Preschooler recovers from rare E. coli-related infection

Patient Stories |



For Anjali Jha, the dangerous bacteria led to an even more serious condition called HUS, which can cause kidney failure.

By Maureen Gilmer, IU Health senior writer,

Jill Landis Jha’s 5-year-old daughter had been sick for a couple days – sore throat, diarrhea, fever.

Jha did what most parents would do. She took Anjali to her pediatrician, where they did a strep test, which came back negative.

That was on a Tuesday earlier this month. By the next day, the preschooler was vomiting, and the diarrhea was worse.

Fast-forward a couple days, and Anjali was admitted to a hospital near the family’s home in Goshen, Indiana, where the little girl tested positive for an E. coli infection. The bacteria can be found in food, in the environment and in the intestines of people and animals.

A person can become infected with E. coli by coming into contact with human or animal feces, which can happen when drinking water or eating food that’s contaminated, or from an infected person who hasn’t washed their hands well after a bowel movement.

That might be scary enough, but a stool and blood test later pointed to a rare complication in Anjali called shiga toxin-producing E. coli associated hemolytic uremic syndrome (HUS), which can cause kidney damage.

She was transferred via ambulance to Riley Hospital for Children, where Dr. Myda Khalid, director of the pediatric nephrology fellowship program, oversaw some of her treatment during her weeklong stay.

“We specialize in taking care of children with diarrhea-positive HUS,” she said. “Here, we have a team, we know how to monitor patients closely, so that if anything does happen, we are prepared to handle it.”

About 15% of children who get bloody diarrhea after an E. coli infection get HUS, according to Dr. Khalid, and of those, as many as two-thirds need dialysis.

Anjali was lucky. She avoided dialysis, but she did require two blood transfusions, in addition to constant fluids to keep her hydrated.

The warmer months are peak season for shiga toxin E. coli HUS, Dr. Khalid said. Kids, in particular, are outdoors more, petting farm animals, swimming in lakes or untreated pools and participating in other outdoor activities where infection risks can be higher.

Proper handwashing for at least 20 seconds after potential exposure to E. coli bacteria, including after using the restroom, is the best way to prevent infection and cross-contamination.

In Anjali’s case, state health department investigators hadn’t determined how she acquired E. coli as of last week, but her mom said they had visited a hobby farm where they interacted with some of the animals. They’d also visited restaurants, where there might have been cross-contamination, and they’d been swimming in a saltwater pool.

Anjali spent a week on the stem cell unit at Riley, a stressful time for Jha, but she looks back with gratitude, despite a rocky start.

“What stood out to me was the ability of the doctors to be flexible, to take notice of the situation and make decisions accordingly,” she said.

“Knowing that Dr. Khalid has done the research made us feel really good about going to Riley,” Jha added. “The medical students, the fellows, the pediatric nephrologists were all very helpful in explaining things and answering questions. And they explained it to my older girls in a way they could understand. Their bedside manner was phenomenal.”

For her part, Dr. Khalid said the fact that Anjali received quick treatment made a difference.

“It was good that Anjali was already admitted to the hospital, so they were watching her very closely. If they hadn’t done bloodwork when they did, who knows when this would have been caught. … Then they called us, and we got her to Riley,” the physician said.

HUS is rare. Riley sees only five to 10 cases a year, Dr. Khalid said. It doesn’t always follow an E. coli infection but can also occur with some medications and cancer treatment.

The fact that Anjali was able to avoid dialysis speaks well for her complete recovery.

“She is going to do very well,” Dr. Khalid said. “We are confident that she will not have long-term side effects. For children who end up on dialysis for several weeks, we worry about long-term kidney damage, but the fact that she did not require dialysis puts her in a very favorable outcome.”

As a caution to parents, Dr. Khalid said to be vigilant when young children develop sudden onset of bloody diarrhea and vomiting and complain of stomach pain or fever.

“Go to your doctor and request a stool culture,” she said. “Go sooner rather than later so they can guide you and … tell you if this is E. coli or not.”

While there are many kinds of E. coli diarrhea infections, not all are shiga toxin-producing E. coli, she said, meaning there’s less risk of HUS, but it is more common in children.

Jha said her daughter is doing well at home. She woke up the day after she was discharged from Riley, ready to play with her cousins. But precautions like frequent handwashing and staying hydrated remain in place.

She wanted to share her family’s story to bring awareness to the dangers of infections like Anjali suffered and to encourage parents to advocate for their child.

“Just know there are certain things you can manage at home, but when it gets unmanageable, like loss of fluid and not being able to stay hydrated, know when to take your child in or call the doctor,” she said, “and insist on a stool test or blood test to make sure your kid is OK.”

The experience has made her more aware of the need for more research into pediatric illnesses, as well as the constant demand for blood donations.

“She got two blood transfusions. I don’t know who the blood came from, but I’m so thankful that they took time out of their day to do that.”

Related Doctor

Myda Khalid, MD

Myda Khalid, MD

Pediatric Nephrology