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Hemolytic uremic syndrome (HUS) is characterized by hemolytic anemia, thrombocytopenia, and acute renal failure — often together with neurologic deficits. Past outbreaks typically have involved children aged <5 years and have been attributable to gastrointestinal infection by enterohemorrhagic Escherichia coli — often type O157:H7. Shiga toxins (Stx) types 1 and 2, produced by these pathogens, play an important role in inducing HUS.
An outbreak of Shiga toxin–producing Escherichia coli (STEC) infections began in Germany in the spring of 2011, ultimately resulting in >3800 reported cases; 845 of the patients developed HUS. Uncharacteristically, 88% of the HUS patients were adults. The causative organism — E. coli serotype O104:H4 — produces S…