Table 1: Investigations recommended in the diagnosis of STEC-associated HUS in children

Bloody diarrhoea and clinically suspected or confirmed Shiga toxin-producing Eschericia coli (STEC) infections
National
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Microbiology Comments
Stool culture Indicate bloody diarrhoea and/or suspicion of E. coli O157/STEC on request form
Stool PCR If stool culture negative
Rectal swab (HUS only) Submit directly to SERL from cases of HUS who are unable to produce a stool sample. Please discuss a suitable swab type with SERL prior to taking sample
Urine Features of HUS
Dipstick Haematuria and proteinuria
Blood Features of HUS

FBC and film

  • film
  • WBC
  • haemoglobin
  • platelets
  • fragmented RBC
  • Neutrophilia5,8,9,10,21
  • anaemia or a falling Hb (may be falsely elevated because of hemoconcentration)
  • low or falling platelet count for age
Urea and electrolytes Rising urea or creatinine
Liver function tests Bilirubin may be elevated because of haemolysis. Transaminitis is not uncommon
Lactate dehydrogenase Elevated because of haemolysis and tissue hypoxia13
C-Reactive protein (CRP) Any increase in CRP is associated with increased risk of HUS, even if a small rise11,12
Coagulation Screen Check in confirmed cases