Hemolytic uremic syndrome following complicated appendicitis in a child: what is the missing link?

Abstract

We herein describe an 18-month-old boy who underwent initially successful surgical and antibiotic treatment of complicated appendicitis with postoperative occurrence of hemolytic uremic syndrome (HUS). This complication was due to Shiga toxin-producing Escherichia coli (STEC) found secondarily in rectal swabs but not in the peritoneal cavity. The literature indicates that a causal link may exist between these two entities, and HUS could be considered an iatrogenic complication of appendicitis management due to a multimodal stress effect in non-symptomatic STEC carriers.

Species Characteristics of Causative Agents of Acute Appendicitis in Children and Determination of Their Susceptibility to Antibiotics

“…Appendicitis is one of the most common causes of intra-abdominal infections in children [1][2][3][4]. Th e causative agents of acute appendicitis (AA) can be various types of pathogenic and opportunistic microorganisms or their associations.…”

“…Th e incidence is high in Western countries, especially in Europe and America [9]. Appendicitis is more common in children, although it can occur in any age group [3,5].…”

“…It is believed that the main pathogens of AA in children are pathogenic and conditionally pathogenic Escherichia and Eacteroids in association with aerobic enterobacteria (Protea, Klebsiella, Edwardsiella, Pseudomonads), Staphylococci and Streptococci, as well as anaerobic Peptococcus, Peptostreptococcus, and Clostridia [3,6].…”

“…Th e results of scientifi c studies indicate that in most cases AA is caused by anaerobic bacteria in the digestive tract. Among them, E. coli occupies a leading place [3,7,10,15,16]. Th us, when studying the intraluminal and appendicular microbiome in children, Schulin et al [16] showed that E. coli dominates in all types of appendicitis (catarrhal -43%, phlegmonous -41%, gangrenous -50%).…”