1/47. Failure of pre-diarrheal antibiotics to prevent hemolytic uremic syndrome in serologically proven escherichia coli o157:H7 gastrointestinal infection.A girl had hemolytic uremic syndrome after escherichia coli o157:H7 infection, despite pre-diarrheal administration of an antibiotic that prevented detectable intestinal colonization. This report casts doubt on the advisability of antibiotic therapy for E coli O157:H7 infections and has implications for our understanding of the mechanism of this disorder.- - - - - - - - - - ranking = 1keywords = hemolytic (Clic here for more details about this article) |
2/47. Unexpected childhood death due to hemolytic uremic syndrome.Two cases of unexpected childhood death due to hemolytic uremic syndrome are reported. A 21-month-old girl who was discovered dead in bed following a short illness was found at autopsy to have overwhelming sepsis resulting from transmural colitis. Escherichia coli serotype 0157A was isolated from the intestine, and renal changes of hemolytic uremic syndrome were found. A 4-year-old girl died suddenly in hospital from intracranial hemorrhage while being treated for hemolytic uremic syndrome-related renal failure. culture of urine and feces grew verocytotoxin producing E. coli. These cases demonstrate that hemolytic uremic syndrome may be a rare cause of unexpected childhood death and that the diagnosis may not be established prior to autopsy. Postmortem culture of tissues and fluids in cases of suspected sepsis in children may be essential in establishing this diagnosis, because histologic evaluation may be compromised by profound sepsis and tissue putrefaction. Accuracy in diagnosis may have significant public health and medicolegal consequences.- - - - - - - - - - ranking = 1.6keywords = hemolytic (Clic here for more details about this article) |
3/47. Indications for laparotomy in infection with verotoxigenic Escherichia coli.Verotoxigenic types of Escherichia coli have emerged as serious and important human pathogens. The clinical disease most frequently manifests as a painful form of bloody diarrhea, which can progress to life-threatening systemic microangiopathic hemolytic anemia, known as the hemolytic-uremic syndrome (HUS). Three children with hemorrhagic enteritis due to verotoxigenic E. coli are presented to illustrate the unique diagnostic, therapeutic, and operative management dilemmas associated with this disease. When contemplating surgery, one should seek to determine the anatomic and transmural extent of the disease.- - - - - - - - - - ranking = 0.4keywords = hemolytic (Clic here for more details about this article) |
4/47. The anesthetic management of a patient with paroxysmal nocturnal hemoglobinuria.Implications: This case report describes the anesthetic considerations for a patient with paroxysmal nocturnal hemoglobinuria. Specific strategies to be applied in the perioperative period to prevent hemolytic episodes and venous thrombosis are also discussed.- - - - - - - - - - ranking = 0.2keywords = hemolytic (Clic here for more details about this article) |
5/47. Two cases of human urinary tract infection complicated by hemolytic uremic syndrome caused by verotoxin-producing Escherichia coli.In 1993, 2 cases of urinary tract infection (UTI) caused by verotoxin-producing Escherichia coli were diagnosed at Rigshospitalet in Copenhagen, denmark. Neither of the patients had any previous history of diarrhea. We suggest that E. coli strains isolated from UTI be examined for the production of verotoxin when hemolytic uremic syndrome is clinically suspected.- - - - - - - - - - ranking = 1keywords = hemolytic (Clic here for more details about this article) |
6/47. Nontoxigenic sorbitol-fermenting escherichia coli o157:H- associated with a family outbreak of diarrhoea.A recent study from germany reported the isolation of E. coli O157:H7/H- from patients with non-bloody diarrhoea and hemolytic uremic syndrome, questioning the role of Shiga toxin as the main trait of virulence for human disease. We isolated 6 sorbitol-fermenting E. coli O157:H- strains that do not contain Shiga toxin genes. The isolates originated from an outbreak (3 patients, 3 asymptomatic contacts) of non-bloody diarrhoea affecting two families sharing one household. Two children (age 10 months and 2 years) suffered severe diarrhoea over 30 and 10 days, respectively. Their uncle had moderate diarrhoea for 2 weeks. In contrast to the other isolates, the uncle's strain (EH109) did not harbour a chromosomal eae gene encoding gamma-intimin nor the plasmid gene E-hly; it also showed a PFGE pattern that was different from the unique pattern of the other isolates. Employing PFGE, phage typing, and P-gene typing, five of the six stx negative isolates were indistinguishable from the stx 2 positive "Bavarian outbreak strain". The only human serum tested, obtained from one asymptomatic contact, contained antibodies to the O157 lipopolysaccharide antigen. Our finding of five stx negative sorbitol-fermenting E. coli O157:H- isolates (harbouring eae and E-hly) associated with an outbreak of non-bloody diarrhoea supports the hypothesis that Stx production is not obligatory for the pathogenicity of E. coli O157 for humans.- - - - - - - - - - ranking = 0.2keywords = hemolytic (Clic here for more details about this article) |
7/47. Localization of shiga toxins of enterohaemorrhagic Escherichia coli in kidneys of paediatric and geriatric patients with fatal haemolytic uraemic syndrome.Haemolytic uraemic syndrome (HUS) is characterized by haemolytic anaemia, thrombocytopenia and renal failure. Infection with enterohaemorrhagic Escherichia coli (EHEC), mainly O157:H7, has been strongly implicated as the major cause of HUS in children. The pathogenesis of HUS caused by the infection is not well understood and the defined sites of Stx in kidney of EHEC-infected humans has not been clearly demonstrated. The aim of this study was to investigate and compare the locations of Stx deposition in kidneys of paediatric and geriatric patients who died from enterohaemorrhagic E. coli O157 (EHEC) associated HUS, using an immunoperoxidase staining of the tissues. The study revealed that binding of Stx was relatively less and limited only to the renal tubules of an adult case (81 years old), while more binding was found at both renal tubules and glomeruli of an infant case (21 months old). The Stx binding in the infant's glomeruli was at podocytes, mesangial and endothelial cells. It has been known that young children are more susceptible than adults to HUS. One possibility for this is that the more extensive binding of the Stx to the kidney tissue of the paediatric patient might be due to the higher synthesis and expression of Stx receptors, i.e. Gb(3), in infants and less so in the aged individuals. However, other alternatives are possible, for example, the difference in stage of HUS in individual patients. Thus it is too early to draw any conclusion on this enigma and further investigation is required.- - - - - - - - - - ranking = 0.0013212899958053keywords = anaemia (Clic here for more details about this article) |
8/47. Two cases of non-O157:H7 Escherichia coli hemolytic uremic syndrome caused by urinary tract infection.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.- - - - - - - - - - ranking = 1keywords = hemolytic (Clic here for more details about this article) |
9/47. Secondary sclerosing cholangitis and portal hypertension after O157 enterocolitis: Extremely rare complications of hemolytic uremic syndrome.The authors experienced an extremely rare case of secondary sclerosing cholangitis and portal hypertension developed as late complications of hemolytic uremic syndrome (HUS) owing to escherichia coli o157:H7 in a 2-year-old boy. HUS after E coli O157 infection is the most frequent cause of acute renal failure in childhood and occasionally is accompanied by extrarenal complications such as encephalopathy, cardiomyopathy, ischemic colitis, and pancreatitis. Rarely, late colonic stenosis may develop secondary to the ischemic damage. Sclerosing cholangitis and subsequent cirrhosis with portal hypertension are very uncommon as late complications of HUS. To our knowledge, such a case has not been previously reported in the literature. J Pediatr Surg 36:1838-1840.- - - - - - - - - - ranking = 1keywords = hemolytic (Clic here for more details about this article) |
10/47. Consanguineous hemolytic uremic syndrome secondary to escherichia coli o157:H7 infection treated with aggressive therapeutic plasma exchange.We describe the successful management of an elderly husband and wife with escherichia coli o157:H7 associated hemolytic uremic syndrome (HUS) treated with aggressive therapeutic plasma exchange (TPE) with replacement with fresh frozen plasma. Following twelve TPEs (three 1.5 volume; nine 1 volume), the husband's platelet count increased from 45 x 10(9)/L to 183 x 10(9)/L. Following ten 1.5 volume TPEs, the wife's platelet count increased from 30 x 10(9)/L to 193 x 10(9)/L. This is the first known occurrence of E. coli O157:H7 associated HUS in an elderly husband and wife successfully treated with aggressive TPE. We conclude that early, aggressive TPE should be considered and may be life-saving for E coli O157:H7 associated HUS in the elderly.- - - - - - - - - - ranking = 1keywords = hemolytic (Clic here for more details about this article) |
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