R. Bhimma et al., POST-DYSENTERIC HEMOLYTIC-UREMIC SYNDROME IN CHILDREN DURING AN EPIDEMIC OF SHIGELLA DYSENTERY IN KWAZULU NATAL/, Pediatric nephrology, 11(5), 1997, pp. 560-564
We report 81 of 107 cases of hemolytic uremic syndrome (HUS), admitted
between July 1994 and February 1996, following an outbreak of Shigell
a dysenteriae type 1 dysentery in Kwazulu/Natal. All patients, excludi
ng 1, were black with a mean age of 38 months (range 1-121); 50 (61.7%
) were males. The mean duration of dysentery was 11.3 days (range 1-41
) and HUS 15 days (range 1-91). Most patients had acute oliguric renal
failure (90.1%); 42 (51.6%) required peritoneal dialysis. Complicatio
ns included encephalopathy 30 (37.0%), convulsions 12 (14.8%) and hemi
plegia 2 (2.3%), gastrointestinal perforation 8 (9.9%), protein losing
enteropathy 26 (32.1%), toxic megacolon 4 (4.9%), rectal prolapse 5 (
6.2%), hepatitis 11 (13.6%), myocarditis 5 (6.2%), congestive cardiac
failure 3 (3.7%), cardiomyopathy 3 (3.7%), infective endocarditis 1 (1
.2%), septicemia 15 (18.5%), disseminated intravascular coagulation 17
(21%). Leukemoid reactions were found in 74 (91.3%) patients, hyponat
remia in 56 (69.1%), and hypoalbuminemia in 67 (82.7%). Stool culture
for Shigella dysenteriae type I was positive in only 7 (8.6%) patients
; Shiga toxin assays were not performed. Outcome was as follows:recove
ry 32 (39.5%), impaired renal function 8 (9.9%), chronic renal failure
26 (32.1%), end-stage renal disease 1 (1.2%), and death 14 (17.3%) pa
tients.