkins ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Shiga Toxin ◽  
Economic Status ◽  
Care Seeking ◽  
Socio Economic Status ◽  
Accident And Emergency ◽  
Incidence Risk ◽  
Potential Risk Factors

Abstract Shiga toxin-producing Escherichia coli (STEC) infection can cause serious illness including haemolytic uraemic syndrome. The role of socio-economic status (SES) in differential clinical presentation and exposure to potential risk factors amongst STEC cases has not previously been reported in England. We conducted an observational study using a dataset of all STEC cases identified in England, 2010–2015. Odds ratios for clinical characteristics of cases and foodborne, waterborne and environmental risk factors were estimated using logistic regression, stratified by SES, adjusting for baseline demographic factors. Incidence was higher in the highest SES group compared to the lowest (RR 1.54, 95% CI 1.19–2.00). Odds of Accident and Emergency attendance (OR 1.35, 95% CI 1.10–1.75) and hospitalisation (OR 1.71, 95% CI 1.36–2.15) because of illness were higher in the most disadvantaged compared to the least, suggesting potential lower ascertainment of milder cases or delayed care-seeking behaviour in disadvantaged groups. Advantaged individuals were significantly more likely to report salad/fruit/vegetable/herb consumption (OR 1.59, 95% CI 1.16–2.17), non-UK or UK travel (OR 1.76, 95% CI 1.40–2.27; OR 1.85, 95% CI 1.35–2.56) and environmental exposures (walking in a paddock, OR 1.82, 95% CI 1.22–2.70; soil contact, OR 1.52, 95% CI 2.13–1.09) suggesting other unmeasured risks, such as person-to-person transmission, could be more important in the most disadvantaged group.

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