Uremic syndrome

Glomerular diseases (e.g., anti-glomerular basement membrane disease, focal segmental glomerularsclerosis, IgA nephropathy, hemolytic uremic syndrome, systemic lupus erythematosus, Alport s syndrome, amyloidosis, membranous nephropathy, and Goodpasture s syndrome)... 

Hemolytic uremic syndrome Minor hemolysis Massive transfusion Newborn... 

EHEC are the pathogenic subgroup of Stx-producing E. coli (STEC). Acute hemorrhagic colitis has been associated mainly with the 0157 H7 serotype. This serotype has been responsible for larger outbreaks of infection, has higher rates of complications, and appears to be more pathogenic than non-EHEC STEC strains. The spectrum of disease associated with E. coli 0157 H7 includes bloody diarrhea, which is seen in as many as 95% of patients, nonbloody diarrhea, hemolytic-uremic syndrome (HUS), and thrombotic thrombocytopenic purpura. 

Hemolytic uremic syndrome A syndrome characterized by microangiopathic hemolytic anemia, acute renal failure, and a low platelet count (thrombocytopenia). 

Escherichia coli 0157 5.5/5416 Hemorrhagic colitis, hemolytic uremic syndrome (HUS) a not infrequent cause of industrial food poisoning... 

Complement factor H and platelet-activating factor acetylhydrolase polymorphisms and hemolytic uremic syndrome due to E. coli 0157... 

Ying L, Katz Y, Schlesinger M et al. Complement factor H gene mutation associated with autosomal recessive-atypical hemolytic uremic syndrome. Am J Hum Genet 1999 65[6] 1538—1546. 

Xu H, Iijima K, Shirakawa T et al. Platelet-activating factor acetylhydrolase gene mutation in Japanese children with Escherichia coli 0157-associated hemolytic uremic syndrome. Am J Kidney Dis 2000 36[1] 42—46. 

In the last 20 years, an increased number of enterohemorrhagic diarrhea outbreaks have been caused by highly virulent E. coli strains. EHEC are capable of causing serious complications such as hemolytic uremic syndrome in children and vascular disease in elderly people. E. coli serotype 0157 H7 has been the primary cause of outbreaks of EHEC, but other serotypes such as 026 and Olll are also a major public health concern. The Center for Disease Control has calculated that E. coli 0157 H7 is responsible for more than 70,000 infections and 60 deaths, and other EHEC strains cause approximately 36,000 illnesses and 30 deaths every year in the USA (Mead et al., 1999). In 1994 E. coli 0157 H7 was legally declared an adulterant in ground beef in the USA (USDA/FSIS Directive 10,010.1, 2004). Since then... 

Mitomycin C -antitumor antibiotic inhibits RNAand DNA synthesis -bone marrow suppression -nausea and vomiting—mild to moderate -mucocutaneous effects (mucositis, stomatitis, diarrhea) -vesicant if extravasated -nephrotoxicity -veno-occlusive disease (VOD) of the liver -hemolytic-uremic syndrome... 

EHEC all ages/primarily in US, Canada, Europe, South America and Japan 12-60h acute bloody (hemorrhagic colitis in 31— 61%) occasionally nonbloody diarrhea SLT-I and -II - bloodstream - inhibition of protein synthesis - endothelial cell damage - microvascular thrombosis - hemolytic-uremic syndrome... 

Griffin PM, Tauxe RV The epidemiology of infections caused by Escherichia coli 0157 H7, other enterohemorrhagic E. coli, and the associated hemolytic uremic syndrome. Epidemiol Rev 1991 13 60-98. 

Louise CB, Obrig TG Shiga toxin-associated hemolytic-uremic syndrome Combined cytotoxic effects of Shiga toxin, interleukin-1 beta, and tumor necrosis factor alpha on human vascular endothelial cells in vitro. Infect Immun 1991 59 4173-4179. 

This material is hazardous through inhalation and ingestion. Symptoms from ingestions include diarrhea (may be bloody), dysentery, and hemolytic-uremic syndrome (HUS). Symptoms from inhalation are not fully documented but may result in breathing difficulty due to fluid accumulation in the lungs. 

Mortality Rate (untreated) <0.5% overall <15% hemolytic uremic syndrome <99% for thrombotic thrombocytopenic purpura. 

Signs and Symptoms Abdominal pain, cramps, diarrhea, fever, vomiting, tenesmus, and blood, pus, or mucus in stools. Infections also cause mucosal ulceration, rectal bleeding, drastic dehydration. Serious less frequent complications include sepsis, seizures, convulsions, rectal prolapse, toxic megacolon, intestinal perforation, renal failure, and hemolytic uremic syndrome. 

Mortality Rate (untreated) <15% <50% (Hemolytic uremic syndrome). 

Suggested Alternatives for Differential Diagnosis Malaria, typhoid fever, shigellosis, meningococcemia, salmonella infection, other tick-borne diseases, rickettsial infections, leukemia, lupus, disseminated intravascular coagulation, hemolytic uremic syndrome, leptospirosis, thrombocytopenic purpura, and idiopathic or thrombotic thrombocytopenic purpura. 

Suggested Alternatives for Differential Diagnosis Acute poststreptococcal glomerulonephritis, spotted fevers, typhus, malaria, hepatitis, Colorado tick fever, septicemia, heat stroke, disseminated intravascular coagulation, leptospirosis, hemolytic uremic syndrome. 

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