Two cases of non-O157:H7 Escherichia coli hemolytic uremic syndrome caused by urinary tract infection

Am J Kidney Dis. 2001 Oct;38(4):E22. doi: 10.1053/ajkd.2001.27731.

Abstract

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.

Publication types

  • Case Reports

MeSH terms

  • Acute Kidney Injury / etiology
  • Child
  • Child, Preschool
  • Escherichia coli / classification
  • Escherichia coli Infections / complications*
  • Escherichia coli Infections / microbiology
  • Female
  • Hemolytic-Uremic Syndrome / microbiology*
  • Humans
  • Male