Hemolytic uremic syndrome in association with typhoid fever

Ali Albaqali, Adel Ghuloom, Ahmed Al Arrayed, Abdulla Al Ajami, Durjoy K. Shome, Afaf Jamsheer, Hyat Al Mahroos, Srdjan Jelacic, Phillip I. Tarr, Bernard S. Kaplan, Radha K. Dhiman

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12 Scopus citations

Abstract

Background: Hemolytic uremic syndrome (HUS) has been associated with typhoid fever caused by Salmonella typhi. The pathogenesis of HUS in the context of S typhi infection is not known. The authors report on a patient with typhoid fever in whom HUS and myocarditis developed during the course of his illness and in whom there was no evidence of a Shiga-toxin (Stx)-producing organism. Methods: Antibodies directed against the Escherichia Coli O157:H7 and S typhilipopolysaccharide (LPS) were sought in the serum sample taken during the acute phase using line-blot immunoassays. Polymerase chain reaction was performed to detect the presence of stx1 and stx2 genes in the patient's S typhi isolate. Results: There was no evidence for immunoglobulin (Ig) M and IgA against the LPS of E coli O157:H7, whereas anti-S typhi LPS IgM and IgA were strongly positive. In the polymerase chain reaction, DNA from the Stx-producing E coli controls yielded stx1 and stx2 fragments of the expected sizes on agarose gel electrophoresis, whereas no stx1 and stx2 fragments were obtained from the S typhi isolate. The S typhi did, however, yield a band when amplified with primers specific for viaB, an S typhi gene. Conclusion: S typhi may be responsible for some cases of HUS, and the inciting toxin may not be Stx.

Original languageEnglish
Pages (from-to)709-713
Number of pages5
JournalAmerican Journal of Kidney Diseases
Volume41
Issue number3
DOIs
StatePublished - Mar 1 2003
Externally publishedYes

Keywords

  • Hemolytic uremic syndrome (HUS)
  • Myocarditis
  • Salmonella typhi
  • Shiga toxin
  • Typhoid fever

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    Albaqali, A., Ghuloom, A., Al Arrayed, A., Al Ajami, A., Shome, D. K., Jamsheer, A., Al Mahroos, H., Jelacic, S., Tarr, P. I., Kaplan, B. S., & Dhiman, R. K. (2003). Hemolytic uremic syndrome in association with typhoid fever. American Journal of Kidney Diseases, 41(3), 709-713. https://doi.org/10.1053/ajkd.2003.50135