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Microbes without frontiers: severe haemolytic-uraemic syndrome due to E coli O104:H4
  1. Sophie Binks1,
  2. Kate Regan2,
  3. Jonathan Richenberg1,3,
  4. Tim Chevassut4
  1. 1Brighton and Sussex Medical School, Brighton, UK
  2. 2Intensive Care Unit, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  3. 3Department of Imaging and Nuclear Medicine, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  4. 4Department of Haematology, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  1. Correspondence to Dr Tim Chevassut, T.Chevassut{at}bsms.ac.uk

Summary

Antibiotic use in infection with Shiga-toxin-producing strains of Escherichia coli (E coli) is thought to increase the risk of developing haemolytic-uraemic syndrome (HUS). One paediatric study concluded that E coli O157:H7-infected patients who had received antibiotic therapy were 17 times more likely to progress to HUS than those who had not. Quinolones are among those incriminated. In vitro experiments suggest toxin induction of 80-fold with ciprofloxacin and E coli O104:H4. We report here the case of a 44-year-old man returning from Hamburg who presented with a 5 day history of bloody diarrhoea which had worsened after starting ciprofloxacin. A severe illness of overlapping HUS and thrombotic thrombocytopaenic purpura (TTP) ensued, with neurological complications requiring ventilation and intensive care admission. Stool sample eventually confirmed E coli O104:H4. Although the patient made a good recovery following treatment with haemofiltration and plasma exchange with fresh frozen plasma (FFP), ciprofloxacin may have exacerbated his clinical course.

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