Summary
Definition
History and exam
Key diagnostic factors
- diarrhea, especially bloody diarrhea
- 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 cyclosporine, chemotherapy, quinine
- pregnancy or postpartum 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 cyclosporine, some chemotherapy agents, targeted cancer agents, and quinine
- pregnancy- or postpartum-related
Diagnostic investigations
1st investigations to order
- CBC
- 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
Contributors
Authors
Byron P. and Francis D. Hollet Professor of Pediatrics, Pediatric Nephrology
Indiana University School of Medicine
Indianapolis
IN
Disclosures
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.
Associate Professor of Pediatric Nephrology
Indiana University School of Medicine
Indianapolis
IN
Disclosures
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.
Disclosures
AZ and JH declare that they have no competing interests.
Peer reviewers
Chief Fellow
Section of Hematology and Oncology
Department of Internal Medicine
Wake Forest University Baptist Medical Center
Winston-Salem
NC
Disclosures
RC declares that she has no competing interests.
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