Next time you are faced with a child with diarrhea, consider STEC infection, prioritize obtaining a stool specimen for PCR testing in the ED, stratify risk based on clinical features and laboratory findings, and monitor high-risk children closely for signs of evolving HUS. It is my hope that with the knowledge you gain from this column you will be better able to identify and manage STEC infections and help prevent progression to life-threatening renal and neurologic complications.

A special thanks to Dr. Stephen Freedman, the guest expert on the EM Cases podcast that inspired this column.

Dr. Helman is an emergency physician at North York General Hospital in Toronto. He is an assistant professor at the University of Toronto, Division of Emergency Medicine, and the education innovation lead at the Schwartz/Reisman Emergency Medicine Institute. He is the founder and host of the Emergency Medicine Cases podcast and website.

References

1. Ylinen E, Salmenlinna S, Halkilahti J, et al. Hemolytic uremic syndrome caused by Shiga toxin-producing Escherichia coli in children: incidence, risk factors, and clinical outcome. Pediatr Nephrol. 2020;35(9):1749-1759.
2. Freedman SB, van de Kar NCAJ, Tarr PI. Shiga toxin-producing Escherichia coli and the hemolytic-uremic syndrome. N Engl J Med. 2023;389(15):1402-1414.
3. McKee RS, Tarr PI, Dietzen DJ, et al. Clinical and laboratory predictors of shiga toxin-producing escherichia coli infection in children with bloody diarrhea. J Pediatric Infect Dis Soc. 2018;7(3):e116-e122.
4. Tack DM, Kisselburgh HM, Richardson LC, et al. Shiga toxin-producing Escherichia coli outbreaks in the United States, 2010-2017. Microorganisms. 2021;9(7):1529.
5. Campbell CT, Poisson MO, Hand EO. An updated review of Clostridium difficile treatment in pediatrics. J Pediatr Pharmacol Ther. 2019;24(2):90-98.
6. McKee RS, Schnadower D, Tarr PI, et al. Predicting hemolytic uremic syndrome and renal replacement therapy in Shiga Toxin-producing Escherichia coli-infected children. Clin Infect Dis. 2020;70(8):1643-1651.
7. Scheiring J, Andreoli SP, Zimmerhackl LB. Treatment and outcome of Shiga-toxin-associated hemolytic uremic syndrome (HUS). Pediatr Nephrol. 2008;23(10):1749-1760.
8. Mansour MA, Khalil DF, Hasham MA, et al. Hemolytic uremic syndrome with central nervous system manifestations, a case report and literature review. Radiol Case Rep. 2023;18(6):2268-2273.