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To investigate three possible causes of the acute hemolysis in the hemolytic-uremic syndrome, we studied prospectively 207 children and 34 adults with shigellosis in Bangladesh. Nineteen children showed acute hemolytic anemia, a leukemoid reaction, thrombocytopenia and oliguria; nine other had, in addition, a serum urea nitrogen level of over 100 mg per diciliter. Eight of the nine had pseudomembranous colitis, and six of the nine died. The frequency of bacteremia was similar in all grades of shigellosis. Circulating immune complexes were found in 10 of 20 patients with uncomplicated shigellosis and in four of six with severe hemolytic-uremic syndrome. Limulus assay for endotoxemia was positive in nine of 18 patients with hemolysis (50 per cent) and three of 61 with uncomplicated shigellosis (5 per cent) (P less than 0.001). These data support the hypothesis that severe colitis in shigellosis is associated with circulating endotoxin from the colon producing coagulopathy, renal microangiopathy and hemolytic anemia.
F Koster, and
J Levin, and
L Walker, and
K S Tung, and
R H Gilman, and
M M Rahaman, and
M A Majid, and
S Islam, and
R C Williams
August 1975,
The New England journal of medicine,
F Koster, and
J Levin, and
L Walker, and
K S Tung, and
R H Gilman, and
M M Rahaman, and
M A Majid, and
S Islam, and
R C Williams
January 1988,
Nephron,
F Koster, and
J Levin, and
L Walker, and
K S Tung, and
R H Gilman, and
M M Rahaman, and
M A Majid, and
S Islam, and
R C Williams
February 1974,
The Journal of pediatrics,
F Koster, and
J Levin, and
L Walker, and
K S Tung, and
R H Gilman, and
M M Rahaman, and
M A Majid, and
S Islam, and
R C Williams
February 1984,
Clinical nephrology,
F Koster, and
J Levin, and
L Walker, and
K S Tung, and
R H Gilman, and
M M Rahaman, and
M A Majid, and
S Islam, and
R C Williams
January 1989,
Nephron,
F Koster, and
J Levin, and
L Walker, and
K S Tung, and
R H Gilman, and
M M Rahaman, and
M A Majid, and
S Islam, and
R C Williams
June 1987,
The Southeast Asian journal of tropical medicine and public health,
F Koster, and
J Levin, and
L Walker, and
K S Tung, and
R H Gilman, and
M M Rahaman, and
M A Majid, and
S Islam, and
R C Williams
June 1987,
The Journal of pediatrics,
F Koster, and
J Levin, and
L Walker, and
K S Tung, and
R H Gilman, and
M M Rahaman, and
M A Majid, and
S Islam, and
R C Williams
January 1983,
Contributions to nephrology,
F Koster, and
J Levin, and
L Walker, and
K S Tung, and
R H Gilman, and
M M Rahaman, and
M A Majid, and
S Islam, and
R C Williams
October 1976,
Pediatrics,
F Koster, and
J Levin, and
L Walker, and
K S Tung, and
R H Gilman, and
M M Rahaman, and
M A Majid, and
S Islam, and
R C Williams
July 1990,
Journal of the Medical Association of Thailand = Chotmaihet thangphaet,
