Shiga Toxin-Associated Hemolytic Uremic Syndrome: Specificities of Adult Patients and Implications for Critical Care Management

Toxins (Basel). 2021 Apr 26;13(5):306. doi: 10.3390/toxins13050306.


Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC-HUS) is a form of thrombotic microangiopathy secondary to an infection by an enterohemorrhagic E. coli. Historically considered a pediatric disease, its presentation has been described as typical, with bloody diarrhea at the forefront. However, in adults, the clinical presentation is more diverse and makes the early diagnosis hazardous. In this review, we review the epidemiology, most important outbreaks, physiopathology, clinical presentation and prognosis of STEC-HUS, focusing on the differential features between pediatric and adult disease. We show that the clinical presentation of STEC-HUS in adults is far from typical and marked by the prevalence of neurological symptoms and a poorer prognosis. Of note, we highlight knowledge gaps and the need for studies dedicated to adult patients. The differences between pediatric and adult patients have implications for the treatment of this disease, which remains a public health threat and lack a specific treatment.

Keywords: Escherichia coli; Shiga toxin; hemolytic uremic syndrome; thrombotic microangiopathy.

Publication types

  • Review

MeSH terms

  • Adult
  • Child
  • Critical Care / methods*
  • Escherichia coli Infections / complications*
  • Escherichia coli Infections / diagnosis
  • Escherichia coli Infections / epidemiology
  • Escherichia coli Infections / therapy
  • Hemolytic-Uremic Syndrome / epidemiology
  • Hemolytic-Uremic Syndrome / etiology*
  • Hemolytic-Uremic Syndrome / microbiology
  • Hemolytic-Uremic Syndrome / therapy
  • Humans
  • Prognosis
  • Shiga-Toxigenic Escherichia coli*