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Article Review/Hyperlink
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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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