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As they have many times before, the Jones family from Prophetstown, Illinois, went boating on the Mississippi River near the end of June 2007.
After anchoring near Princeton Beach on the Iowa side of the river, Bill and Amy Jones relaxed while their two sons, Sam and Max, went swimming.
As the two boys splashed in the water, the area suddenly reeked from the smell of raw sewage. It seemed to come from one of several boats beached just upstream.
The day ended without further incident, but three days later, on June 27, 7-year-old Sam got sick with severe diarrhea and abdominal cramps. The illness lasted eight days but he recovered with no complications
On July 2, however, 4-year-old Max awakened with severe cramping and bloody diarrhea. A visit to Peter Metcalf, MD, was followed by hospitalization at Genesis Medical Center, Illini Campus, for possible E. coli bacteria poisoning.
"It was horrible," Amy says. "Max was screaming in terrible pain. His blood work showed numbers out of whack and his kidneys were failing. They couldn't give antibiotics and pain medication would have slowed his body's ability to recover."
After culturing a stool sample, doctors identified the E. coli strain as 0157:H7. The bacteria creates toxins that can damage the intestines and destroy red blood cells. It can also lead to an acute kidney disorder called Hemolytic Uremic Syndrome (HUS).
HUS occurs when an infection in the digestive system, such as E. coli, produces toxic substances that destroy red blood cells. It often affects the kidneys.
Because Max required highly specialized care, the Genesis staff transferred him to University of Iowa Children's Hospital and child kidney specialist Craig Porter, MD.
"HUS is the most common cause of community-acquired acute renal failure in children," says Porter, the only full-time pediatric nephrologist in eastern Iowa and western Illinois. "Our tests confirmed that Max had it, and his very survival required treatment in an intensive care setting with blood transfusions and dialysis. We had to act fast."
On July 9, UI surgeon John Lawrence, MD, performed a five-hour surgical procedure to prepare Max for peritoneal dialysis. The procedure involved the placement of a catheter in the peritoneal cavity.
Max was then able to begin dialysis at 2 a.m. on July 10. Max remained on dialysis for 11 days as his body waged a life and death struggle to eliminate the E. coli infection from his body.
Max was finally able to urinate on July 19.
"It was a major step toward a complete recovery," Porter says.
The pediatric nephrology team was finally able to remove the catheter for good on July 23. Twenty-one days after coming to UI Children's Hospital ("the longest three weeks of my life," Amy says), the family was able to complete Max's recovery at home.
"Max is doing great and we're told there should be no long-term effects," she says. "We appreciate everything they did. Our care was great, we had a lot of great nurses and doctors and the activity personnel for children was awesome!"
Meanwhile, Porter notes that he hopes to be joined before year's end by a second pediatric nephrologist, who is still being recruited by UI Children's Hospital.
For information about UI pediatric nephrology services, patients and families should call UI Health Access and ask for Nurse Clinician Rhonda Cass, or e-mail rhonda-cass@uiowa.edu.
For consultation or referral, physicians should call UI Consult.
—Michael Sondergard
E. coli 0157:H7
Poisoning most often occurs when people eat undercooked beef or contaminated raw vegetables. The bacteria can also be contracted by swimming in under-chlorinated water or accidentally drinking sewage-contaminated water, as apparently happened with Max Jones.
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