Clinical and Laboratory ObservationsHemolytic uremic syndrome in a child with laboratory-acquired Escherichia coli O157:H7
Section snippets
Case report
A 6-year-old girl had abdominal pain, fever, and bloody diarrhea. Laboratory studies revealed a hemoglobin concentration of 13.4 g/dL, a white blood cell count of 13,400/mm3, and a platelet count of 256,000/mm3. Blood urea nitrogen concentration was 10 mg/dL, and serum creatinine concentration was 0.3 mg/dL. Results of urinalysis were normal. Over 3 days, her urine output decreased despite intravenous hydration, and she had uremia, hemolytic anemia, and thrombocytopenia. The serum creatinine
Methods and results
Stool specimens were cultured by using a standard technique. Sorbitol-negative E coli colonies were analyzed for the presence of O157 and H7 antigens by using commercial antisera (RIM; Remel, Lenexa, Kan). Testing of stool samples for Shiga toxins was performed by using the Premier∗ E. coli Toxin EIA assay (Meridian Diagnostics Inc; Cincinnati, Ohio) after overnight broth enrichment.
The E coli isolate touched by the patient and that obtained from stool culture were processed by using
Discussion
Shiga toxin-producing E coli O157:H7 colitis and its complication, HUS, is an important public health concern. The clinical course is characterized by diarrhea (often bloody), abdominal pain, and sometimes low-grade fever, followed by thrombocytopenia, microangiopathic hemolytic anemia, and acute renal failure.1 E coli O157:H7 (or other enterohemorrhagic E coli) cultured from the stool of patients with this presentation confirms the diagnosis. The routes of transmission of E coli O157:H7 are
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