Gianluigi Ardissino1, Ilaria Possenti2, Chiara Vignati3, Laura Daprai3, Valentina Capone4, Maurizio Brigotti5, Mario Vittorio Luini6, Dario Consonni7, Giovanni Montini4,8. 1. Center for HUS Prevention, Control and Management, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Commenda 9, 20122, Milan, Italy. ardissino@centroseu.org. 2. Pediatric Unit, Ospedale Infantile C.Arrigo, Spalto Marengo 46, 15121, Alessandria, Italy. 3. Unit of Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Commenda 9, 20122, Milan, Italy. 4. Center for HUS Prevention, Control and Management, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Commenda 9, 20122, Milan, Italy. 5. Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40126, Bologna, Italy. 6. Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia-Romagna, 26900, Lodi, Italy. 7. Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via San Barnaba 8, 20122, Milan, Italy. 8. Giuliana and Bernardo Caprotti Chair of Pediatrics, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Abstract
BACKGROUND: Shigatoxin (Stx)-producing Escherichia coli (STEC) are the most common causes of hemolytic uremic syndrome (STEC-HUS). The aim of our study is to compare the risk of developing STEC-HUS in relation to the type of Stx genes (Stx1, Stx2, or both). METHODS: This is a prospective, observational, multicenter study involving 63 pediatric units in Northern Italy (ItalKid-HUS Network). STEC-infected children were identified within a screening program for bloody diarrhea during a 10-year period (2010-2019). Stx genes were detected by reverse dot blot or real-time PCR. After the identification of STEC infection, children were followed until diarrhea complete recovery for the possible development of STEC-HUS. RESULTS: Of the 214 Stx-positive patients, 34 (15.9%) developed STEC-HUS. The risk of HUS in STEC-infected children with Stx1 (n: 62; 29.0%) and Stx2 (n: 97; 45.3%) was respectively 0% and 23.7%, while in patients carrying both Stx1 and Stx2 (n: 55; 25.7%), the risk was 12.7% (p: 0.001). CONCLUSIONS: Our data confirm that Stx1 is a very rare cause of STEC-HUS and demonstrate that the risk of STEC-HUS halves in the case of Stx1+2-producing Escherichia coli infection compared with infections where Stx2 is present alone. This observation is helpful in assessing the risk of individual STEC-infected patients for the development of HUS and suggests that Stx1, in the presence of Stx2, might exert a protective role possibly by receptor competition.
BACKGROUND: Shigatoxin (Stx)-producing Escherichia coli (STEC) are the most common causes of hemolytic uremic syndrome (STEC-HUS). The aim of our study is to compare the risk of developing STEC-HUS in relation to the type of Stx genes (Stx1, Stx2, or both). METHODS: This is a prospective, observational, multicenter study involving 63 pediatric units in Northern Italy (ItalKid-HUS Network). STEC-infectedchildren were identified within a screening program for bloody diarrhea during a 10-year period (2010-2019). Stx genes were detected by reverse dot blot or real-time PCR. After the identification of STEC infection, children were followed until diarrhea complete recovery for the possible development of STEC-HUS. RESULTS: Of the 214 Stx-positive patients, 34 (15.9%) developed STEC-HUS. The risk of HUS in STEC-infectedchildren with Stx1 (n: 62; 29.0%) and Stx2 (n: 97; 45.3%) was respectively 0% and 23.7%, while in patients carrying both Stx1 and Stx2 (n: 55; 25.7%), the risk was 12.7% (p: 0.001). CONCLUSIONS: Our data confirm that Stx1 is a very rare cause of STEC-HUS and demonstrate that the risk of STEC-HUS halves in the case of Stx1+2-producing Escherichia coliinfection compared with infections where Stx2 is present alone. This observation is helpful in assessing the risk of individual STEC-infectedpatients for the development of HUS and suggests that Stx1, in the presence of Stx2, might exert a protective role possibly by receptor competition.
Authors: Laura F Alconcher; Alejandro Balestracci; Paula A Coccia; Angela Del C Suarez; Flavia B Ramírez; Marta L Monteverde; María Graciela Perez Y Gutiérrez; Paula M Carlopio; Illiana Principi; Patricia Estrella; Susana Micelli; Daniela C Leroy; Nahir E Quijada; Claudia Seminara; Marta I Giordano; Susana B Hidalgo Solís; Mariana Saurit; Alejandra Caminitti; Andrea Arias; Miguel Liern; Marta Rivas Journal: Pediatr Nephrol Date: 2021-02-18 Impact factor: 3.714