Shiga toxin induced haemolytic uraemic syndrome occurs in a minority of patients after infection with enterohaemorrhagic Escherichia coli or Shigella spp. It is characterised by thrombotic microangiopathy and renal failure, which are attributed to toxic effects of Shiga toxin on systemic and renal microcirculation. The pathogen is commonly part of the intestinal flora of cattle and is transmitted by contaminated food. Worldwide, the most common strain is E coli O157:H7, which causes the syndrome mainly in young children.1 Prognosis is good and treatment is mainly supportive, because no treatment has been proved to be effective and the use of antibiotics or plasmapheresis is controversial.2

In a linked research paper (doi:10.1136/bmj.e4565), Menne and colleagues present data on the effects of various treatments on the course of Shiga toxin induced haemolytic uraemic syndrome in a cohort of 298 patients treated at 23 German hospitals.3 In 2011, Germany experienced the largest reported outbreak of Shiga toxin induced haemolytic uraemic syndrome, which affected 855 of the 3842 people who had been infected with enterohaemorrhagic E coli from contaminated fenugreek …