Haemolytic uraemic syndrome following Shigella dysenteriae type 1 outbreak in Zimbabwe: a clinical experience.

ABSTRACT

Shigella dysenteriae type 1 related dysentery outbreak in Zimbabwe at the end of 1992 has been associated with an increase in the frequency of haemolytic uraemic syndrome (HUS). In order to document this new clinical experience a retrospective study was undertaken to document clinical and laboratory features, treatment and outcome of children with HUS. During the period January 1993 to June 1994, 96 children with HUS were seen at the referral hospitals in Harare. Severe and prolonged anaemia was a common feature and 80 pc of the children were given blood transfusions. Severe anaemia (HB < 6g/dl) was however, present in 50 pc of the children prior to death. Leucocytosis (white blood cell count > 20 x 10(9)/L) was present in 87 pc of the children on admission and there was no association between the level of leucocytosis and anuria. Anuria was present in 37 (39 pc) and was associated with a mortality of 68 pc. Peritoneal dialysis was performed in 26 (27 pc) patients. Major neurological complications were seen in a third of the children. Thirty eight children died, an overall case fatality rate (CFR) of 40 pc. Earlier recognition, prompt and comprehensive supportive therapy may improve the immediate survival in children with HUS in Zimbabwe.