Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome

Lancet. 2005 Mar 19-25;365(9464):1073-86. doi: 10.1016/S0140-6736(05)71144-2.

Abstract

Most cases of diarrhoea-associated haemolytic uraemic syndrome (HUS) are caused by Shiga-toxin-producing bacteria; the pathophysiology differs from that of thrombotic thrombocytopenic purpura. Among Shiga-toxin-producing Escherichia coli (STEC), O157:H7 has the strongest association worldwide with HUS. Many different vehicles, in addition to the commonly suspected ground (minced) beef, can transmit this pathogen to people. Antibiotics, antimotility agents, narcotics, and non-steroidal anti-inflammatory drugs should not be given to acutely infected patients, and we advise hospital admission and administration of intravenous fluids. Management of HUS remains supportive; there are no specific therapies to ameliorate the course. The vascular injury leading to HUS is likely to be well under way by the time infected patients seek medical attention for diarrhoea. The best way to prevent HUS is to prevent primary infection with Shiga-toxin-producing bacteria.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Diagnosis, Differential
  • Diarrhea / microbiology
  • Disease Outbreaks
  • Escherichia coli Infections / diagnosis
  • Escherichia coli Infections / epidemiology
  • Escherichia coli Infections / microbiology*
  • Escherichia coli Infections / therapy
  • Escherichia coli O157 / metabolism*
  • Hemolytic-Uremic Syndrome / diagnosis
  • Hemolytic-Uremic Syndrome / epidemiology
  • Hemolytic-Uremic Syndrome / microbiology*
  • Hemolytic-Uremic Syndrome / therapy
  • Humans
  • Shiga Toxins / metabolism*

Substances

  • Shiga Toxins