Post-Diarrheal Hemolytic Uremic Syndrome
Hemolytic uremic syndrome is a reportable disease in Oklahoma. Hemolytic uremic syndrome (HUS) is a syndrome that is characterized by sudden, short-term kidney failure and abnormally low platelets in the blood (thrombocytopenia). Post-diarrheal HUS primarily affects children, although people of any age may experience the syndrome. Toxins called shiga toxins, or shiga-like toxins cause post-diarrheal HUS. Several kinds of bacteria produce shiga toxins, although E. coli O157:H7 is the most common cause of HUS in the U.S. Other species of E. coli can produce shiga toxin, collectively they are called enterohemorrhagic E. coli, or EHEC. Other types of bacteria that can produce shiga toxin include Campylobacter, Shigella, Salmonella, and Yersinia. When these bacteria produce shiga toxin, HUS can occur following the diarrheal illness that is normally caused by these organisms. Not all cases of HUS are caused by shiga toxin; while uncommon, a variety of viral and bacterial infections, as well as some cancers, can cause HUS.
Symptoms of HUS include extreme irritability and fatigue, paleness of the skin, and a decrease in urine output. Children must be watched very carefully for signs of HUS following a diarrheal illness, especially if a test of the stool reveals the presence of EHEC. Most people with HUS require hospitalization, and approximately 50% will need dialysis. HUS usually occurs between the eighth and twelfth day following the onset of diarrhea, although it may occur a few days or several weeks after the diarrheal illness.
Medical care is supportive in nature and aimed at easing the immediate symptoms and at preventing further complications. Care is provided in the hospital for treatment of kidney failure, including dialysis, blood transfusions, high blood pressure medicine, and a controlled dietary plan. Intravenous immunoglobulin G (IgG) may be given. It is not clear whether antibiotics can help treat the syndrome.