Haemolytic uraemic syndrome

There have been a number of cases of food poisoning associated with pathogenic E. coli 0157 contamination of fresh apple juice (Battey Schaffner, 2001 Czajka Batt, 1996 Miller Kasper, 1994 Parish, 1997, 2000 Splittsoesser et al., 1996 Zhao et al., 1993), which was found to be able to grow in apple juice with low pH. The organism potentially has a low infective dose of <100 cells, and this, coupled with the occasional severe side-effect of haemolytic uraemic syndrome, makes E. coli 0157 a severe hazard within unpasteurised juices. 

Montes A, Powles TJ, O Brien ME, Ashley SE, Luckit J, Treleaven J. A toxic interaction between mitomycin C and tamoxifen causing the haemolytic uraemic syndrome. Eur J Cancer 1993 29A(13) 1854-7. 

Tschape, H., Prager, R., Streckel, W., Fruth, A., Tietze, E. and Bohme, G. (1995) Verotoxinogenic Citrobacter freundii associated with severe gastroenteritis and cases of haemolytic uraemic syndrome in a nursery school green butter as the infection source. Epidemiology and Infection 114, 441-450. 

MITOMYCIN HORMONES AND HORMONE ANTAGONISTS -TAMOXIFEN t incidence of anaemia and thrombocytopenia and risk of haemolytic-uraemic syndrome Mitomycin causes subdinical endothelial damage in addition to the thrombotic effect on platelets caused by tamoxifen, which leads to haemolytic-uraemic syndrome Monitor renal function at least twice weekly during concurrent therapy and watch clinically for bleeding episodes, e.g. nose bleeds, bleeding from the gums, skin bruising... 

Verotoxic Escherichia coli (VTEC 0157) may cause severe bloody diarrhoea and systemic effects such as the haemolytic uraemic syndrome (HUS) antibiotic therapy has been shown in some trials to worsen the prognosis, perhaps by releasing more toxin from d5nng bacteria. An antimicrobial should generally therefore be avoided for bloody diarrhoea unless the diagnosis has been confirmed bacte-riologically not to be VTEC. 

Mitomycin Nausea and vomiting tissue necrosis fever Bone marrow depression (cumulative) stomatitis alopecia acute pulmonary loxlcJty pulmonary fibrosis hepatotoxicity renal toxicity amcnorrhoca haemolytic-uraemic syndrome bladder calcification (with intravesical administration)... 

Kohli HS, Sud K, Jha V, Gupta KL, Minz M, Joshi K, Sakhuja V. Cyclosporin-induced haemolytic-uraemic syndrome presenting as primary graft dysfunction. Nephrol Dial Transplant 1998 13(ll) 2940-2. 

Serke S, Riess H, Oettle H, Huhn D. Elevated reticulocyte count—a clue to the diagnosis of haemolytic-uraemic syndrome (HUS) associated with gemcitabine therapy for metastatic duodenal papillary carcinoma a case report. Br J Cancer 1999 79(9-10) 1519-21. 

McGregor DO, Robson RA, Lynn KL. Haemolytic-uraemic syndrome in a renal transplant recipient treated by conversion to mycophenolate mofetil. Nephron 1998 80(3) 365-6. 

Brandslund I, Petersen PH, Strange P, Hole P, Worth V. Haemolytic uraemic syndrome and accumulation of haemoglobin-haptoglobin complexes in plasma in serum sickness caused by penicillin drugs. Haemostasis 1980 9(4) 193-203. 

Agarwal N, Cherascu B. Concomitant acral necrosis and haemolytic uraemic syndrome following ingestion of quinine. J Postgrad Med 2002 48(3) 197-8. 

Morton AP. Quinine-induced disseminated intravascular coagulation and haemolytic-uraemic syndrome. Med J Aust 2002 176(7) 351. 

Schmidt RH, Lenz T, Grone HJ, Geiger H, Scheuermann EH. Haemolytic-uraemic syndrome after tacrohmus rescue therapy for cortisone-resistant rejection. Nephrol Dial Transplant I999 14(4) 979-83. 

Hollenbeck M, Kutkuhn B, Aul C, et al. Haemolytic-uraemic syndrome and thrombotic-thrombocytopenic purpura in adults clinical findings and prognostic factors for death and end-stage renal disease. Nephrol Dial Transplant 13 76-81,1998. 

Peces R, Diaz-Corte C, Baltar J, Seco M, Alvarez-Grande J. Haemolytic-uraemic syndrome in a heroin addict. Nephrol Dial Transplant. 1998 13 3197-3199. 

McCauley J, BronstherO, Fung J,Todo S, Starzl TE. Treatment of cyclosporin-induced haemolytic uraemic syndrome with FK506. Lancet 1989 2 1516. 

Karmali MA, Steele BT, Petrie M, Lim C (1983) Sporadic cases of haemolytic-uraemic syndrome associated with faecal cytotoxin and cytotoxin-producing Escherichia coli in stools. Lancet 1 619-620... 

Russmann H, Schmidt H, Heesemann J, Caprioli A, Karch H (1994) Variants of Shiga-like toxin 11 constitute a major toxin component in Escherichia coli 0157 strains from patients with haemolytic uraemic syndrome. J Med Microbiol 40 338-343... 

Rye s syndrome Cardiovascular bypass surgery Haemolytic uraemic syndrome Diazinon... 

Dussol B, Brunet P, Vacher-Coponat H, Saingra Y, Casanova P, Berland Y Haemolytic uraemic syndrome in a renal transplant recipient during OKT3 therapy. Nephrol Dial Transplant 1994 9(8) 1191-1193. 

Morris-Stiff G, Evans M, Baboolal K, Balaji V, Moore R, Jurewicz A, Lord R. Haemolytic uraemic syndrome associated with OKT3. TranspI Int 1996 9(5) 522-523. 

It has been employed as an anticoagulant in dialysis procedures. It has also been used in preeclampsia, and in the haemolytic-uraemic syndrome and thrombotic thrombocytopenic purpura. 

Xaylor, M.B., A. Jackson, and J.M. Weller, Dynamic susceptibility contrast enhanced MRI in reversible posterior leukoencephalopathy syndrome associated with haemolytic uraemic syndrome. Br J Radiol, 2000. 73(868) p. 438-42. 

Haemolytic anaemia, thrombocytopenia and renal impairment, leading to potentially fatal haemolytic uraemic syndrome, has occurred in a few patients given tamoxifen with, or shortly after, mitomycin. 

The authors of the first study suggested that this haemolytic uraemic syndrome was due to a combination of subclinical endothelial damage induced by mitomycin C, and a thrombotic effect on platelets caused by tamoxifen. They advise the avoidance of tamoxifen with or shortly after mitomycin C unless concurrent use ean be earefully monitored. Erythropoietin may be useful in managing the syndrome. This syndrome has also occurred rarely with mitomycin alone, or when combined with fluorouracil, see Mitomycin + Fluorouracil , above. 

The haemolytic uraemic syndromes (HUSs) are a heterogeneous group of similar entities with variable expression and severity. Renovascular endothelial cell injury is central to the pathogenesis, leading to platelet activation and intravascular coagulation, haemolytic anaemia with fragmented erythrocytes, thrombocytopenia, and renal failure. 

---