Campylobacter jejuni and Hemolytic-Uremic Syndrome
Campylobacter jejuni and Hemolytic-Uremic Syndrome
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空肠弯曲菌与溶血性尿毒症综合征
作者：
M. Sillero;J. Almirall
http://BioMedNet.com/karger溶血性尿毒综合征（HUS）是一种罕见的疾病，其特征是微血管病性贫血、血小板减少性紫癜和急性少尿性肾衰竭。这是一种常见于幼儿的疾病。许多情况可能与HUS有关，特别是感染性疾病。最常见的相关性是在感染大肠杆菌0157：H7-产志贺样毒素的儿童中。其他不太常见的相关感染与肺炎链球菌、志贺氏菌、沙门氏菌、耶尔森氏菌和几种病毒有关。弯曲杆菌很少与溶血尿毒综合征的发生有关。在过去17年的Medline修订版中，只有6篇参考文献涉及弯曲杆菌属。[1][2][3][4][5][6][7]我们描述了一个新的情况下，溶血尿毒综合征的发展后，空肠弯曲菌肠炎的成年患者。一位76岁的单纯性慢性支气管炎患者，因吸烟习惯（15支/天）而因少尿和呕血入院。四周前，他曾出现急性胃肠炎发作，伴有大量腹泻和呕吐。C.粪便培养分离出空肠，未发现与其他病原体的混合感染。最初，仅通过饮食措施，进展良好，但几天后，他主诉进行性黄疸、全身恶化和进行性少尿。在进一步吐血后，他决定咨询医院。入院时，他的全身状况不佳，血压为14/8 mm Hg，体温为37 °C。黄疸明显，并检测到全身性紫癜，尤其是在腿部远端。体格检查时未观察到其他显著变化。生化和血液学检查显示：正常的白色血细胞计数和公式，溶血性贫血2.7！106个红细胞，血红蛋白7.5 mg/dl，丰富的外周裂红细胞，低结合珠蛋白水平（！5 mg/dl）和30，000种元素的血小板减少症。其他测试披露：GOT 287，GPT 147，LDH 7，135，总胆红素5.5 mg/dl（间接胆红素3 mg/dl），尿素270 mg/dl，肌酐6.6 mg/dl，电离图正常。B、C型肝炎和HIV的血清学值均为阴性;此外，免疫学检查（cryopulins、ANA、ANCA、补体、抗肾小球基底膜）正常或阴性。腹部超声心动图和放射学检查也正常。尽管进行了利尿剂治疗，但患者在入院数小时后仍严重少尿，肾功能进行性恶化。HUS的诊断被确立，我们开始用新鲜冷冻血浆1,000 ml/天，双嘧达莫100 mg/8 h，甲泼尼龙80 mg/天静脉注射和血液透析治疗。8天后，他的总体状况开始改善（表1）; 3周后，他出院，总体状况良好。6个月后，他完全无症状，分析测试正常。在最后一次控制中，12个月后他仍然很好。溶血尿毒综合征是一种罕见疾病，儿童的发病率约为1-2.5例/105;成人的发病率为1/106。临床资料
Accessible online at: http://BioMedNet.com/karger Dear Sir, The hemolytic-uremic syndrome (HUS) is an infrequent illness characterized by microangiopathic anemia, thrombocytopenic purpura and acute oliguric renal failure. It is a disorder usually encountered in young children. A number of conditions can be associated with HUS, especially infectious diseases. The most frequently described association has been in children infected by the Escherichia coli 0157:H7-producing Shigalike verotoxin. Other less frequently associated infections have been described with Streptococcus pneumoniae, Shigella, Salmonella, Yersinia and several viruses. Infrequently, Campylobacter has been implicated in the development of HUS. In the Medline revision of the last 17 years, only 6 references relate Campylobacter spp. and HUS in adults [1–6]. We describe a new case of HUS that developed after Campylobacter jejuni enteritis in an adult patient. A 76-year-old patient with a simple chronic bronchitis secondary to smoking habit (15 cigarettes/day) was admitted because of oliguria and hematemsesis. Four weeks earlier he had had an acute gastroenteritic episode, with abundant diarrhea and vomiting. C. jejuni was isolated in the stool culture, no coinfection with other pathogens was detected. The evolution was initially favorable with only dietetic measures, but several days later he complained of progressive icterus, general worsening, and progressive oliguria. After further hematemesis, he decided to consult the hospital. At admission he appeared in bad general condition, blood pressure was 14/8 mm Hg, temperature 37 °C. Icterus was evident and a generalized purpura was detected especially in the distal part of the legs. No other remarkable alterations were noted at physical examination. The biochemical and hematological examinations disclosed: normal white blood cell count and formula, hemolytic anemia with 2.7 ! 106 red blood cells, hemoglobin 7.5 mg/dl, abundant peripheral schistocytes, depressed haptoglobin levels (! 5 mg/dl) and thrombopenia of 30,000 elements. Other tests disclosed: GOT 287, GPT 147, LDH 7,135, total bilirubin 5.5 mg/dl (indirect bilirubin 3 mg/dl), urea 270 mg/dl, creatinine 6.6 mg/dl, with normal ionogram. Serological values for hepatitis B, C and HIV were negative; further, immunological tests (cryoglobulins, ANA, ANCA, complement, antiglomerular basement membrane) were normal or negative. Abdominal echography and radiological examinations also were normal. The patient remained severely oliguric after several hours of admission, in spite of the diuretic treatment, with progressive worsening of the kidney function. The diagnosis of HUS was established and we started treatment with fresh-frozen plasma 1,000 ml/ day, dipyridamole 100 mg/8 h, methylprednisolone 80 mg/day intravenously and hemodialysis. After 8 days his overall condition started to improve (table 1); he was discharged after 3 weeks in good general condition. After 6 months he was completely asymptomatic with normal analytical tests. In the last control, 12 months later he was still well. HUS is an infrequent illness, with an approximate incidence in children of 1–2.5 cases/105; in adults the incidence is 1/106 Table 1. Clinical data
一名 6 岁女孩因产志贺毒素大肠杆菌 O103:H2 尿路感染而出现溶血尿毒症综合征。
DOI：
10.1056/nejm199608293350905
发表时间：
1996
期刊：
The New England journal of medicine.
影响因子：
--
作者：
Tarr,PI;Fouser,LS;Stapleton,AE;Wilson,RA;Kim,HH;VaryJr,JC;Clausen,CR
通讯作者：
Clausen,CR
影响因子：
158.5
作者：
BELL, WR;BRAINE, HG;KICKLER, TS
通讯作者：
KICKLER, TS