Ayşe Ağbaş1, Nilüfer Göknar2, Nurver Akıncı3, Zeynep Yürük Yıldırım4, Mehmet Taşdemir5, Meryem Benzer6, İbrahim Gökçe7, Cengiz Candan8, Nuran Küçük9, Selçuk Uzuner10, Gül Özçelik3, Demet Demirkol11,12, Lale Sever13, Salim Çalışkan13. 1. Pediatric Nephrology, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey. yurtayse@hotmail.com. 2. Pediatric Nephrology, Bezmialem Vakıf University, Istanbul, Turkey. 3. Pediatric Nephrology, Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey. 4. Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. 5. Pediatric Nephrology, Faculty of Medicine, Koç University, Istanbul, Turkey. 6. Pediatric Nephrology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Istanbul, Turkey. 7. Pediatric Nephrology, Faculty of Medicine, Marmara University, Istanbul, Turkey. 8. Pediatric Nephrology, Faculty of Medicine, Medeniyet University, Istanbul, Turkey. 9. Pediatric Nephrology, Kartal Education and Research Hospital, Istanbul, Turkey. 10. Pediatric Intensive Care Unit, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey. 11. Pediatric Intensive Care Unit, Faculty of Medicine, Koç University, Istanbul, Turkey. 12. Pediatric Intensive Care Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. 13. Pediatric Nephrology, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Abstract
BACKGROUND: This study aims to identify epidemiological and clinical characteristics of patients and report our experience with eculizumab treatment during an outbreak of hemolytic uremic syndrome (HUS) caused by Shiga toxin-producing Escherichia coli (STEC) in Istanbul in 2015. METHODS: Thirty-two children (21 females, median age 3.25 years) were included in this study. Demographic, clinical and laboratory data, and treatment details were retrospectively collected. Renal outcomes were assessed at last follow-up visit. To assess the effect of eculizumab on prognosis of STEC-HUS, subgroup analysis was performed on patients who required dialysis. RESULTS: A high number of cases occurred within a certain region of Istanbul. Stool samples were cultured from 21 patients (65%), and enteroaggregative E. coli (EAEC; n = 7) and enterohemorrhagic E. coli (EHEC; n = 3) strains were detected. Rates of dialysis treatment, neurological manifestations, and death were 59%, 25%, and 3%, respectively. Mean follow-up duration was 8.6 ± 2.6 months (range 3-12 months). None of the patients (n = 25) was on dialysis at the final visit. The complete renal recovery rate was 54%. Nine patients were treated with eculizumab. At final follow-up visit, no differences in estimated glomerular filtration rate, proteinuria level, or hypertension incidence were observed between patients treated with eculizumab and those not treated with eculizumab. CONCLUSIONS: An outbreak of EAEC occurred in a specific region of Istanbul. Livestock markets were suspected as the source. Evidence for beneficial effects of eculizumab on renal outcome was not clear in this cohort.
BACKGROUND: This study aims to identify epidemiological and clinical characteristics of patients and report our experience with eculizumab treatment during an outbreak of hemolytic uremic syndrome (HUS) caused by Shiga toxin-producing Escherichia coli (STEC) in Istanbul in 2015. METHODS: Thirty-two children (21 females, median age 3.25 years) were included in this study. Demographic, clinical and laboratory data, and treatment details were retrospectively collected. Renal outcomes were assessed at last follow-up visit. To assess the effect of eculizumab on prognosis of STEC-HUS, subgroup analysis was performed on patients who required dialysis. RESULTS: A high number of cases occurred within a certain region of Istanbul. Stool samples were cultured from 21 patients (65%), and enteroaggregative E. coli (EAEC; n = 7) and enterohemorrhagic E. coli (EHEC; n = 3) strains were detected. Rates of dialysis treatment, neurological manifestations, and death were 59%, 25%, and 3%, respectively. Mean follow-up duration was 8.6 ± 2.6 months (range 3-12 months). None of the patients (n = 25) was on dialysis at the final visit. The complete renal recovery rate was 54%. Nine patients were treated with eculizumab. At final follow-up visit, no differences in estimated glomerular filtration rate, proteinuria level, or hypertension incidence were observed between patients treated with eculizumab and those not treated with eculizumab. CONCLUSIONS: An outbreak of EAEC occurred in a specific region of Istanbul. Livestock markets were suspected as the source. Evidence for beneficial effects of eculizumab on renal outcome was not clear in this cohort.
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Authors: Philip A McFarlane; Martin Bitzan; Catherine Broome; Dana Baran; Jocelyn Garland; Louis-Philippe Girard; Kuljit Grewal; Anne-Laure Lapeyraque; Christopher Jordan Patriquin; Katerina Pavenski; Christoph Licht Journal: Can J Kidney Health Dis Date: 2021-04-22