There are several types of hemolytic uremic syndrome, including typical hemolytic uremic syndrome, atypical hemolytic uremic syndrome, and streptococcal pneumonia associated hemolytic uremic syndrome. Individuals who are most at risk include anyone under five years old, who consumes unpasteurized milk or undercooked meat, and who comes in contact with another individual infected by certain strains of E. coli. Individuals who do not wash their hands after handling farm animals or swim in unclean water are also at an increased risk of developing hemolytic uremic syndrome. A diagnosis is made with urine testing, blood testing, stool testing, physical examination, and kidney biopsy. Treatment for this condition may include dialysis, blood or platelet transfusions, intravenous fluids, and plasma exchange.
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Abdominal pain is most often seen in individuals affected by typical hemolytic uremic syndrome caused by an infection with a harmful strain of E. coli bacteria. The E. coli bacteria invade the intestinal tract and produce a byproduct called Shiga, which is toxic to the specialized tissues that make up the lining of the intestines. The Shiga toxin causes damage to the lining and blood vessels that supply the large intestine lining, crippling its ability to absorb fluid from the stool properly. Abdominal pain occurs because of the irritation, inflammation, and swelling in the intestinal tissues due to the tissue damage. The immune system responds to tissue damage in the intestine and causes further inflammation of not only the intestinal tissue but other structures around it. The nerves in the intestinal wall send pain signals to the brain in response to the damage, and the nerves in surrounding tissues become irritated from swelling and the influx of immune components to the site.
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An elevated body temperature or fever is an adaptive response produced by the brain when harmful pathogens are present in the body. This response is triggered to create an inhospitable or unfavorable environment for the harmful bacteria, virus, parasite, or fungus affecting the individual. A fever can manifest in a hemolytic uremic syndrome patient because many cases are caused by an infection with certain types of viruses and bacteria. Bacteria known to induce fever-producing hemolytic uremic syndrome include E. coli, S pneumoniae, salmonella typhi, campylobacter jejuni, Yersinia pseudotuberculosis, Neisseria meningitides, legionella pneumophila, and mycoplasma species. Viruses known to induce fever-producing hemolytic uremic syndrome include human immunodeficiency virus, coxsackievirus, echovirus, influenza, Epstein-Barr, herpes simplex, and herpesvirus 8. When any of these viruses or bacteria enter the body, colonize, and induce hemolytic uremic syndrome, a healthy immune system will respond by raising the body temperature and producing a fever.
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Nausea and vomiting are reported to occur in around half of all patients who develop hemolytic uremic syndrome. Vomiting is a term used to describe when an individual has a forceful and involuntary contraction in their stomach that causes the food inside of it to be propelled up their esophagus and out of their mouth. Vomiting is a natural response in the body when the brain detects dangerous substances in the blood or digestive system the kidneys and liver are not clearing efficiently. The vomiting center in the brain is activated in an attempt to remove the toxin, as it automatically assumes toxins in the blood are the result of toxin ingestion into the digestive tract. Hemolytic uremic syndrome patients experience nausea and vomiting because their kidneys are functioning poorly and allow certain substances to build up in the blood. At normal levels, these natural substances and waste products are not harmful. However, high levels of natural waste substances in the blood can cause all of the organs to become poisoned from the inside out. Vomiting can also be a symptom of gastroenteritis if that is the underlying cause of an individual's hemolytic uremic syndrome.
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Diarrhea associated with hemolytic uremic syndrome tend to contain blood. Diarrhea or loose stools occur as a complication of infection by certain strains of E. coli bacteria that colonize in the intestines. These E. coli strains include serotypes O157:H7, O103:H2, O145, O113, O111:H8, O121, O26, and O104:H4. A healthy individual's stool is not watery and does not contain any blood because the specialized lining in the large intestine functions to remove excess fluid before it is excreted. The E. coli infections that cause hemolytic uremic syndrome produce a certain toxin in the large intestine called Shiga toxin. The Shiga toxin and other toxins cause severe damage to the specialized tissue that forms the large intestine lining, causing it to lose absorption functionality and rupture blood vessels. This mechanism causes the stool to become loose, watery, and bloody.
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When an individual develops hemolytic uremic syndrome, it means more red blood cells are being destroyed than made. This imbalance is what causes low red blood cell counts and characterizes a condition referred to as hemolytic anemia. Red blood cells are what carry oxygen molecules around the body to the cells so they can carry out their differentiated and respective functions. When there are not enough red blood cells in circulation because of hemolytic uremic syndrome, the cells in the body do not receive enough oxygen. Cells require oxygen and glucose to carry out the metabolic process that produces usable cellular energy (ATP). A shortage of oxygen causes a shortage of ATP in the cells, which induces an adaptive response by the body to allocate the little bit of energy it has to the most important tissues like the brain and heart. This reallocation of cellular energy is what makes an individual feel extreme fatigue when they are affected by hemolytic uremic syndrome.