The hemolytic-uremic syndrome in siblings: a prospective survey

Microangiopathic anemia without thrombocytopenia and kidney disease in a child with diarrhea caused by Shiga toxin-producing Escherichia coli

A child with a history of diarrhea presented with transient anemia, reticolucytosis, and red blood cell fragmentation. Blood pressure and levels of blood platelets, creatinine, and urea were normal, as were results of urinalysis. Escherichia coli harboring genes for Shiga toxin were detected in stool specimens. It is concluded that extraintestinal diseases caused by Shiga toxin-producing bacteria sometimes present without any renal involvement.

A family outbreak of hemolytic-uremic syndrome associated with verotoxin-producing Escherichia coli serotype O157:H7

All five siblings (three boys and two girls, aged 1.5-9 years) in a family developed hemolytic-uremic syndrome associated with verotoxin-producing Escherichia coli O157:H7 at a lakeside vacation cottage during the fall of 1985. All five were hospitalized and made a full recovery. Both parents remained asymptomatic, and neither had evidence of this infection. In four children who were investigated prospectively, free verotoxin was still detectable in the stools for between 3 and 7 weeks. The prodromal diarrheal illness in the children occurred over a 10-day period. The epidemic curve was consistent with a point-source outbreak, but continuous exposure or person-to-person transmission could not be ruled out. The source of the infection was not identified.

Paroxysmal nocturnal hemoglobinuria presenting as recurrent hemolytic uremic syndrome

Paroxysmal nocturnal hemoglobinuria (PNH) may present with acute anemia, thrombocytopenia and, if hemoglobin nephropathy or dehydration is present, azotemia. Thus PNH may be confused with the hemolytic uremic syndrome (HUS). Recurrent episodes, though common in PNH, are unusual in HUS. A positive acid hemolysis test can be used to differentiate between the two diseases.

Prostacyclin production by whole blood from children: impairment in the hemolytic uremic syndrome and excessive formation in chronic renal failure

The capacity of leukocytes to produce prostacyclin (PGI2) from endogenous and from platelet-derived endoperoxides was tested in whole blood. During the acute phase of the hemolytic uremic syndrome (H.U.S.), the PGI2-production was lower than the controls, whereas the blood from children with chronic renal failure produced higher amounts. Production of PGI2 by blood from children 3/12 to 6 years after the acute phase of H.U.S. was normal, as was the case with blood from their parents. Furthermore, in two H.U.S.-patients studied serially, the decreased PGI2-production capacity normalized 2 1/2 months after the acute phase.

Haemolytic uraemic syndrome: evidence of multiple viral infections in a cluster of ten cases

During July 1979, ten patients were admitted to the hospital with bloody diarrhoea followed by manifestations of haemolytic uraemic syndrome (HUS): acute microangiopathic haemolytic anaemia, intravascular coagulopathy, and impaired renal function. Ages ranged from 13 months to 58 yr, with only two patients more than 5 yr old. In a household that included seven children born to three sisters who married three brothers, six children required hospitalization for bloody diarrhoea and four developed HUS; the father of one case and the maternal grandmother also developed bloody diarrhoea. Echovirus type 11 was isolated from the pharyngeal secretions or faeces of all members of the household with bloody diarrhoea, with the exception of the grandmother. Picornavirus-like particles were seen by direct electron microscopy (E/M) in faeces from four other HUS patients and an adenovirus in one, but these viruses failed to replicate in cell cultures. Parvovirus-like particles were seen by E/M in faeces from six patients. Serological examination indicated recent infection with one or more enteroviruses (echovirus 11, coxsackieviruses A4, B2, B4) in nine cases. Combined viral studies revealed presumptive evidence of recent infection with two or more viruses in all of the patients with HUS. Stools were negative for bacterial pathogens including campylobacter, salmonella, shigella, and yersinia organisms. Only one of nine patients tested had circulating immune complexes. Our data support the concept that the pathology seen in HUS may be due to a Shwartzman-type reaction provoked by concurrent infection with two or more viral agents.

Hemolytic uremic syndrome in families

The occurrence of the hemolytic uremic syndrome in three siblings prompted us to study this illness in families. Two groups of patients could be identified when 83 siblings with the syndrome in 41 families were examined. Siblings whose onset occurred within a short time of each other had a relatively good prognosis (19 per cent mortality); those whose onset was more than a year apart had a poorer prognosis (68 per cent mortality). We speculate that an environmental agent may have caused the syndrome in the first group, and that genetic factors may have been important in the second.