URGENT! | În atenţia MEDICILOR şi PACIENŢILOR care se luptă cu BACTERIA UCIGAŞĂ! RECOMANDĂRI de la specialistul NAŞUL TV din Las Vegas

ATENTIE foarte mare: acesti pacienti NU trebuie tratati cu antibiotice decit daca bacteria este in singe sau in plamini. Antibioticele vor omori multe bacterii foarte repede si ele vor elimina si mai multa toxina care va agrava boala si in final  va duce la decesul pacientului.

„In patients with confirmed or suspected infections due to enterohemorrhagic E. coli, we recommend antibiotics and antimotility agents not be given „…NOT TO BE GIVEN

Atit copiii cit si adultii trebuie urmariti cu mare atentie in spital. Tratamentul este in general suportabil.

„SUMMARY AND RECOMMENDATIONS — The hemolytic uremic syndrome (HUS) is defined by the simultaneous occurrence of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury (AKI). The most common cause of HUS is due to Shiga toxin-producing Escherichia coli (STEC).

●The prevention of STEC-HUS is dependent on measures that decrease the risk of infection. (See „Microbiology, pathogenesis, epidemiology, and prevention of enterohemorrhagic Escherichia coli (EHEC)”, section on ‘Prevention’.)

●There is no known effective therapy to prevent progression from the bloody diarrheal phase (acute infectious phase) to the postdiarrheal phase of HUS.

●In patients with confirmed or suspected infections due to enterohemorrhagic E. coli, we recommend antibiotics and antimotility agents not be given (Grade 1C). (See ‘Prevention’ above.)

●We suggest that children with significant volume depletion during the diarrheal phase of STEC infection receive early parenteral volume expansion to avoid renal hypoperfusion (Grade 2B).

Management of acute phase — Therapy for STEC-HUS is supportive and includes the following (see ‘Supportive therapy’ above):

●Patients with HUS can become profoundly and rapidly anemic and require red blood cell transfusions. In our clinical experience, we transfuse when the hemoglobin level falls below 6 g/dL. (See ‘Anemia’ above.)

●We suggest platelet transfusion only if there is active bleeding or prior to a required invasive procedure in patients with platelet counts less than 30,000/mm3 (Grade 2C). (See ‘Thrombocytopenia’ above.)

●For each patient, the fluid status is assessed and management is directed toward returning the patient to a euvolemic state. In particular, management should be directed to rapidly correct any evidence of volume depletion. Fluids are then administered as insensible losses plus urine output until renal function returns to normal. Frequent monitoring of fluid balance, weight, and vital signs is required to detect early signs of fluid overload. If this occurs, prompt fluid restriction is begun. (See ‘Fluid management’ above.)

●Initial assessment and monitoring are required to detect hyperkalemia, hyperphosphatemia, and metabolic acidosis. Management of these disorders is the same as in patients with other causes of AKI. (See „Prevention and management of acute kidney injury (acute renal failure) in children”, section on ‘Electrolyte management’.)

●Dialysis therapy is initiated as indicated for AKI. (See „Prevention and management of acute kidney injury (acute renal failure) in children”, section on ‘Renal replacement therapy’ and „Pediatric acute kidney injury: Indications, timing, and choice of modality for renal replacement therapy (RRT)”.)

●Hypertension is managed by fluid restriction, antihypertensive agents, and dialysis if needed. We suggest the use of calcium channel blockers (such as nifedipine or nicardipine) as the initial choice of antihypertensive agents in the acute phase of the illness (Grade 2C). (See ‘Hypertension’ above.)

●Parenteral antiepileptic agents (eg, diazepam, phenytoin, and fos-phenytoin) are used in the management of seizures in patients with HUS. (See „Management of convulsive status epilepticus in children”.)

●In patients with severe neurologic involvement, we suggest administering eculizumab, a monoclonal antibody to complement factor C5 that blocks complement activation (Grade 2C). (See ‘Eculizumab’ above.)

●We do not recommend the use of antithrombotic agents or oral Shiga toxin-binding agent (Grade 1B). (See ‘Specific therapy’ above.

Prognosis and follow-up

●In general, the short-term prognosis is favorable with mortality rates below 5 percent. However, the risk of renal failure 20 years after recovery is not negligible and long-term follow-up is recommended. In patients who require renal transplantation, recurrence of HUS is rare. (See ‘Prognosis’ above.)

●Yearly evaluations of patients with HUS include blood pressure measurement, urinalysis, and serum creatinine. (See ‘Follow-up’ above.)

●After the acute phase of HUS, we suggest that angiotensin converting enzyme (ACE) inhibitors be given in patients who have renal sequelae (Grade 2C). (See ‘Hypertension’ above.)

Ion Alexie MD
Infectious Diseases and Internal Medicine
Diplomate of the American Boards of Infectious Diseases
Las Vegas, Nevada