Haemolytic-uraemic syndrome complicating shigella dystentery in south Indian children.

Abstract

The infants of mothers with skinfold thicknesses less than 7 mm (less than 25th percentile for the whole group) had significantly smaller anthropometric measurements than those of mothers with skinfold thicknesses greater than 12-1 mm (greater than 75th percentile) (see table II).There were significant differences between the paying and nonpaying groups in infant weight and length and maternal height and triceps skinfold thickness (see table III). Infants weighing under 2500 g constituted 24 % of the whole group, 15 % of the paying group, and 30 % of the non-paying group. DiscussionThe positive correlation we found between maternal triceps skinfold thickness and infant anthropometric measurements is further evidence that the nutrition of the mother affects the nutrition of her baby. The social class differences in these measurements confirm this point, as many of our mothers were appreciably malnourished. Indeed, the mean maternal triceps skinfold thickness in our non-paying group was only 8-7 mm compared with the 16 mm found by Turner and Whitehouse8 in British young women. Furthermore, the fetal growth retarding factor of maternal smoking was absent in our mothers.Perinatal mortality in south India is as high as 68-8 per 1000rural population and 62-8 per 1000 urban population."0 This high rate is due partly to problems of intrauterine growth retardation. Our results emphasise the need to pay attention to maternal nutrition in developing countries. Indeed, at least two studies" 12 have shown that dietary supplementation during pregnancy benefits the growth of the infants. In Britain Trussell" and Smalley and Bissenden14 have also emphasised the importance of an adequate diet during pregnancy, particularly among immigrants. Furthermore, Davies et all5 have suggested that the growth-retarding effect of maternal smoking is due to poor food intake during pregnancy. Our work has added to the evidence that an adequate maternal diet is necessary for adequate fetal growth-a fact that is important for the West as well as developing countries.We thank the British Paediatric Association and H J Heinz company for funding the fellowship of JRS.

Neutrophil Function in an Experimental Model of Hemolytic Uremic Syndrome

“…We have previously demonstrated that platelet function is impaired in a modified model of the MGSR (14). This model which has similar features to the form of HUS associated with shigellosis (5,8) has been studied extensively in our laboratory (14). The purpose of the present study was to determine whether circulating neutrophils were functionally impaired as a result of prolonged infusion of endotoxin in this model.…”

Protein conjugates of synthetic saccharides elicit higher levels of serum IgG lipopolysaccharide antibodies in mice than do those of the O-specific polysaccharide fromShigella dysenteriaetype 1

“…Within the genus of Shigella, Shigella dysenteriae type 1 (Shiga's Bacillus) causes both endemic and epidemic shigellosis with serious extraintestinal complications, including the hemolytic uremic syndrome, accompanied by a high rate of mortality: Today the organism manifests almost universal antibiotic resistance (2)(3)(4)(5)(6)(7). In addition, S. dysenteriae type 1 is unique among shigellae in that it alone expresses an exotoxin called Shiga toxin.…”

Haemolytic uraemic syndrome due to ciprofloxacin-resistant Shigella dysenteriae serotype 1

“…HUS has been reported to be a frequent complication during such outbreaks, with an incidence ranging from 14 out of 91 cases to almost one-third of cases (Oneko et al, 2001;Nathoo et al, 1998). HUS following shigellosis appears to be a much more aggressive and severe disease than HUS due to enterohaemorrhagic E. coli because of severe renal involvement with prolonged oliguria (Bhimma et al, 1997;Raghupathy et al, 1978;Koster et al, 1984;Bhuyan et al, 1985). The reported mortality (range 17 .…”

“…Studies from Europe and Americas have documented evidence of STEC infections in 33-60 % of patients with HUS (Karmali et al, 1983;Scotland et al, 1988;Lopez et al, 1989). However, in South-East Asia and Africa, HUS has been related to epidemics of S. dysenteriae type 1 (Raghupathy et al, 1978;Nathoo et al, 1995;Bhimma et increase in incidence of HUS has been reported that coincided with an epidemic of S. dysenteriae 1 (Rollins et al, 1995). HUS has been reported to be a frequent complication during such outbreaks, with an incidence ranging from 14 out of 91 cases to almost one-third of cases (Oneko et al, 2001;Nathoo et al, 1998).…”

“…Of all serotypes of shigellae, Shigella dysenteriae type 1 attracts special attention for its epidemic-causing potential and its association with most serious dysentery cases, with a high attack rate, high case fatality rate and various complications (Bennish et al, 1990). Haemolytic uraemic syndrome (HUS) can be a sequela of infection with S. dysenteriae serotype 1, which characteristically expresses the Shiga cytotoxin (Raghupathy et al, 1978;Lopez et al, 1989).…”