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EHEC-Induced Hemolytic Uremic Syndrome (HUS):
The Leading Cause of Acute Kidney Failure in Young Children — With No Approved Therapy to Date

EHEC Infections and Hemolytic Uremic Syndrome (HUS):

Enterohemorrhagic Escherichia coli (EHEC) infections can result in severe, potentially life-threatening complications. The most serious complication is Hemolytic Uremic Syndrome (HUS), a condition associated with hemolytic anemia, thrombocytopenia, and acute kidney injury.
HUS has particularly severe consequences for vulnerable populations. In children under five years of age, HUS is the leading cause of acute kidney failure, and it can also cause long-term health sequelae or death

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Recent EHEC Outbreaks in Europe, 2025

  • France (Hauts-de-France, Jun–Jul): 32 confirmed infections, 10 cases of HUS, and 1 pediatric death.

  • Germany – Mecklenburg-Vorpommern (Aug–Sep): 40–60 confirmed infections reported between late August and mid-September; multiple pediatric HUS cases.

  • Germany – Niedersachsen (statewide, 2025): More than 500 confirmed infections; the state surveillance dashboard recorded 25 cases in week 36 alone.

  • Belgium – Flanders (Aug–Sep): Approximately 50 infections linked to nursing homes across several provinces; multiple fatalities reported.

  • Ireland (Q1): Three outbreaks, including 17 cases in a childcare facility; four cases progressed to HUS.

EHEC

What is EHEC?

Escherichia coli (E. coli) are Gram-negative bacteria commonly found in the intestinal microbiota of humans and animals. While most strains are harmless or beneficial, certain pathogenic variants can cause gastrointestinal and systemic disease.
Among these, Enterohemorrhagic E. coli (EHEC) — also referred to as Shiga toxin–producing E. coli (STEC) — is of particular concern.

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After colonizing the gut, EHEC produces Shiga toxins (Stx1 and Stx2). These toxins injure the intestinal epithelium and subsequently translocate into the bloodstream. Once systemic, they target vascular endothelial cells, with a particular tropism for the kidneys and, in some cases, the central nervous system. This pathophysiological process underlies the development of HUS.

No Treatment Available

Currently, there is no specific therapy or vaccine for EHEC infections or HUS. Management is limited to supportive care, leaving patients—most often young children—with little more than hope that the disease does not progress to severe, life-threatening complications.

How Do People Get Infected?

EHEC infection usually occurs through:

  • Eating undercooked ground beef or contaminated meat

  • Consuming unpasteurized milk or juice

  • Eating raw fruits and vegetables contaminated during harvesting or handling

  • Drinking or swimming in contaminated water

  • Person-to-person contact, particularly in daycare centers

References:

  1. Centers for Disease Control and Prevention (CDC). E. coli (Escherichia coli). Updated 2024. CDC link

  2. World Health Organization (WHO). E. coli. Fact sheet, 2023. WHO link

The Three Main Features of HUS

  • Hemolytic anemia – destruction of red blood cells

  • Thrombocytopenia – low platelet count, increasing bleeding risk

  • Acute kidney injury – ranging from mild impairment to complete kidney failure

References:

  1. Noris M, Remuzzi G. Hemolytic uremic syndrome. J Am Soc Nephrol. 2005;16(4):1035–50.

  2. Loos S, Ahlenstiel T, Kranz B, et al. An updated review of typical hemolytic uremic syndrome in children. Pediatr Nephrol. 2018;33(10):1785–99.

What Is Hemolytic Uremic Syndrome (HUS)?

Hemolytic Uremic Syndrome (HUS) is a severe complication that develops in about 5–10% of people infected with EHEC.
It primarily affects children under 5 years of age, though anyone can be affected.

HUS is a thrombotic microangiopathy — a disorder characterized by small blood clots that damage blood vessels and organs. It typically develops about one week after the onset of diarrhea, especially when diarrhea is bloody.

References:

  1. Tarr PI, Gordon CA, Chandler WL. Shiga-toxin–producing Escherichia coli and haemolytic uraemic syndrome. Lancet. 2005;365(9464):1073–86.

  2. European Centre for Disease Prevention and Control (ECDC). Shiga toxin/verotoxin-producing Escherichia coli (STEC/VTEC) infection. Disease factsheet, 2024.

Signs and Symptoms of HUS

After the initial symptoms of E. coli infection (severe abdominal cramps, vomiting, bloody diarrhea), patients who progress to HUS may develop:

  • Pale skin or unusual bruising

  • Fatigue and irritability

  • Decreased urination or dark-colored urine

  • Swelling, especially around the eyes and ankles

  • High blood pressure

  • Seizures or confusion (in severe cases)

References:

  1. National Kidney Foundation. Hemolytic Uremic Syndrome (HUS). 2023.

  2. Rosales A, Hofer J, Zimmerhackl LB. Clinical spectrum of typical hemolytic uremic syndrome in children and adults. Semin Thromb Hemost. 2010;36(6):623–30.

Diagnosis and Treatment

Diagnosis

HUS is diagnosed using:

  • Blood tests to evaluate red blood cells, platelet count, and kidney function

  • Urine tests to assess kidney damage

  • Stool tests to detect Shiga toxin–producing E. coli (STEC)

Treatment

There is currently no specific cure for HUS. Management relies on supportive care, which may include:

  • IV fluids to maintain hydration

  • Blood transfusions for severe anemia

  • Dialysis if kidney function is severely impaired

  • Close monitoring for neurological complications

⚠️ Antibiotics and anti-diarrheal medications are not recommended in STEC infections, as they may increase Shiga toxin release and the risk of HUS.

References:

  1. Kidney Disease: Improving Global Outcomes (KDIGO). Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012;2(1).

  2. Michael M, Elliott EJ, Ridley GF, Hodson EM, Craig JC. Interventions for hemolytic uremic syndrome and thrombotic thrombocytopenic purpura. Cochrane Database Syst Rev. 2009;(1):CD003595.

Prognosis

Most patients, especially children, recover fully from HUS with appropriate medical care.
However, some may develop long-term complications, such as:

  • Chronic kidney disease

  • Hypertension

  • Neurological problems

Early recognition and prompt supportive treatment significantly improve the chances of recovery.

References:

  1. Garg AX, Suri RS, Barrowman N, et al. Long-term renal prognosis of diarrhea-associated hemolytic uremic syndrome: a systematic review, meta-analysis, and meta-regression. JAMA. 2003;290(10):1360–70.

  2. Fremeaux-Bacchi V, et al. Long-term outcomes in atypical hemolytic uremic syndrome: clinical and genetic prognostic factors. Blood. 2013;122(2):183–92.

How to Prevent E. coli Infections

Prevention remains the most effective defense. Steps to reduce risk include:

  • Cooking ground beef thoroughly (internal temperature of 160°F / 71°C)

  • Avoiding unpasteurized milk, juice, and dairy products

  • Washing fruits and vegetables under running water before consumption

  • Practicing good hand hygiene, especially after toilet use or changing diapers

  • Keeping raw meat separate from other foods during preparation

  • Drinking only treated or safe water when traveling or hiking

References:

  1. Centers for Disease Control and Prevention (CDC). Prevention of E. coli Infection. Updated 2024.

  2. European Food Safety Authority (EFSA). Pathogenic bacteria: Shiga toxin-producing Escherichia coli (STEC). Updated 2023.

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