■溶血性尿毒症综合征(HUS)的特征是进行性肾损伤并伴有血栓性微血管病,临床定义为微血管病性溶血性贫血伴血小板减少和器官损伤。产志贺毒素的大肠杆菌(STEC)-HUS是由致病性大肠杆菌菌株感染引起的,通常是O157、O26和O111。然而,其他类型的致病性大肠杆菌的患病率一直在增加,这些病原体有时会导致STEC-HUS的不典型临床表现。
■我们报告了一名3岁女孩的病例,该女孩被诊断为STEC-HUS,并伴有一种罕见的O80:H2stx2血清型,以非典型的临床过程为特征。她出现严重溶血性贫血和轻度肾功能不全,但没有肠出血性腹泻。入院时使用拭子收集的粪便样本的第一次培养测试没有发现STEC的迹象,导致非典型HUS的初步诊断;因此,在红细胞输血以及重组血栓调节蛋白α和结合珠蛋白的基础上,给予依库珠单抗.然而,随后对她的第二个粪便样本进行的培养测试显示存在O80:H2stx2,证实了STEC-HUS的诊断.随后,病人的病情好转,血清肌酐水平在3个月内逐渐恢复正常。
■对于缺乏典型STEC-HUS症状的病例,认真诊断至关重要。我们提倡反复进行粪便培养测试,以确保准确识别和及时处理此类病例。
UNASSIGNED: Hemolytic uremic syndrome (HUS) is characterized by progressive kidney injury accompanied by thrombotic microangiopathy, which is clinically defined as microangiopathic hemolytic anemia with thrombocytopenia and organ injury. Shiga toxin-producing Escherichia coli (STEC)-HUS is caused by infection with pathogenic E. coli strains, typically O157, O26, and O111. However, the prevalence of other types of pathogenic E. coli has been increasing, and these pathogens sometimes cause atypical clinical manifestations of STEC-HUS.
UNASSIGNED: We report the case of a 3-year-old girl diagnosed with STEC-HUS associated with a rare O80:H2 stx2 serotype, characterized by an atypical clinical course. She presented with severe hemolytic anemia and mild renal dysfunction but did not have enterohemorrhagic diarrhea. The first culture test of her stool sample collected using a swab upon admission yielded no signs of STEC, leading to an initial diagnosis of atypical HUS; thus, eculizumab was administered adding to red blood cell transfusion and recombinant thrombomodulin alfa and haptoglobin. However, a subsequent culture test of her second stool sample revealed the presence of O80:H2 stx2, confirming the diagnosis of STEC-HUS. Subsequently, the patient\'s condition improved, and her serum creatinine level gradually normalized over the course of 3 months.
UNASSIGNED: Diligently diagnosis is crucial in cases lacking typical STEC-HUS symptoms. We advocate for repeated stool culture testing to ensure accurate identification and timely management of such cases.