Two cases of non-O157:H7 Escherichia coli hemolytic uremic syndrome caused by urinary tract infection

Escherichia coli serotype O157:H7 Is a leading cause of diarrhea and hemolytic uremic syndrome (HUS). Because of the limitations of current diagnostic techniques, the prevalence of non-O157:H7 Shiga toxin-producing E coli strains Is not known. We describe two patients with HUS in whom no E coli O157:H7 was demonstrable In stool cultures. On culture of the urine, the first patient was found to have E coli O113:H21 strain, and the second patient had E coli O6:H1 serotype. Shiga toxin production (stx2) by the O113:H21 Isolate was confirmed. The first patient required 15 days of peritoneal dialysis and subsequently recovered renal function. At last follow-up, serum creatinine was 0.9 mg/dL. The second patient had preservation of renal function throughout the acute illness with serum creatinine of 0.5 mg/dL. The clinical presentation, bacteriology, course, and outcome as well as epidemiologic Implications of the Increasing number of patients with E coli urinary tract infections associated with HUS are discussed. These cases Illustrate the need to investigate patients with nondiarrheal HUS for Infection with Shiga toxin-producing E coli of the non-O157 strain variety. (C) 2001 by the National Kidney Foundation, Inc.