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Hemolytic uremic syndrome (HUS)

Definition

HUS is an illness in which the red blood cells are destroyed and the kidneys fail. HUS is a condition that can follow diarrhea caused by E. coli O157:H7 or Shigella dysenteriae. It can be serious, however, only a small percent of people with E. coli O157:H7 or Shigella dysenteriae develop HUS. Not all cases of HUS are caused by infection with these bacteria.

Pathogenic E. coli and Shigella including HUS is reportable to the Iowa Department of Public Health by Iowa Administrative Code 641 IAC 1.

Symptoms

Infection with the bacteria E. coli O157:H7 and Shigella dysenteriae may produce symptoms of stomach cramps, vomiting, bloody diarrhea, and/or mild fever. If a person goes on to develop HUS they will then become lethargic (feeling very tired) and pass decreasing amounts of urine. Other features include high blood pressure, kidney failure, jaundice (yellowish discoloration of the skin and the whites of the eyes), seizures, and bleeding into the skin. HUS, if it occurs, develops an average 7 days (but up to 3 weeks) after the first symptoms, when the diarrhea is improving.

Causes

HUS cannot be spread. However, the bacteria E. coli O157:H7 and Shigella dysenteriae, that can cause HUS, can be spread to others if personnel hygiene is not good.

Risk Factors

Anyone can get HUS but children under five and the elderly are at higher risk.

Prevention

There is no known medical treatment that will prevent the development of HUS. You can greatly reduce the risk of HUS by reducing the chances of becoming infected with E. coli O157:H7 or Shigella dysenteriae:

  • Do not fix food for others while having diarrhea.
  • Always wash hands thoroughly with soap and water before eating and before and after fixing any food, especially raw meat.
  • Wash hands after using the toilet and after changing diapers. (Wash the diapered child’s hands also.)
  • When caring for someone with diarrhea, wash your hands with plenty of soap and water after cleaning the bathroom, helping the person use the toilet, or changing diapers, soiled clothes or soiled sheets. Be sure to wash their hands also.
  • Always refrigerate meat. Never leave raw meat at room temperature.
  • Keep food that will be eaten raw, such as fruits and vegetables, from being in contact with food products from animals. (Wash thoroughly, especially those that will not be cooked.)
  • Never eat raw meat. If you are served an undercooked hamburger or other ground beef product in a restaurant, send it back for further cooking.
  • Cook all ground beef and hamburger thoroughly - to a temperature of 155 degrees F for at least 15 - 16 seconds or until juices run clear and no pink is visible.
  • Always wash hands, cutting boards and utensils between fixing raw meat or poultry and other items such as fruits and vegetables.
  • Drink only pasteurized milk, juice, or cider.
  • Avoid sexual practices that may permit fecal-oral transmission. Latex barrier protection (condoms) should be used to prevent the spread of pathogenic E. coli to sexual partners as well as other pathogens.

Treatment

In severe cases, kidney function is greatly reduced, and dialysis may be necessary. Abnormalities of the blood clotting system can cause a tendency to bleed, and the red blood count may be low (anemia). Transfusions are often needed in severe cases. Fortunately, most people with HUS recover completely, and kidney function returns to normal. However, a prolonged hospital stay is often required.

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