Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- diarrhea, especially bloody diarrhea
- childhood, especially age <5 years
Otros factores de diagnóstico
- 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 adverse effect following treatment with cyclosporine, some chemotherapy agents, targeted cancer agents, and quinine
- pregnancy or postpartum status
- unusual adverse effect following bone marrow transplant
- family history of possible HUS-like syndrome
Factores de riesgo
- 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
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- CBC
- peripheral blood smear
- renal function/creatinine
- serum electrolytes (sodium, potassium, chloride and bicarbonate, calcium and phosphorus)
- prothrombin time (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
Pruebas diagnósticas que deben considerarse
- urinalysis
- ADAMTS13 level
- LFTs
- serum amylase, lipase, glucose
Algoritmo de tratamiento
Shiga toxin-producing Escherichia coli (STEC) HUS
atypical HUS
secondary HUS: not due to Streptococcus pneumoniae
secondary HUS: due to S pneumoniae
Colaboradores
Autores
Sharon Andreoli, MD
Byron P. and Francis D. Hollet Professor of Pediatrics, Pediatric Nephrology
Indiana University School of Medicine
Indianapolis
IN
Divulgaciones
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
Indianapolis
IN
Divulgaciones
MK declares that she has no competing interests.
Agradecimientos
Dr Sharon Andreoli and Dr Myda Khalid would like to gratefully acknowledge Dr Ann Zimrin and Dr John Hess, previous contributors to this topic.
Divulgaciones
AZ and JH declare that they have no competing interests.
Revisores por pares
Rebecca Connor, MD
Chief Fellow
Section of Hematology and Oncology
Department of Internal Medicine
Wake Forest University Baptist Medical Center
Winston-Salem
NC
Divulgaciones
RC declares that she has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
Fakhouri F, Zuber J, Frémeaux-Bacchi V, et al. Haemolytic uraemic syndrome. Lancet. 2017 Aug 12;390(10095):681-96. Resumen
Banatvala N, Griffin PM, Greene KD, et al. The United States national prospective hemolytic uremic syndrome study: microbiologic, serologic, clinical and epidemiologic findings. J Infect Dis. 2001 Apr 1;183(7):1063-70. Resumen
Tarr PI, Gordon CA, Chandler WL. Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome. Lancet. 2005 Mar 19-25;365(9464):1073-86. Resumen
Wong CS, Jelacic S, Habeeb RL, et al. The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections. N Engl J Med. 2000 Jun 29;342(26):1930-6.Texto completo Resumen
McKee RS, Schnadower D, Tarr PI, et al; Pediatric Emergency Medicine Collaborative Research Committee and Pediatric Emergency Research Canada. Predicting hemolytic uremic syndrome and renal replacement therapy in Shiga toxin-producing Escherichia coli-infected children. Clin Infect Dis. 2020 Apr 10;70(8):1643-51.Texto completo Resumen
Loirat C, Fakhouri F, Ariceta G, et al; HUS International. An international consensus approach to the management of atypical hemolytic uremic syndrome in children. Pediatr Nephrol. 2016 Jan;31(1):15-39. Resumen
Boyce TG, Swerdlow DL, Griffin PM. Escherichia coli O157:H7 and the hemolytic uremic syndrome. N Engl J Med. 1995 Aug 10;333(6):364-8. Resumen
Rathbone J, Kaltenthaler E, Richards A, et al. A systematic review of eculizumab for atypical haemolytic uraemic syndrome (aHUS). BMJ Open. 2013 Nov 4;3(11):e003573.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
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