Article Discusses Hemolytic Uremic Syndrome and Encephalopathy in a Pregnant Woman

An article published this month in the International Journal of Infectious Diseases1 discusses a case of hemolytic uremic syndrome (HUS) with encephalopathy in a pregnant woman. Both the baby and mother survived.

The following is information from the case study found in the article (“Hemolytic–uremic syndrome with acute encephalopathy in a pregnant woman infected with epidemic enterohemorrhagic Escherichia coli: characteristic brain images and cytokine profiles”, cited below).

A 26-year-old woman ate raw beef at 31 weeks and 4 days of pregnancy. The next day, she had bloody diarrhea and abdominal pain, symptoms of an infection of Escherichia (E. coli) bacteria. The incubation period for E. coli illnesses is generally 3 to 10 days, so this was a very fast onset.

By day 4, she was admitted to the hospital with very bloody diarrhea and severe pain. On day 5 after eating the raw beef, her baby was delivered by C-section. Prior to this surgery, she was diagnosed with incomplete HUS with the following laboratory data:

red blood cell (RBC) count 4.35 × 1012/l, hematocrit 36%, hemoglobin 12.8 g/dl, absence of RBC fragmentation, platelet count 43 × 109/l, lactate dehydrogenase (LDH) 1161 IU/l, blood urea nitrogen 21 mg/dl, creatinine 2.7 mg/dl, prothrombin time 15.8 s, fibrin degradation products 16.2 μg/ml, and antithrombin 59%.

In the recovery room, she had problems breathing, went into respiratory arrest and had a heart attack (cardiac arrest). After resuscitation, her Glasgow Coma Scale score was 11 (the range is 3 to 15—the higher the score, the less responsive the patient).

At the same time, her urine output was almost nonexistent, suggesting kidney failure from the HUS. She was put on hemodiafiltration and plasma exchange therapy for the HUS.

During this time, a stool sample tested positive for both E. coli O157 and O111, two distinct serotypes of the bacteria, both capable of making someone sick. The authors of the article called it a “superinfection”. She was part of an E. coli outbreak linked to raw beef served at a chain restaurant. This poor woman, a new mother, was almost dead because a restaurant served tainted meat.

The second day after the C-section, she had mild seizures, and anti-convulsion therapy was started. 4 days later,  “steroid pulse therapy and cytokine adsorption therapy were added because θ ∼ δ waves were shown on her electroencephalogram indicating diffuse brain cortex damage; several findings of acute encephalopathy were also observed on brain CT, which depicted diffuse brain edema and low-density areas in the bilateral putamen.”

It was not until 14 days after the C-section that the young mother regained consciousness. She required rehabilitation for recovery of motor and cognitive function.

The E. coli Outbreak

The woman was sickened in an outbreak of Escherichia coli (E. coli) O111 and O157 infections in Japan in 2011. 326 people reported gastrointestinal symptoms consistent with an E. coli infection, including severe abdominal pain and bloody diarrhea. Of those, 181 presented as outbreak-related cases, 86 met the outbreak’s case definition, and 55 had laboratory-confirmed (by pulsed-field gel electrophoresis (PFGE)) cases of O111 and/or O157.1, 2 Of the 86 case patients, 34 (40%) developed HUS and 21 (about 24%) developed acute encephalopathy.1 5 people died due to HUS, encephalopathy, and brain edema (swelling).1

Of the 55 laboratory-confirmed cases, some were positive for only O111, some for both O111 and O157, and some for only O157. Interestingly, there was a far higher rate of HUS in the case patients sickened by O111:

Of the 37 EHEC O111-positive cases (groups 1 and 2), 17 developed HUS, including 13 cases of acute encephalopathy. However, of the 30 EHEC O157-positive cases (groups 2 and 3), only 9 cases developed HUS, including 6 cases of acute encephalopathy.2

The source of the outbreak was a raw beef dish yukhoe served at a barbecue restaurant chain. The fact that all of those sickened in the outbreak at at the same restaurant during the same time period is concrete evidence that restaurant food caused the illnesses. An outbreak strain of E. coli O111 was found in the beef, which is “smoking gun” evidence that beef from the restaurant caused the illnesses.

In the United States, with this kind of evidence, those sickened would have personal injury claims and have the right to sue the restaurant and beef processor. The families of those who didn’t survive would have wrongful death claims. These rights are important because companies that sell contaminated meat should be held accountable.

1. Ito, M., et al. “Hemolytic–uremic syndrome with acute encephalopathy in a pregnant woman infected with epidemic enterohemorrhagic Escherichia coli: characteristic brain images and cytokine profiles.” International Journal of Infectious Diseases 34 (2015): 119-121.
2. Yahata, Y., et al. “Characterization of Enterohemorrhagic Escherichia coli O111 and O157 strains isolated from outbreak patients in Japan.” Journal of Clinical Biology (2014): 2757-2763.

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Category: Food Poisoning
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