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Hemolytic-uremic syndrome is usually a consequence of enteric verotoxigenic Escherichia coli infection,and a prevailing hypothesis contends that systemaically absorbed verotoxins are responsible for the multiple organ involvement.In an attempt to determine whether the central nervous system(CNS)manifestations could occur owing to factors that reflect a toxin insult,the authors studied the association of clinical and laboratory variables with the development of neurological disease.Ninety- one patients with hemolytic-uremic syndrome from 1982 through 1990 were included.Twenty-seven(18 female,9 male)had a CNS disorder;17 of these had seizures and there were two deaths.Multivariate analyses led to the following observations:female gender(odds ratio[OR]8.50;95%confidence interval[CI]2.08 to 50.0),prolonged use of an antimotility pharmacological agent(OR 8.50;95%CI 1.69 to 42.81),and an increased hemoglobin level(OR 1. 11;95%CI 1.05 to 1.17)were associated with an increased risk for developing a neurological manifestation.Prior administration of a blood product was associated with a decreased risk(OR 0.12;95%CI 0.02 to 0.52). The findings suggest that other mechanisms for CNS disease may exist in addition to direct toxin insult. |
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