Petting Zoo Perils: <i>Escherichia coli O157:h7</i> Associated Hemolytic Uremic Syndrome Secondary to Animal Exposure

Animal exhibits can be a source of E. coli O157:h7 transmission and may lead to hemolytic uremic syndrome. The E. coli O157:h7 outbreak in Tennessee affected over 64 children. Five children, 15 months to 7 years of age, developed acute renal failure due to HUS, requiring renal replacement therapy. They were admitted to the hospital with acute renal failure between 7 and 12 days after exposure to animals. All children presented with vomiting, diarrhea, abdominal pain, and oligo-anuria and had laboratory confirmation of E. coli O157:h7 in the stool sample. They all required renal replacement therapy, and one child required therapeutic plasma exchange due to thrombotic microangiopathy vasculitis-associated encephalopathy. These children experienced dialysis catheter malfunction (n = 1), encephalopathy (n = 1), and thrombosis of the right jugular vein (n = 1). All children developed hypertension, and three out of five required anti-hypertensives at discharge. At the 1-year follow-up, the GFR ranged from 54 to 92 mL/min. Hypertension was noted in two. Hemolytic uremic syndrome can cause long-term sequelae like cerebral atrophy, hypertension, and chronic kidney disease. Hygiene measures can potentially prevent hemolytic uremic syndrome.