What is hemolytic uremic syndrome?

People who have hemolytic uremic syndrome, or HUS, have hemolytic anemia (not enough red blood cells), thrombocytopenia (not enough platelets) and renal failure (kidney failure). Most cases of HUS happen after someone has become infected with E. coli. E. coli is short for Escherichia coli -- a common germ that people and many animals normally have in their digestive tract. Certain strains of E. coli can cause severe abdominal cramps and bloody diarrhea or other problems. These strains of E. coli produce a poison that damages the lining of blood vessels. As red blood cells travel through the damaged vessels, they are often destroyed.

Who gets HUS?

Anyone can get HUS, but children and older adults are more likely to get it.

What are the symptoms of HUS?

Symptoms of HUS usually appear 5 to 10 days after the diarrhea starts. You should call your doctor if you notice any of the following symptoms:

• Fatigue
• Pale skin
• Unexplained bruising or bleeding
• Swelling of the face, hands, feet or any other part of the body
• Decreased urination

How do you get HUS?

Most cases of HUS occur after an E. coli infection. You can catch E. coli infection by doing one of the following:

• Eating undercooked ground beef (for example, the inside of a hamburger that you have eaten was pink)
• Drinking contaminated (impure) water
• Drinking unpasteurized (raw) milk
• Eating unwashed, contaminated raw vegetable and fruits
• Working with cattle

Healthy beef and dairy cattle may carry E. coli in their intestines. When the animals are slaughtered, the meat can get contaminated with these bacteria. When the meat is ground, the E. coli bacteria get mixed throughout the meat.

Ponds and lakes can also become contaminated with E coli. Sometimes contaminated water is unknowingly used to irrigate crops.

The most common way to get infected with E. coli is to eat undercooked ground beef. You can be infected with E. coli if you don't use a high enough temperature to cook your beef, or if you don't cook it long enough. When you eat undercooked beef, the bacteria go into your stomach and intestines.

The bacteria can also be passed from person to person in day care centers and nursing homes. If you have this infection and don't wash your hands well with soap after going to the bathroom, you can give the bacteria to other people when you touch things, especially food.

How is HUS treated?

Most people who become infected with E. coli won't get HUS. If you do, you will need to go to the hospital so that your doctor can watch your kidney function and make sure you keep enough fluid in your body. If you have hemolytic anemia, you may need to have a red blood cell transfusion. If you have thrombocytopenia, you may need a platelet transfusion. If you have kidney failure, you may need dialysis. During dialysis, a machine is used to filter waste products from the blood. Dialysis is only needed in the most severe cases of HUS.

Most people who are diagnosed with HUS go on to make a full recovery.

How can I prevent HUS?

To lower your risk of being infected with E. coli, follow these rules:

• Wash your hands carefully with soap before you start cooking.
• Cook ground beef until you see no pink anywhere.
• Don't taste small bites of raw ground beef while you're cooking.
• Don't put cooked hamburgers on a plate that had raw ground beef on it.
• Cook all hamburgers to at least 155°F. A meat thermometer can help you test your hamburgers.
• In restaurants, always order hamburgers and steaks that are cooked well done so that no pink shows.
• Defrost meats in the refrigerator or the microwave. Don't put meat on the counter at room temperature to defrost.
• Keep raw meat and poultry separate from other foods. Use hot water and soap to wash cutting boards and dishes after raw meat and poultry have touched them.
• Wash all fruits and vegetables thoroughly with clean water.
• Drink only clean water.
• Don't drink raw milk.
• Keep food refrigerated or frozen.
• Keep hot food hot and cold food cold.
• Refrigerate leftovers right away or throw them away.
• People who have diarrhea should wash their hands carefully and often, using hot water and soap, and washing for at least 30 seconds.
• People who work in day care centers and homes for the elderly should wash their hands often, too.
• Do not swim in dirty lakes or rivers.
• Wash your hands well after petting farm animals.

• What treatment is best for me?
• How did I get E. coli infection?
• Are there any medicines I can take?
• Will I need dialysis?
• Should I have my family tested for E. coli infection?
• Will there be any permanent damage to my kidneys?
• What changes should I make to my diet?
• I work at a day care center. Should I let the parents know that I have E. coli infection?
• Should I stop eating ground beef?
• How often should I wash my hands?