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Semin Thromb Hemost 2014; 40(04): 508-516
DOI: 10.1055/s-0034-1375298
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Treatment of Enterohemorrhagic Escherichia coli–Induced Hemolytic Uremic Syndrome (eHUS)

Reinhard Würzner
1   Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Innsbruck, Austria
,
Magdalena Riedl
2   Department of Pediatrics I, Innsbruck Medical University, Innsbruck, Austria
3   Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
4   Cell Biology Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
,
Alejandra Rosales
2   Department of Pediatrics I, Innsbruck Medical University, Innsbruck, Austria
,
Dorothea Orth-Höller
1   Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Innsbruck, Austria
› Author Affiliations
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Publication History

Publication Date:
06 May 2014 (online)

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Abstract

Treatment of enterohemorrhagic Escherichia coli–induced hemolytic uremic syndrome (eHUS) still mostly relies on supportive intensive care regimens. Antibiotic treatment, as administered to eHUS patients during the 2011 O104:H4 outbreak, may reduce the shedding period, but this may apply only to this particular strain. In any case, there is no evidence for a beneficial use in the diarrheal phase and earlier warnings that antibiotic therapy at this stage may actually increase the likelihood of HUS remain unrefuted. Plasma exchange, a frequently chosen therapy in acute atypical HUS, was not beneficial for the outbreak patients and a prospective study of 274 pediatric eHUS patients even indicates a poorer long-term outcome. As eHUS is a disease where complement plays a pathophysiological role and individual beneficial treatments had been published, eculizumab was broadly administered during the outbreak, in particular to severely ill patients. The equally good outcome of treated versus untreated patients obviously does not allow a clear-cut statement, but rather points toward an advantageous use, at least for the severe cases. Although the role of complement should not be overestimated, the use of a complement blocker—not necessarily being a therapeutic option for uncomplicated eHUS—in severe disease may actually make the difference between favorable or detrimental outcome.

Keywords

hemolytic uremic syndrome - enterohemorrhagic Escherichia coli - complement - Shiga toxin
 

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