HEMOLYTIC-UREMIC SYNDROME FOLLOWING URINARY-TRACT INFECTION WITH ENTEROHEMORRHAGIC ESCHERICHIA-COLI - CASE-REPORT AND REVIEW

A 6-week-old child with acute urinary tract infection caused by Shiga toxin-producing Escherichia coli (STEC) O5:H-developed hemolytic-uremi c syndrome (HUS). Molecular and phenotypic analysis of the urinary iso late indicated that it lacked uropathic properties and that it was pro bably of intestinal origin. Nevertheless, the patient did not experien ce a diarrheal prodrome, nor was STEC or Shiga toxin detected in his f eces at any time. Examination of the patient's serum pointed to recent infection with E. coli O5, with no evidence of exposure to E. coli O1 57, O111, or O26. A review of 13 previously reported cases of HUS asso ciated with acute urinary tract infection indicated that this was the first case of nondiarrheal HUS in which infection with the most common STEC serogroups was specifically excluded. This case illustrates the need to investigate patients with nondiarrheal HUS for infection with STEC.