This week, more than 1,000 people got sick and 16 died in an outbreak of HUS – a disease related to the bacteria E. coli. Initially cucumbers imported from Spain were blamed to be contaminated with the bacteria, but today this theory was proved wrong, and the source of the infection remains a mystery. What exactly is HUS, and what can you do to avoid it?
Initially, Germans have been warned not to eat cucumbers. (Photo by kobiz7)
Danger Level: High
What is it?
Hemolytic Uremic Syndrome (HUS) is a disease that causes anemia, renal failure and a low platelet count in the blood.
Who gets it?
Most cases of HUS develop in young children, but it can certainly happen in adolescents and adults as well.
It can affect men and women alike.
It’s usually not very common, occurring to 0.5-2 people out of 100,000 in the US per year.
What causes it?
The most common cause for HUS is infection with E. Coli bacteria. E. coli (or by its full name, Escherichia coli) is actually a large group of germs, some of them live in the intestines of healthy people. The type of E. coli which causes HUS is a violent type, which produces a toxin called Shiga-Like Toxin. The toxin is absorbed to the blood through the intestines, and damages the cells that create the most internal layer of blood vessels – especially in the kidney but also in other organs. This damage causes all the symptoms of HUS.
You can get infected with this type of E. coli by eating contaminated and undercooked meat or produce, drinking unpasteurized contaminated milk or swimming in contaminated pools and lakes. It can also be transferred by contact with infected people, for example – in day-cares.
E. coli (Photo by Phil Moyer)
There are other not-common causes for HUS, including:
- Other infections: Some other bacterial and viral infections can also cause HUS, but this is much less common.
- Medications: Several medications can (rarely) cause HUS, including birth control pills, some chemotherapy drugs and cyclosporine – which is used to suppress the immune system (for example after an organ transplant).
- Other diseases: Systemic Lupus Erythematosus (SLE), Preeclampsia and inflammation in the kidneys after radiation treatments.
- Some cases are genetic.
How does it feel?
- Food Poisoning: The first symptoms are food-poisoning symptoms caused by the E. coli bacteria themselves. This can include abdominal pain, a fever, vomiting and diarrhea which usually becomes bloody at some point. these symptoms appear 5-10 days before all the other symptoms.
- Anemia: This causes the sick person to look pale and be pretty tired, weak and irritable.
- Bleeding: There might be external bleeding (from the nose of mouth) or bleeding under the skin, which looks like small unexplained bruises. this is caused by a low number of platelets, which are the cells in our body responsible for blood clots.
- Kidney Failure: Can cause the body to produce less urine.
The story of 16-year-old Aly, who recovered from HUS
How is it discovered?
When suspecting HUS, the doctors will draw some blood. They will check several things: Complete Blood Count will let them know if there is anemia or low platelets, and kidney function tests will determine if there is kidney failure. They will also look at the blood under a microscope. Other tests that might be needed are a urine test (to look for blood in the urine) and a stool sample (to look for the germs).
How is it treated?
The treatment is given in the hospital, and the goal is to relieve the symptoms:
- The most important part of the treatment is dialysis treatments until the kidneys start working again. If the disease is diagnosed early enough, dialysis might not be needed. The doctors can save the kidneys from failing by giving a lot of fluids.
- The anemia is treated with blood transfusions, and the bleeding problems with platelet transfusions.
- Another possible treatment is plasma-exchange (also called plasmapheresis) – in which blood is removed from the body and blood from a donor is returned back. This is used to remove elements that cause the disease from the blood.
Although the cause is an infection, antibiotics are not part of the treatment.
Dialysis treatment.
What happens after treatment?
In most cases (about 90%, and especially in children), if the disease is discovered early enough and treated correctly, the patient recovers. The other 10% might die or remain with chronic kidney failure which will require dialysis treatments for the rest of their life or a kidney transplant. Some of the people who recover will develop kidney problems or hypertension later in life.
The bottom line – how do I avoid it?
The best way to avoid HUS is to avoid food-poisoning with E. coli – this can be done in several ways:
- Treating foods carefully: You should wash hands often when cooking, keep meat in the refrigerator or freezer, wash fruit and vegetables under running water, cook meat thoroughly without leaving pink areas (if you have a thermometer for cooking, cook to a temperature of at least 160°F [70°C]).
- Avoiding certain foods: Especially undercooked meat, unpasteurized milk and cider. Drink only clean water. Remember that the contaminated food will not necessarily look spoiled of taste bad.
- Avoid swimming in dirty lakes and pools.
- If you have diarrhea – wash hands often.
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