Hemolytic uremic syndrome in adults: A case report

Abstract

Thrombotic microangiopathies (TMA) are microvascular occlusive disorders characterized by platelet aggregation and mechanical damage to erythrocytes, clinically characterized by microangiopatic haemolytic anemia, thrombocytopenia and organ injury. We are reporting a case of a woman patient with severe hemolytic uremic syndrome associated to infectious diarrhoea caused by Shiga toxin-producing pathogen, who were admitted to our intensive care unit. The patient described developed as organ injury, neurological failure and acute renal failure, with need of haemodialysis technique. Due to the severity of the case and the delay in the results of the additional test that help us to the final diagnose, we treated her based on a syndromic approach of TMA with plasma exchange, with favourable clinical evolution with complete recovery of organ failures. We focus on the syndromic approach of these diseases, because thrombotic thrombocytopenic purpura, one of the disorders that are included in the syndromes of TMA, is considered a haematological urgency given their high mortality without treatment; and also review the TMA in adults: Their pathogenesis, management and outcomes.

Multidrug resistance in Shiga toxin-producing Escherichia coli (STEC) isolated from broiler chickens at slaughter

“…Escherichia coli is one of the major pathogens involved in foodborne outbreaks in Brazil (Brasil, 2019). Among E. coli pathotypes, Shiga toxin-producing Escherichia coli (STEC) is known to cause severe episodes of diarrhea that can progress to systemic complications (Pèrez-Cruz et al, 2017). Broiler chickens and derived products are reservoirs of this pathotype (Alonso, Lucchesi, Rodríguez, Parma, & Padola, 2012;Doregiraee et al, 2016;Momtaz & Jamshidi, 2011;Runa, Lijon, & Rahman, 2018), playing an important role as source of transmission to humans.…”

Combination of plasma exchange and haemofiltration for treating thrombotic microangiopathy in children

“…8 However in clinical settings, PE is still used to treat Shiga toxinmediated TMA, 9,10 and some case reports have described therapeutic success. 11,12 Plasma exchange is a therapeutic haemopurification procedure in which the blood of the patient is passed through medical apparatus that removes high molecular weight substances and replaces them with a solution such as albumin or fresh frozen plasma, which provides missing essential factors, for example, complement factor H and I in patients with complementmediated TMA are contained. 1,13 The targeted substances that are planned to be removed include immune complexes, endotoxins, autoantibodies and lipoproteins, all of which are potentially related to immune-mediated disorders.…”