Last reviewed: 25 Dec 2021
Last updated: 08 Oct 2019



History and exam

Key diagnostic factors

  • diarrhoea, especially bloody diarrhoea
  • childhood, especially age <5 years

Other diagnostic factors

  • known community outbreak of Shiga toxin-producing E coli
  • history of ingestion of food that may have been contaminated with Shiga toxin-producing E coli
  • unusual side effect seen after treatment with ciclosporin, chemotherapy, quinine
  • pregnancy or post-partum status
  • unusual adverse effect seen after bone marrow transplant
  • family history of possible HUS-like syndrome

Risk factors

  • ingestion of contaminated food or water
  • known community outbreak of toxicogenic E coli
  • exposure to infected individuals in institutional settings
  • genetic predisposition (atypical HUS)
  • bone marrow transplant
  • exposure to ciclosporin, some chemotherapy agents, targeted cancer agents, and quinine
  • pregnancy- or postpartum-related

Diagnostic investigations

1st investigations to order

  • FBC
  • peripheral blood smear
  • renal function/creatinine
  • serum electrolytes (sodium, potassium, chloride and bicarbonate, calcium and phosphorus)
  • PT, PTT
  • LDH
  • haptoglobin
  • stool culture on sorbitol-MacConkey agar to detect Shiga toxin-producing Escherichia coli
  • polymerase chain reaction (PCR) to detect Shiga toxin 1/Shiga toxin 2
  • proteins involved in complement regulation

Investigations to consider

  • urinalysis
  • ADAMTS13 level
  • LFTs
  • serum amylase, lipase, glucose

Treatment algorithm



Sharon Andreoli, MD

Byron P. and Francis D. Hollet Professor of Pediatrics, Pediatric Nephrology

Indiana University School of Medicine




SA owns stock in Merck and Pfizer, and has been a consultant for Reata Pharmaceuticals. SA is on the Editorial Board of Pediatric Nephrology and the Journal of Pediatrics.

Myda Khalid, MD

Associate Professor of Pediatric Nephrology

Indiana University School of Medicine




MK declares that she has no competing interests.


Dr Sharon Andreoli and Dr Myda Khalid would like to gratefully acknowledge Dr Ann Zimrin and Dr John Hess, previous contributors to this topic.


AZ and JH declare that they have no competing interests.

Peer reviewers

Rebecca Connor, MD

Chief Fellow

Section of Hematology and Oncology

Department of Internal Medicine

Wake Forest University Baptist Medical Center




RC declares that she has no competing interests.

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