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Paediatrics, Children's Hospital and Woman's 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.
Paediatric age onset systemic autoimmune diseases are infrequent, complex entities that require a multi-disciplinary approach. The most frequent include juvenile onset systemic lupus erythematosus, mixed connective tissue disease, juvenile onset Sjögren’s syndrome, juvenile dermatomyositis, juvenile scleroderma, and paediatric age onset vasculitis, such as Kawasaki disease, IgA vasculitis (also known as Schönlein-Henoch purpura), polyarthritis nodosa and Takayasu disease.
The clinical manifestations of these diseases are highly varied. Juvenile systemic lupus erythematosus may affect several organs in the body, particularly the skin, joints, blood, kidneys and the central nervous system. In children, it is common for fever to appear without an infectious cause or an increase in the size of the lymph nodes.
Juvenile dermatitis is characterised by the presence of fatigue, muscle pain, weakness and the appearance of rashes that may affect the face, with inflammation around the eyes (periorbital oedema) There may also be reddening of the cheeks (malar rash) and other parts of the body (top part of the knuckles, knees and elbows), where the skin may become thicker (Gottron’s papules). Juvenile scleroderma, whose name comes from the Greek and means “hard skin”, is characterised by the presence of lesions on the skin and affects various organs. Two types can mainly be identified: localised scleroderma and systemic scleroderma.
Kawasaki disease is characterised by the presence of a high fever of unknown origin, irritability, reddening of the eyes and various skin lesions, such as a rash on the torso, flaking fingers and reddening of the tongue (normally called “strawberry tongue”). The involvement of the heart is the most serious manifestation of Kawasaki disease, due to the possibility of long-term complications.
Schönlein-Henoch purpura is characterised by a rash on the legs called “palpable purple” because the skin lesions can be touched, and painful and swollen joints, abdominal pain and kidney problems may appear.
All the conditions within the group are infrequent and have an incidence of less than 5 cases per 10,000 inhabitants, for which reason they are considered to be rare conditions. The spread is different depending on the disease. For example juvenile systemic lupus erythematosus, along with juvenile dermatomyositis and scleroderma, are more common in girls, while Schönlein-Henoch purpura is more common in boys.
Diagnosis of paediatric systemic autoimmune diseases is eminently clinical and we are guided by classification and diagnostics criteria in many of them. Blood tests are important for diagnosing the different systemic autoimmune diseases, as various autoantibodies can be identified that can help with the diagnosis and monitoring of these diseases. Supplementary tests, such as a capillaroscopy, chest X-ray, respiratory function tests, nuclear magnetic resonance and echocardiogram, amongst others, can be helpful when we come to approaching a paediatric patient with a suspected systemic disease.
Treatment fundamentally depends on the type of condition and the response to the therapy chosen. There is not currently any specific curative treatment for each one of the diseases, but the treatments available will help to control the signs and symptoms of the disease and prevent complications, including permanent damage to organs and tissue.
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