Shiga Toxin–Producing Escherichia coli and the Hemolytic–Uremic Syndrome

   This comprehensive review examines Shiga toxin–producing Escherichia coli (STEC) as major causes of bloody diarrhea and hemolytic–uremic syndrome (HUS), particularly in children. It explores STEC pathogenesis, highlighting Shiga toxin 2 as the primary virulence factor driving endothelial injury and thrombotic microangiopathy. The article details the mechanisms of toxin uptake, ribosomal inhibition, and organ damage especially in the kidneys. It reviews global epidemiologic data, serogroup-specific risks, and diagnostic modalities, emphasizing the need for timely stool testing and toxin genotyping. Clinical management focuses on avoiding unnecessary antibiotics, aggressive hydration to prevent HUS progression, and careful monitoring. Experimental therapies like complement inhibitors and plasma exchange are discouraged outside trials. The piece concludes with insights into risk factors, including dehydration, age, and laboratory markers, recommending proactive monitoring during the high-risk period.

   This comprehensive review examines Shiga toxin–producing Escherichia coli (STEC) as major causes of bloody diarrhea and hemolytic–uremic syndrome (HUS), particularly in children. It explores STEC pathogenesis, highlighting Shiga toxin 2 as the primary virulence factor driving endothelial injury and thrombotic microangiopathy. The article details the mechanisms of toxin uptake, ribosomal inhibition, and organ damage especially in the kidneys. It reviews global epidemiologic data, serogroup-specific risks, and diagnostic modalities, emphasizing the need for timely stool testing and toxin genotyping. Clinical management focuses on avoiding unnecessary antibiotics, aggressive hydration to prevent HUS progression, and careful monitoring. Experimental therapies like complement inhibitors and plasma exchange are discouraged outside trials. The piece concludes with insights into risk factors, including dehydration, age, and laboratory markers, recommending proactive monitoring during the high-risk period.