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Tarr PI, Fouser LS, Stapleton AE, Wilson RA, Kim HH, Vary JC Jr, Clausen CR
Brief Report: Hemolytic uremic syndrome in a six-year-old girl with a urinary tract infection with shiga-toxin-producing E. coli O103:H2
New Engl J Med (Aug) 335:635-638 1996
Hemolytic uremic syndrome is usually associated with Shiga-toxin producing E. Coli of the O157:H7 strain, a strain which does not ferment sorbitol. In this report HUS followed an apparent urinary tract infection and pyelonephritis with a sorbitol fermenting strain of E. Coli, O103:H2. There was initially no diarrhea, although diarrhea did develop in hospital. Stools were negative for O157:H7. It was concluded that severe UTI, perhaps via pyelonephritis, may be sufficient to cause HUS. HUS due to O103:H2 has been previously reported, but mostly in association with diarrhea.
Comment: The case made is rather weak, in that stool was not tested for O103:H2. One clinical lesson to draw is that screening of stool with sorbitol fermentation may not be enough, as sorbitol fermenting O103:H2 E. Coli may be interpreted as normal flora. A good discussion of these issues can be found in the accompanying editorial by Rondeau and Peraldi, which is available in its entirety from NEJM. (John T. Daugirdas, M.D., University of Illinois at Chicago)
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