Hemolytic–Uremic Syndrome in a Six-Year-Old Girl after a Urinary Tract Infection with Shiga-Toxin–Producing Escherichia coli O103:H2

Abstract

In the United States, the hemolytic-uremic syndrome of childhood typically follows gastrointestinal infection with Escherichia coli O157:H7.(1-3) It is presumed that the absorption from the gastrointestinal tract of Shiga toxins 1, 2, or both (formerly called Shiga-like toxins(4)) produced by E. coli O157:H7 causes microangiopathic hemolytic anemia as a result of endothelial-cell injury.(5) Shiga-toxin-producing E. coli belonging to serotypes other than O157:H7 can also cause the hemolytic-uremic syndrome.(5,6) However, even though such organisms have been implicated as causes of sporadic cases(7) or outbreakss of gastroenteritis, they are not believed to be important causes of the hemolytic-uremic syndrome in this country. The hemolytic-uremic syndrome occasionally follows urinary tract infections.(9-14) In two cases, the syndrome was atypical: it was recurrent in one case(9) and associated with familial hypocomplementemia in another.(10) In two other reports that associated the hemolytic-uremic syndrome with urinary tract infection, E. coli O157:H7 was recovered from the urine of one child with hemorrhagic colitis and cystitis,(13) and Shiga-toxin-producing E. coli O17:H18 was recovered from the urine and blood of a child with antecedent diarrhea.(14) We describe a child who had the hemolytic-uremic syndrome but no prodromal diarrhea after a nonbacteremic urinary tract infection with E. coli O103:H2 that produced Shiga toxin 1. We also describe the characteristics of the infecting organism.