Hemolytic Uremic Syndrome in a Patient with Bacteroides fragilis Infection

Acute renal injury from thrombotic microangiopathy associated with enteritis in New Zealand white rabbits

“…The period of clinical illness was 1-13 d. Because of their worsening clinical course, all rabbits were euthanized via barbiturate overdose. Antemortem blood collection was carried out for hematology (6 rabbits; cases 1, 3, 5, 7, 8, 10) and clinical chemistry (5 rabbits; cases 1,5,7,8,11). Hematology findings included anemia in all 6 rabbits and heterophilia in 4 rabbits (cases 3, 5, 7, 8).…”

“…HUS typically follows enterocolitis associated with infections of Stx-producing organisms such as Shigella dysenteriae type 1 or E. coli O157:H7; however, other infectious agents such as Streptococcus pneumoniae, Legionella pneumophila, and B. fragilis have also been associated with HUS. 5,6,11 Additional causes of HUS include genetic dysregulation of the complement cascade, a variety of systemic conditions, such as autoimmune disease or neoplasia, and exposure to a variety of drugs. 6 Changes consistent with HUS have been reported in Dutch Belted rabbits infected with E. coli O157:H7, 8 and we observed similar lesions in the kidneys and intestines of the NZW rabbits of our report.…”

“…B. fragilis , isolated from case 12, is a gram-negative organism that also possesses an endotoxin and has been associated with nephropathy. 11,20 In an experiment using male NZW rabbits, a 5-h infusion of E. coli endotoxin produced acute renal failure associated with anemia and decreased platelet numbers. Within the glomeruli, capillary endothelial damage was followed by transient heterophilic infiltration, thrombosis, and fibrin deposition.…”

“…14 Klebsiella oxytoca and Citrobacter spp. were also isolated from the intestinal tract of 2 of the E. coli-positive rabbits (cases 10,11). No Clostridium, Campylobacter, or Salmonella species were isolated.…”