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Hemorrhagic Colitis With Escherichia coli 0157:H7 Preceding Adult Hemolytic Uremic Syndrome

Hemorrhagic Colitis With Escherichia coli 0157:H7 Preceding Adult Hemolytic Uremic Syndrome Abstract Escherichia coli serotype 0157:H7 is a rarely identified organism that has recently been associated with hemorrhagic colitis in all age groups and with the hemolytic uremic syndrome (HUS) in children. We now report the development of HUS in two young women following enteric infection with E coli 0157:H7. Both patients were hospitalized because of the severity of their colitis. They later developed major hemolysis requiring transfusion and significant renal failure requiring, in one case, hemodialysis. One patient underwent laparotomy, where sterile ascites, marked right colonic edema, and intraserosal hemorrhage were noted. Both women survived and are currently improving. Fecal E coli serotype 0157:H7 was sought only after routine cultures were negative and features of HUS were recognized. The search for the E coli was facilitated by the continued availability of stool cultures obtained early in the course of the illness. The source of infection was not ascertained, but ingestion of untreated water was a feature of both cases. The HUS is a potential complication of the hemorrhagic colitis associated with E coli serotype 0157:H7 and may develop in adults as well as children following enteric infection with this organism. (Arch Intern Med 1985;145:2215-2217) References 1. Riley LW, Remis RS, Helgerson SD, et al: Hemorrhagic colitis associated with a rare Escherichia coli serotype. N Engl J Med 1983;308:681-685.Crossref 2. Update: Sporadic hemorrhagic colitis. MMWR 1984;33:28-29. 3. Remis RS, MacDonald KL, Riley LW, et al: Sporadic cases of hemorrhagic colitis associated with Escherichia coli 0157:H7. Ann Intern Med 1984;101:624-626.Crossref 4. Sporadic cases of hemorrhagic colitis associated with E coli 0157:H7. Can Dis Weekly Rep 1983;9:181-184. 5. Pai CH, Gordon R, Sims HV, et al: Sporadic cases of hemorrhagic colitis associated with Escherichia coli 0157:H7. Ann Intern Med 1984;101:738-742.Crossref 6. Campos A, Sibley R, Kim Y, et al: Hemolytic uremic syndrome. Kidney 1981;14:23-30. 7. Fong JSC, de Chadarevian J-P, Kaplan BS: Hemolytic uremic syndrome: Current concepts and management. Pediatr Clin North Am 1982;29:835-856. 8. Koster F, Levin J, Walker L, et al: Hemolytic uremic syndrome after shigellosis. N Engl J Med 1978;298:927-933.Crossref 9. Baker NM, Mills AE, Rachman I, et al: Haemolytic-uraemic syndrome in typhoid fever. Br Med J 1974;2:84-87.Crossref 10. Prober CG, Tune B, Hoder L: Yersinia pseudotuberculosis septicemia. AJDC 1979;133:623-624. 11. Chamovitz BN, Hartstein AL, Alexander SR, et al: Campylobacter jejuni-associated hemolytic uremic syndrome in a mother and daughter. Pediatrics 1983;71:253-256. 12. Austin TW, Ray CG: Coxsackie virus group B infections and the hemolytic uremic syndrome. J Infect Dis 1973;127:698-701.Crossref 13. Ray CG, Tucker VL, Harris DJ, et al: Enteroviruses associated with the hemolytic uremic syndrome. Pediatrics 1970;46:378-388. 14. O'Regan S, Robitaille P, Mongeau J-G, et al: Hemolytic uremic syndrome associated with ECHO 22 infection. Clin Pediatr 1980;19:125-127.Crossref 15. Dolislager D, Tune B: Hemolytic uremic syndrome: Spectrum of severity and significance of the prodrome. AJDC 1978;132:55-58. 16. Surawicz C, Belie L: Rectal biopsy helps to distinguish acute self-limited colitis from idiopathic inflammatory bowel disease. Gastroenterology 1984;86:104-113. 17. Istre GR, Kreiss K, Hopkins RS, et al: An outbreak of amebiasis spread by colonic irrigation at a chiropractic clinic. N Engl J Med 1982;307:339-342.Crossref 18. Wade WG, Thom BT, Evans N: Cytotoxic enteropathogenic Escherichia coli. Lancet 1979;2:1235-1236.Crossref 19. Johnson WM, Lior H, Bezanson GS: Cytotoxic Escherichia coli 0157:H7 associated with haemorrhagic colitis in Canada. Lancet 1983;1:76.Crossref 20. O'Brien AO, Lively TA, Chen ME, et al: Escherichia coli 0157:H7 strains associated with haemorrhagic colitis in the United States produce a Shigella dysenteriae-1 (Shiga)-like cytotoxin. Lancet 1983;1:702.Crossref 21. O'Brien AD, Newland JW, Miller SF, et al: Shiga-like toxin-converting phages from Escherichia coli strains that cause hemorrhagic colitis or infantile diarrhea. Science 1984;226:694-696.Crossref 22. Karmali BS, Petric M, Steele BT, et al: Sporadic cases of haemolytic uremic syndrome associated with faecal cytotoxin and cytotoxin-producing Escherichia coli in stools. Lancet 1983;1:619-620.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Hemorrhagic Colitis With Escherichia coli 0157:H7 Preceding Adult Hemolytic Uremic Syndrome

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References (24)

Publisher
American Medical Association
Copyright
Copyright © 1985 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1985.00360120087014
Publisher site
See Article on Publisher Site

Abstract

Abstract Escherichia coli serotype 0157:H7 is a rarely identified organism that has recently been associated with hemorrhagic colitis in all age groups and with the hemolytic uremic syndrome (HUS) in children. We now report the development of HUS in two young women following enteric infection with E coli 0157:H7. Both patients were hospitalized because of the severity of their colitis. They later developed major hemolysis requiring transfusion and significant renal failure requiring, in one case, hemodialysis. One patient underwent laparotomy, where sterile ascites, marked right colonic edema, and intraserosal hemorrhage were noted. Both women survived and are currently improving. Fecal E coli serotype 0157:H7 was sought only after routine cultures were negative and features of HUS were recognized. The search for the E coli was facilitated by the continued availability of stool cultures obtained early in the course of the illness. The source of infection was not ascertained, but ingestion of untreated water was a feature of both cases. The HUS is a potential complication of the hemorrhagic colitis associated with E coli serotype 0157:H7 and may develop in adults as well as children following enteric infection with this organism. (Arch Intern Med 1985;145:2215-2217) References 1. Riley LW, Remis RS, Helgerson SD, et al: Hemorrhagic colitis associated with a rare Escherichia coli serotype. N Engl J Med 1983;308:681-685.Crossref 2. Update: Sporadic hemorrhagic colitis. MMWR 1984;33:28-29. 3. Remis RS, MacDonald KL, Riley LW, et al: Sporadic cases of hemorrhagic colitis associated with Escherichia coli 0157:H7. Ann Intern Med 1984;101:624-626.Crossref 4. Sporadic cases of hemorrhagic colitis associated with E coli 0157:H7. Can Dis Weekly Rep 1983;9:181-184. 5. Pai CH, Gordon R, Sims HV, et al: Sporadic cases of hemorrhagic colitis associated with Escherichia coli 0157:H7. Ann Intern Med 1984;101:738-742.Crossref 6. Campos A, Sibley R, Kim Y, et al: Hemolytic uremic syndrome. Kidney 1981;14:23-30. 7. Fong JSC, de Chadarevian J-P, Kaplan BS: Hemolytic uremic syndrome: Current concepts and management. Pediatr Clin North Am 1982;29:835-856. 8. Koster F, Levin J, Walker L, et al: Hemolytic uremic syndrome after shigellosis. N Engl J Med 1978;298:927-933.Crossref 9. Baker NM, Mills AE, Rachman I, et al: Haemolytic-uraemic syndrome in typhoid fever. Br Med J 1974;2:84-87.Crossref 10. Prober CG, Tune B, Hoder L: Yersinia pseudotuberculosis septicemia. AJDC 1979;133:623-624. 11. Chamovitz BN, Hartstein AL, Alexander SR, et al: Campylobacter jejuni-associated hemolytic uremic syndrome in a mother and daughter. Pediatrics 1983;71:253-256. 12. Austin TW, Ray CG: Coxsackie virus group B infections and the hemolytic uremic syndrome. J Infect Dis 1973;127:698-701.Crossref 13. Ray CG, Tucker VL, Harris DJ, et al: Enteroviruses associated with the hemolytic uremic syndrome. Pediatrics 1970;46:378-388. 14. O'Regan S, Robitaille P, Mongeau J-G, et al: Hemolytic uremic syndrome associated with ECHO 22 infection. Clin Pediatr 1980;19:125-127.Crossref 15. Dolislager D, Tune B: Hemolytic uremic syndrome: Spectrum of severity and significance of the prodrome. AJDC 1978;132:55-58. 16. Surawicz C, Belie L: Rectal biopsy helps to distinguish acute self-limited colitis from idiopathic inflammatory bowel disease. Gastroenterology 1984;86:104-113. 17. Istre GR, Kreiss K, Hopkins RS, et al: An outbreak of amebiasis spread by colonic irrigation at a chiropractic clinic. N Engl J Med 1982;307:339-342.Crossref 18. Wade WG, Thom BT, Evans N: Cytotoxic enteropathogenic Escherichia coli. Lancet 1979;2:1235-1236.Crossref 19. Johnson WM, Lior H, Bezanson GS: Cytotoxic Escherichia coli 0157:H7 associated with haemorrhagic colitis in Canada. Lancet 1983;1:76.Crossref 20. O'Brien AO, Lively TA, Chen ME, et al: Escherichia coli 0157:H7 strains associated with haemorrhagic colitis in the United States produce a Shigella dysenteriae-1 (Shiga)-like cytotoxin. Lancet 1983;1:702.Crossref 21. O'Brien AD, Newland JW, Miller SF, et al: Shiga-like toxin-converting phages from Escherichia coli strains that cause hemorrhagic colitis or infantile diarrhea. Science 1984;226:694-696.Crossref 22. Karmali BS, Petric M, Steele BT, et al: Sporadic cases of haemolytic uremic syndrome associated with faecal cytotoxin and cytotoxin-producing Escherichia coli in stools. Lancet 1983;1:619-620.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Dec 1, 1985

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