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Nephrology, General Hospital
The Escherichia coli (E. coli) bacteria is one of the most common causes of human illness. It forms part of the digestive flora and is always present in faecal matter.
By little known mechanisms it episodically causes disease in humans, either due to mutations that make it resistant to our body’s control mechanisms, or because it is present in places it should not normally be, such as the urinary tract or in the blood itself.
E. coli infections cover a range of severities, from a urinary tract infection which causes urinary discomfort, to infections from very aggressive strains such as the O157 strain: H7 causes Haemolytic Uraemic Syndrome (HUS).
A urinary infection caused by E. coli is the most common infection caused by the bacteria.
The low-severityE. coli infection that leads to a urinary tract infection is much more common than that which leads to HUS, which is considered a rare condition, and very uncommon in the general population.
In the case of HUS, a rare condition as previously stated, the E. coli bacteria causes bloody diarrhoea and blood clotting in the smallest veins (thrombotic microangiopathy). This leads to kidney failure and also the alteration of other organs such as the heart and brain.
HUS is a serious phenomenon, which, if is not diagnosed and treated early, can cause death.
Infection with E. coli, which primarily affects the urinary tracts, causes discomfort when urinating, pain and increased frequency of urination, and fever if the kidneys are affected.
HUS is characterised by a feeling of general unwellness, bloody diarrhea, with or without a fever.
Infection by E. coli, normally a urinary infection, affects breastfeeding infants who do not have control of their sphincters, something which facilitates the extension of the intestinal flora into the urinary tract, and also in women of childbearing age.
HUS can occur at any age, but is most common between the ages of 4 and 12, after having consumed foods contaminated with E. coli O157, normally meat or dairy products from cows that are themselves infected with E. coli O157.
E. coli is diagnosed in the Microbiology laboratory, using cultures of a suitable medium, or through detection using techniques of molecular biology.
The treatment is an antibiotic, either oral or intravenous, depending on the extent of the infection and the patient’s general condition.
The treatment for HUS caused by E. coli is always hospitalisation, with the possibility of hemodialysis being prescribed to treat renal failure.
Patients with HUS produced by E. coli very often make a full recovery, despite it being a serious disease.
In the case of suspected E. coli, it is necessary to identify E. coli, generally in the blood or urine, through cultures, to confirm the diagnosis and prescribe the appropriate antibiotic.
Additionally, if infection by E. coli is confirmed, an image test such as an ultrasound is indicated in order to evaluate the state of the kidneys and urinary tracts.
If HUS is suspected, hospitalisation is always indicated to check for signs of thrombotic microangiopathy (TMA): anemia, renal failure, decreased platelet count, and broken or fragmented red blood cells.
A universally effective prevention for E. coli does not exist.
It is important to drink a lot of water in order to urinate every 2-3 hours, and above all not to hold pee in when you feel the urge to go.
Veterinary control of animals who carry E. coli O157 is fundamental for the prevention of HUS.
This is a disease that typically occurs during pregnancy and one of the main causes of complications for pregnant women and new-born babies. It is characterized by high blood pressure and signs of damage to other organs, such as the liver and kidneys.
Symptoms are unspecific and often appear in any pregnant woman: Headaches, swollen legs, stomach-ache, feeling “foggy”, buzzing in the ears. It is not symptomatic, the diagnosis is mainly made by measuring blood pressure and blood and urine tests.
Pregnant women over 20 weeks into pregnancy. Women who are black, elderly, obese or have a diagnosis of high blood pressure or diabetes before pregnancy are at greater risk.
Blood pressure> 140/90 repeatedly and persistently accompanied by proteinuria (protein in the urine) or blood, kidney or liver alterations reported in blood tests.
There is no treatment, though the signs and symptoms can be controlled for a few days / weeks, the definitive treatment is childbirth.
Blood and urine tests. Foetal ultrasound and Doppler.
In patients with high risk of preeclampsia it can be prevented with aspirin. A tablet must be taken every day from the first-trimester ultrasound and until the 36th week of pregnancy.
SLE is a systemic autoimmune disease. Under normal conditions, the immune system produces proteins (antibodies) to protect us from bacteria, viruses, and other foreign substances (what we call antigens). In autoimmune diseases like SLE, the immune system gets "confused" and cannot distinguish between foreign particles and our own cells, so it produces antibodies against our own body, which causes inflammation and damage to different organs.
It being a systemic disease means that it can affect most parts/organs of our body: skin, joints, kidney, lungs, etc. It is a chronic disease that has flares or flare-ups, meaning that it goes through periods where it is more active (flare-ups) and periods of inactivity.
Antiphospholipid syndrome is characterized by the appearance of thrombosis (blood clots) in any area of the body, complications during pregnancy (especially recurring miscarriages and premature births), and the presence of antibodies against phospholipids. Half of the cases of APS are associated with SLE.
SLE can affect almost every organ in the body. The most frequent symptoms are:
The most characteristic clinical manifestations of APS are thrombosis (blood clots) and serial miscarriages.
This thrombosis can trigger deep vein thrombosis in the legs, strokes or brain bleeding, myocardial infarctions, pulmonary thrombosis, ocular thrombosis, etc.
Among the complications that APS may cause during pregnancy, the most common are repeated miscarriages (mostly before week 10 of gestation), although it can also give rise to premature births (before week 34 of gestation).
Apart from the thrombosis and obstetric complications, patients with APS may also present with anaemia, kidney problems, convulsions, arrhythmia, and different kinds of skin lesions.
SLE is a disease that predominantly affects women; one man is diagnosed with this illness for every nine women. It can appear at any age, although most cases manifest between 17 and 35 years of age.
What exactly triggers the disease is unknown. It is believed that an infectious agent may initiate the disease, but at the same time, the individual must present genetic and hormonal factors for this to occur.
APS also affects women (60-80%) more than it affects men. It is unknown exactly why there are individuals who test positive for antiphospholipid antibodies but have never had thrombosis or a miscarriage, while others who are positive do have these issues.
The diagnosis for SLE is clinical and is based on three main aspects: the symptoms the patient reports, the alterations observed on the physical examination, and the results of the blood and urine analysis. There is no single test to diagnose SLE.
There are some abnormalities on a blood test that can make us suspect that a patient may have SLE. It is common for these patients to have a low number of leukocytes, lymphocytes, and/or platelets. We can also detect the presence of antinuclear antibodies (ANAs). Almost 100% of patients with SLE are positive for these, but this does not constitute a diagnosis of the disease, since healthy people or those with other illnesses can test positive.
Diagnosing APS is based on the combination of clinical characteristics mentioned previously (presence of thrombosis or obstetric problems like miscarriages or premature births) and the presence of one or more of the antibodies typically associated with the disease (lupus anticoagulant, cardiolipin antibodies, and anti-beta 2-glycoprotein antibodies).
There is no single cure for SLE, since treatment will vary for each patient based on the clinical manifestations they present. It is usually a long-term, chronic treatment. Generally speaking, anti-inflammatory agents and corticosteroids are prescribed to treat flares and immunosuppressants (hydroxychloroquine, methotrexate, azathioprine, mycophenolate, etc.) are used, based on the areas/organs affected, to treat and prevent new flare-ups. Currently, we only have one biological pharmaceutical approved for SLE, belimumab, although numerous studies are underway that aim to find new, effective drugs to treat this disease.
Treatment for APS mainly includes the administration of an anti-clotting treatment (aspirin) or anticoagulant, based on the clinical manifestations and antibody profile of the patient.
The most common diagnostic test used for suspected SLE and APS is the blood analysis, which includes testing for auto-antibodies.
Other studies and tests can also be used, based on the patient's symptoms: urinalysis to evaluate whether the kidney is affected, chest X-rays and echocardiogram when the heart or lungs are involved, renal biopsy if kidney problems are detected, skin biopsy, head CT or MRI if neurological symptoms appear, etc.
There is no specific measure we can take to prevent the appearance of SLE and APS.
Once manifested, an early diagnosis is essential for both illnesses in order to begin treatment quickly and thus avoid possible complications. Patients must regularly see and work in close collaboration with their specialists.
In addition, for both SLE and APS, it's very important to strictly control the classic cardiovascular risk factors (high blood pressure, diabetes, dyslipidaemia, obesity, and tobacco use), because they can very negatively affect the prognosis of both diseases.
Lupus-Eritematoso
American College of Rheumatology: Lupus
American College of Rheumatology: Síndrome Antifosfolípido
American College of Rheumatology: Tratamientos
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