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Bloody Diarrhea

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Sara K Vesely – 1st expert on this subject based on the ideXlab platform

  • sporadic Bloody Diarrhea associated thrombotic thrombocytopenic purpura hemolytic uremic syndrome ttp hus in adults in oklahoma comparison to adults with severe adamts13 deficiency and to children with typical hus
    Blood, 2007
    Co-Authors: Loan Nguyen, Sara K Vesely, Deirdra R Terrell, Bernhard Lammle, Charity A Karpac, Johanna Kremer A Hovinga, James N George

    Abstract:

    The frequency, presenting features and clinical outcomes of sporadic TTP-HUS following a prodrome of Bloody Diarrhea in adults are not described. The Oklahoma TTP-HUS Registry enrolled 237 consecutive patients over age 18 years with their first episode of clinically diagnosed TTP from 11-13-1995 (the date of our initial ADAMTS13 measurement) to 12-31-2006 for whom plasma exchange treatment (PEX) was requested. ADAMTS13 activity was measured on 218 (92%) patients immediately before their first PEX. 16 (7%) of these 218 patients presented with a prodrome of acute Bloody Diarrhea. 42 (19%) patients had ADAMTS13 activity Conclusions: TTP-HUS following Bloody Diarrhea is an endemic, sporadic disorder among adults that is less common and less familiar than in children. Distinct from children, adults with Bloody Diarrhea have a higher frequency of severe neurologic abnormalities and death; distinct from adults with severe ADAMTS13 deficiency, adults with Bloody Diarrhea are primarily white, have a higher frequency of acute renal failure, and have not relapsed. Although the role of PEX in the recovery of adult patients presenting with Bloody Diarrhea is unclear, PEX may be appropriate initial treatment since the mortality is high, many patients appear to respond, and patients with severe ADAMTS13 deficiency may also present with Bloody Diarrhea apparently caused by intestinal ischemia.

  • thrombotic thrombocytopenic purpura hemolytic uremic syndrome ttp hus in adults following a prodrome of Bloody Diarrhea
    Blood, 2004
    Co-Authors: Qurana F Lewis, Deirdra R Terrell, Bernhard Lammle, Johanna Kremerhovinga, James N George, Sara K Vesely

    Abstract:

    Diarrhea, often Bloody Diarrhea caused by infection with E. coli 0157:H7, is the prodrome for typical HUS in children. In adults, HUS has been reported following epidemics of enteric infections, however the frequency and clinical features of sporadic HUS or TTP in adults following a prodrome of Bloody Diarrhea have not been characterized. In the Oklahoma TTP-HUS Registry, January 1, 1989 to December 31, 2003, 19 (6%) of 301 consecutive patients had a prodrome of Bloody Diarrhea. The 19 cases were separated by time and location, indicating no common source outbreak. 5/10 patients who were appropriately tested had positive stool cultures for E. coli O157:H7. Although more cases (12/19, 63%) occurred in warm months, April–September, a seasonal difference was not significant (p= 0.25). We compared the clinical features of these 19 patients to the 119 patients who had no apparent etiologies or associated conditions and were therefore defined as idiopathic TTP-HUS.

    | | Bloody Diarrhea | Idiopathic | p-value |
    |:———————————————————————————————————————- | ————— | ———– | ——- |
    | | (n=19) | (n=119) | |
    | Median values are presented for continuous data. Laboratory data: most abnormal value at diagnosis of TTP-HUS ± 7 days |
    | Age (years) | 59 | 48 | 0.109 |
    | Race (% Black) | 5% | 25% | 0.073 |
    | Gender (% female) | 79% | 74% | 0.781 |
    | Obesity (BMI ≥ 30 kg/m 2 ) | 21% | 40% | 0.120 |
    | Severe neurologic abnormalities | 63% | 49% | 0.243 |
    | Platelet count | 26 | 13 | 0.010 |
    | Hematocrit | 22 | 22 | 0.931 |
    | LDH | 1410 | 1305 | 0.115 |
    | Acute renal failure | 68% | 29% | <0.001 | | Response to PE | 84% | 82% | 1.000 | | ADAMTS13 deficiency (<5%) | 0% (0/13) | 30% (20/67) | 0.031 | | Death | 32% | 19% | 0.233 | | Relapse in 30 day survivors | 0% | 20% | 0.119 | Although women predominated in both groups, 18/19 patients with a prodrome of Bloody Diarrhea were White, consistent with the predominance of White subjects among children with Diarrhea-associated HUS, but distinct from the significantly higher incidence of Blacks among adult patients with idiopathic TTP-HUS (compared to the incidence among other races, p<0.0001). 3 patients with a prodrome of Bloody Diarrhea never had an abnormal serum creatinine, therefore the term TTP-HUS, rather than HUS, may better describe these patients. The only significant differences in presenting features and outcomes were the severity of thrombocytopenia, the relative frequency of acute renal failure, and the relative frequency of severe ADAMTS13 deficiency (<5% activity). ADAMTS13 activity was measured in 13 of the 19 patients with a prodrome of Bloody Diarrhea (median 50%, range 5–100%). We conclude that there is a continuous occurrence of TTP-HUS in adults preceded by a prodrome of Bloody Diarrhea, presumably related to Shiga toxin-producing enteric infections, even in the absence of recognized outbreaks. Plasma exchange is an appropriate treatment for adult patients with a prodrome of Bloody Diarrhea since they cannot be accurately distinguished from patients with idiopathic TTP, they have a high mortality rate, and they apparently respond to plasma exchange treatment.

  • Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome (TTP-HUS) in Adults Following a Prodrome of Bloody Diarrhea.
    Blood, 2004
    Co-Authors: Qurana F Lewis, Deirdra R Terrell, Bernhard Lammle, James N George, Johanna Kremer-hovinga, Sara K Vesely

    Abstract:

    Diarrhea, often Bloody Diarrhea caused by infection with E. coli 0157:H7, is the prodrome for typical HUS in children. In adults, HUS has been reported following epidemics of enteric infections, however the frequency and clinical features of sporadic HUS or TTP in adults following a prodrome of Bloody Diarrhea have not been characterized. In the Oklahoma TTP-HUS Registry, January 1, 1989 to December 31, 2003, 19 (6%) of 301 consecutive patients had a prodrome of Bloody Diarrhea. The 19 cases were separated by time and location, indicating no common source outbreak. 5/10 patients who were appropriately tested had positive stool cultures for E. coli O157:H7. Although more cases (12/19, 63%) occurred in warm months, April–September, a seasonal difference was not significant (p= 0.25). We compared the clinical features of these 19 patients to the 119 patients who had no apparent etiologies or associated conditions and were therefore defined as idiopathic TTP-HUS.

    | | Bloody Diarrhea | Idiopathic | p-value |
    |:———————————————————————————————————————- | ————— | ———– | ——- |
    | | (n=19) | (n=119) | |
    | Median values are presented for continuous data. Laboratory data: most abnormal value at diagnosis of TTP-HUS ± 7 days |
    | Age (years) | 59 | 48 | 0.109 |
    | Race (% Black) | 5% | 25% | 0.073 |
    | Gender (% female) | 79% | 74% | 0.781 |
    | Obesity (BMI ≥ 30 kg/m 2 ) | 21% | 40% | 0.120 |
    | Severe neurologic abnormalities | 63% | 49% | 0.243 |
    | Platelet count | 26 | 13 | 0.010 |
    | Hematocrit | 22 | 22 | 0.931 |
    | LDH | 1410 | 1305 | 0.115 |
    | Acute renal failure | 68% | 29% |

James N George – 2nd expert on this subject based on the ideXlab platform

  • sporadic Bloody Diarrhea associated thrombotic thrombocytopenic purpura hemolytic uremic syndrome ttp hus in adults in oklahoma comparison to adults with severe adamts13 deficiency and to children with typical hus
    Blood, 2007
    Co-Authors: Loan Nguyen, Sara K Vesely, Deirdra R Terrell, Bernhard Lammle, Charity A Karpac, Johanna Kremer A Hovinga, James N George

    Abstract:

    The frequency, presenting features and clinical outcomes of sporadic TTP-HUS following a prodrome of Bloody Diarrhea in adults are not described. The Oklahoma TTP-HUS Registry enrolled 237 consecutive patients over age 18 years with their first episode of clinically diagnosed TTP from 11-13-1995 (the date of our initial ADAMTS13 measurement) to 12-31-2006 for whom plasma exchange treatment (PEX) was requested. ADAMTS13 activity was measured on 218 (92%) patients immediately before their first PEX. 16 (7%) of these 218 patients presented with a prodrome of acute Bloody Diarrhea. 42 (19%) patients had ADAMTS13 activity Conclusions: TTP-HUS following Bloody Diarrhea is an endemic, sporadic disorder among adults that is less common and less familiar than in children. Distinct from children, adults with Bloody Diarrhea have a higher frequency of severe neurologic abnormalities and death; distinct from adults with severe ADAMTS13 deficiency, adults with Bloody Diarrhea are primarily white, have a higher frequency of acute renal failure, and have not relapsed. Although the role of PEX in the recovery of adult patients presenting with Bloody Diarrhea is unclear, PEX may be appropriate initial treatment since the mortality is high, many patients appear to respond, and patients with severe ADAMTS13 deficiency may also present with Bloody Diarrhea apparently caused by intestinal ischemia.

  • thrombotic thrombocytopenic purpura hemolytic uremic syndrome ttp hus in adults following a prodrome of Bloody Diarrhea
    Blood, 2004
    Co-Authors: Qurana F Lewis, Deirdra R Terrell, Bernhard Lammle, Johanna Kremerhovinga, James N George, Sara K Vesely

    Abstract:

    Diarrhea, often Bloody Diarrhea caused by infection with E. coli 0157:H7, is the prodrome for typical HUS in children. In adults, HUS has been reported following epidemics of enteric infections, however the frequency and clinical features of sporadic HUS or TTP in adults following a prodrome of Bloody Diarrhea have not been characterized. In the Oklahoma TTP-HUS Registry, January 1, 1989 to December 31, 2003, 19 (6%) of 301 consecutive patients had a prodrome of Bloody Diarrhea. The 19 cases were separated by time and location, indicating no common source outbreak. 5/10 patients who were appropriately tested had positive stool cultures for E. coli O157:H7. Although more cases (12/19, 63%) occurred in warm months, April–September, a seasonal difference was not significant (p= 0.25). We compared the clinical features of these 19 patients to the 119 patients who had no apparent etiologies or associated conditions and were therefore defined as idiopathic TTP-HUS.

    | | Bloody Diarrhea | Idiopathic | p-value |
    |:———————————————————————————————————————- | ————— | ———– | ——- |
    | | (n=19) | (n=119) | |
    | Median values are presented for continuous data. Laboratory data: most abnormal value at diagnosis of TTP-HUS ± 7 days |
    | Age (years) | 59 | 48 | 0.109 |
    | Race (% Black) | 5% | 25% | 0.073 |
    | Gender (% female) | 79% | 74% | 0.781 |
    | Obesity (BMI ≥ 30 kg/m 2 ) | 21% | 40% | 0.120 |
    | Severe neurologic abnormalities | 63% | 49% | 0.243 |
    | Platelet count | 26 | 13 | 0.010 |
    | Hematocrit | 22 | 22 | 0.931 |
    | LDH | 1410 | 1305 | 0.115 |
    | Acute renal failure | 68% | 29% | <0.001 | | Response to PE | 84% | 82% | 1.000 | | ADAMTS13 deficiency (<5%) | 0% (0/13) | 30% (20/67) | 0.031 | | Death | 32% | 19% | 0.233 | | Relapse in 30 day survivors | 0% | 20% | 0.119 | Although women predominated in both groups, 18/19 patients with a prodrome of Bloody Diarrhea were White, consistent with the predominance of White subjects among children with Diarrhea-associated HUS, but distinct from the significantly higher incidence of Blacks among adult patients with idiopathic TTP-HUS (compared to the incidence among other races, p<0.0001). 3 patients with a prodrome of Bloody Diarrhea never had an abnormal serum creatinine, therefore the term TTP-HUS, rather than HUS, may better describe these patients. The only significant differences in presenting features and outcomes were the severity of thrombocytopenia, the relative frequency of acute renal failure, and the relative frequency of severe ADAMTS13 deficiency (<5% activity). ADAMTS13 activity was measured in 13 of the 19 patients with a prodrome of Bloody Diarrhea (median 50%, range 5–100%). We conclude that there is a continuous occurrence of TTP-HUS in adults preceded by a prodrome of Bloody Diarrhea, presumably related to Shiga toxin-producing enteric infections, even in the absence of recognized outbreaks. Plasma exchange is an appropriate treatment for adult patients with a prodrome of Bloody Diarrhea since they cannot be accurately distinguished from patients with idiopathic TTP, they have a high mortality rate, and they apparently respond to plasma exchange treatment.

  • Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome (TTP-HUS) in Adults Following a Prodrome of Bloody Diarrhea.
    Blood, 2004
    Co-Authors: Qurana F Lewis, Deirdra R Terrell, Bernhard Lammle, James N George, Johanna Kremer-hovinga, Sara K Vesely

    Abstract:

    Diarrhea, often Bloody Diarrhea caused by infection with E. coli 0157:H7, is the prodrome for typical HUS in children. In adults, HUS has been reported following epidemics of enteric infections, however the frequency and clinical features of sporadic HUS or TTP in adults following a prodrome of Bloody Diarrhea have not been characterized. In the Oklahoma TTP-HUS Registry, January 1, 1989 to December 31, 2003, 19 (6%) of 301 consecutive patients had a prodrome of Bloody Diarrhea. The 19 cases were separated by time and location, indicating no common source outbreak. 5/10 patients who were appropriately tested had positive stool cultures for E. coli O157:H7. Although more cases (12/19, 63%) occurred in warm months, April–September, a seasonal difference was not significant (p= 0.25). We compared the clinical features of these 19 patients to the 119 patients who had no apparent etiologies or associated conditions and were therefore defined as idiopathic TTP-HUS.

    | | Bloody Diarrhea | Idiopathic | p-value |
    |:———————————————————————————————————————- | ————— | ———– | ——- |
    | | (n=19) | (n=119) | |
    | Median values are presented for continuous data. Laboratory data: most abnormal value at diagnosis of TTP-HUS ± 7 days |
    | Age (years) | 59 | 48 | 0.109 |
    | Race (% Black) | 5% | 25% | 0.073 |
    | Gender (% female) | 79% | 74% | 0.781 |
    | Obesity (BMI ≥ 30 kg/m 2 ) | 21% | 40% | 0.120 |
    | Severe neurologic abnormalities | 63% | 49% | 0.243 |
    | Platelet count | 26 | 13 | 0.010 |
    | Hematocrit | 22 | 22 | 0.931 |
    | LDH | 1410 | 1305 | 0.115 |
    | Acute renal failure | 68% | 29% |

Bernhard Lammle – 3rd expert on this subject based on the ideXlab platform

  • sporadic Bloody Diarrhea associated thrombotic thrombocytopenic purpura hemolytic uremic syndrome ttp hus in adults in oklahoma comparison to adults with severe adamts13 deficiency and to children with typical hus
    Blood, 2007
    Co-Authors: Loan Nguyen, Sara K Vesely, Deirdra R Terrell, Bernhard Lammle, Charity A Karpac, Johanna Kremer A Hovinga, James N George

    Abstract:

    The frequency, presenting features and clinical outcomes of sporadic TTP-HUS following a prodrome of Bloody Diarrhea in adults are not described. The Oklahoma TTP-HUS Registry enrolled 237 consecutive patients over age 18 years with their first episode of clinically diagnosed TTP from 11-13-1995 (the date of our initial ADAMTS13 measurement) to 12-31-2006 for whom plasma exchange treatment (PEX) was requested. ADAMTS13 activity was measured on 218 (92%) patients immediately before their first PEX. 16 (7%) of these 218 patients presented with a prodrome of acute Bloody Diarrhea. 42 (19%) patients had ADAMTS13 activity Conclusions: TTP-HUS following Bloody Diarrhea is an endemic, sporadic disorder among adults that is less common and less familiar than in children. Distinct from children, adults with Bloody Diarrhea have a higher frequency of severe neurologic abnormalities and death; distinct from adults with severe ADAMTS13 deficiency, adults with Bloody Diarrhea are primarily white, have a higher frequency of acute renal failure, and have not relapsed. Although the role of PEX in the recovery of adult patients presenting with Bloody Diarrhea is unclear, PEX may be appropriate initial treatment since the mortality is high, many patients appear to respond, and patients with severe ADAMTS13 deficiency may also present with Bloody Diarrhea apparently caused by intestinal ischemia.

  • thrombotic thrombocytopenic purpura hemolytic uremic syndrome ttp hus in adults following a prodrome of Bloody Diarrhea
    Blood, 2004
    Co-Authors: Qurana F Lewis, Deirdra R Terrell, Bernhard Lammle, Johanna Kremerhovinga, James N George, Sara K Vesely

    Abstract:

    Diarrhea, often Bloody Diarrhea caused by infection with E. coli 0157:H7, is the prodrome for typical HUS in children. In adults, HUS has been reported following epidemics of enteric infections, however the frequency and clinical features of sporadic HUS or TTP in adults following a prodrome of Bloody Diarrhea have not been characterized. In the Oklahoma TTP-HUS Registry, January 1, 1989 to December 31, 2003, 19 (6%) of 301 consecutive patients had a prodrome of Bloody Diarrhea. The 19 cases were separated by time and location, indicating no common source outbreak. 5/10 patients who were appropriately tested had positive stool cultures for E. coli O157:H7. Although more cases (12/19, 63%) occurred in warm months, April–September, a seasonal difference was not significant (p= 0.25). We compared the clinical features of these 19 patients to the 119 patients who had no apparent etiologies or associated conditions and were therefore defined as idiopathic TTP-HUS.

    | | Bloody Diarrhea | Idiopathic | p-value |
    |:———————————————————————————————————————- | ————— | ———– | ——- |
    | | (n=19) | (n=119) | |
    | Median values are presented for continuous data. Laboratory data: most abnormal value at diagnosis of TTP-HUS ± 7 days |
    | Age (years) | 59 | 48 | 0.109 |
    | Race (% Black) | 5% | 25% | 0.073 |
    | Gender (% female) | 79% | 74% | 0.781 |
    | Obesity (BMI ≥ 30 kg/m 2 ) | 21% | 40% | 0.120 |
    | Severe neurologic abnormalities | 63% | 49% | 0.243 |
    | Platelet count | 26 | 13 | 0.010 |
    | Hematocrit | 22 | 22 | 0.931 |
    | LDH | 1410 | 1305 | 0.115 |
    | Acute renal failure | 68% | 29% | <0.001 | | Response to PE | 84% | 82% | 1.000 | | ADAMTS13 deficiency (<5%) | 0% (0/13) | 30% (20/67) | 0.031 | | Death | 32% | 19% | 0.233 | | Relapse in 30 day survivors | 0% | 20% | 0.119 | Although women predominated in both groups, 18/19 patients with a prodrome of Bloody Diarrhea were White, consistent with the predominance of White subjects among children with Diarrhea-associated HUS, but distinct from the significantly higher incidence of Blacks among adult patients with idiopathic TTP-HUS (compared to the incidence among other races, p<0.0001). 3 patients with a prodrome of Bloody Diarrhea never had an abnormal serum creatinine, therefore the term TTP-HUS, rather than HUS, may better describe these patients. The only significant differences in presenting features and outcomes were the severity of thrombocytopenia, the relative frequency of acute renal failure, and the relative frequency of severe ADAMTS13 deficiency (<5% activity). ADAMTS13 activity was measured in 13 of the 19 patients with a prodrome of Bloody Diarrhea (median 50%, range 5–100%). We conclude that there is a continuous occurrence of TTP-HUS in adults preceded by a prodrome of Bloody Diarrhea, presumably related to Shiga toxin-producing enteric infections, even in the absence of recognized outbreaks. Plasma exchange is an appropriate treatment for adult patients with a prodrome of Bloody Diarrhea since they cannot be accurately distinguished from patients with idiopathic TTP, they have a high mortality rate, and they apparently respond to plasma exchange treatment.

  • Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome (TTP-HUS) in Adults Following a Prodrome of Bloody Diarrhea.
    Blood, 2004
    Co-Authors: Qurana F Lewis, Deirdra R Terrell, Bernhard Lammle, James N George, Johanna Kremer-hovinga, Sara K Vesely

    Abstract:

    Diarrhea, often Bloody Diarrhea caused by infection with E. coli 0157:H7, is the prodrome for typical HUS in children. In adults, HUS has been reported following epidemics of enteric infections, however the frequency and clinical features of sporadic HUS or TTP in adults following a prodrome of Bloody Diarrhea have not been characterized. In the Oklahoma TTP-HUS Registry, January 1, 1989 to December 31, 2003, 19 (6%) of 301 consecutive patients had a prodrome of Bloody Diarrhea. The 19 cases were separated by time and location, indicating no common source outbreak. 5/10 patients who were appropriately tested had positive stool cultures for E. coli O157:H7. Although more cases (12/19, 63%) occurred in warm months, April–September, a seasonal difference was not significant (p= 0.25). We compared the clinical features of these 19 patients to the 119 patients who had no apparent etiologies or associated conditions and were therefore defined as idiopathic TTP-HUS.

    | | Bloody Diarrhea | Idiopathic | p-value |
    |:———————————————————————————————————————- | ————— | ———– | ——- |
    | | (n=19) | (n=119) | |
    | Median values are presented for continuous data. Laboratory data: most abnormal value at diagnosis of TTP-HUS ± 7 days |
    | Age (years) | 59 | 48 | 0.109 |
    | Race (% Black) | 5% | 25% | 0.073 |
    | Gender (% female) | 79% | 74% | 0.781 |
    | Obesity (BMI ≥ 30 kg/m 2 ) | 21% | 40% | 0.120 |
    | Severe neurologic abnormalities | 63% | 49% | 0.243 |
    | Platelet count | 26 | 13 | 0.010 |
    | Hematocrit | 22 | 22 | 0.931 |
    | LDH | 1410 | 1305 | 0.115 |
    | Acute renal failure | 68% | 29% |