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Multicenter Study
. 2021 Sep;36(9):2811-2817.
doi: 10.1007/s00467-021-04988-y. Epub 2021 Feb 18.

Hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli infection in Argentina: update of serotypes and genotypes and their relationship with severity of the disease

Laura F Alconcher  1 , Alejandro Balestracci  2 , Paula A Coccia  3 , Angela Del C Suarez  4 , Flavia B Ramírez  5 , Marta L Monteverde  6 , María Graciela Perez Y Gutiérrez  7 , Paula M Carlopio  8 , Illiana Principi  9 , Patricia Estrella  10 , Susana Micelli  11 , Daniela C Leroy  12 , Nahir E Quijada  13 , Claudia Seminara  14 , Marta I Giordano  15 , Susana B Hidalgo Solís  16 , Mariana Saurit  17 , Alejandra Caminitti  18 , Andrea Arias  19 , Miguel Liern  20 , Marta Rivas  21
Affiliations
Multicenter Study

Hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli infection in Argentina: update of serotypes and genotypes and their relationship with severity of the disease

Laura F Alconcher et al. Pediatr Nephrol. 2021 Sep.

Abstract

Background: Shiga toxin-producing Escherichia coli (STEC) infection is the most common cause of hemolytic uremic syndrome (HUS). Only few studies correlated serotypes and stx genotypes with disease severity. This study aimed to update STEC serotypes, stx genotypes, and virulence factors (eae and ehxA) in a cohort of patients with STEC-HUS and investigate whether they influence the severity of disease.

Methods: In this multicentric study, children hospitalized between 2005 and 2016 with STEC-HUS confirmed by the National Reference Laboratory were included. Serotypes (O157, O145, O121, and others), stx genotypes (stx1a, stx2a, stx2c, stx2d, and others), and virulence factors were analyzed, and their association with dialysis requirement (>10 days); severe neurological, cardiovascular, and/or bowel involvement; and death was assessed.

Results: The records of 280 patients were reviewed; 160 females, median age 21 months (IQR18m). STEC O157 was isolated in 206 (73.6%) patients, O145 in 47 (16.8%), O121 in 15 (5.4%), and other serotypes in 12 (4.2%). The stx2a/2c genotype was carried by 179 (63.9%) strains, stx2a by 94 (33.6%), stx1a/stx2a by five (1.8%), and stx1a only by two (0.7%). All strains except six harbored eae and ehxA genes. Fifty-nine (21.1%) patients had severe neurological involvement, 29 (10.4%) severe bowel injury, 14 (5%) cardiovascular involvement, 53 (18.9%) required > 10 days of dialysis, and 12 (4.3%) died. Neither serotypes nor stx genotypes detected were significantly linked to severity.

Conclusions: Serotype O157 and virulence stx2a/2c, eae, ehxA genotype are prevalent in Argentina, and no relationship was found between severity and serotypes and genotypes of STEC detected.

Keywords: Children; E. coli O157; Hemolytic uremic syndrome; STEC virulence factors; Shiga toxin-producing Escherichia coli; stx genes.

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References

    1. Alconcher LF, Coccia PA, Suarez ADC, Monteverde ML, Perez Y, Gutiérrez MG, Carlopio PM, Missoni ML, Balestracci A, Principi I, Ramírez FB, Estrella P, Micelli S, Leroy DC, Quijada NE, Seminara C, Giordano MI, Hidalgo Solís SB, Saurit M, Caminitti A, Arias A, Rivas M, Risso P, Liern M (2018) Hyponatremia: a new predictor of mortality in patients with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome. Pediatr Nephrol 33:1791–1798. https://doi.org/10.1007/s00467-018-3991-6 - DOI - PubMed
    1. Scheiring J, Andreoli SP, Zimmerhackl LB (2008) Treatment and outcome of Shiga-toxin-associated hemolytic uremic syndrome (HUS). Pediatr Nephrol 23:1749–1760. https://doi.org/10.1007/s00467-008-0935-6 - DOI - PubMed - PMC
    1. Ministerio de Salud de la Nación Argentina. Boletín Integrado de Vigilancia. N° 477 – SE 50 – 2019. Página 47. [Consulta: 11 de Junio 2020. Disponible en: https://www.argentina.gob.ar/sites/default/files/201912-biv_477.pdf ]
    1. Monteverde ML, Paz M, Ibáñez JP, Chaparro AB, Solernou V, Sager C, Tessi C, Locane F (2020) Kidney transplantation in children with CAKUT and non-CAKUT causes of chronic kidney disease: Do they have the same outcomes? Pediatr Transplant 24:e13763. https://doi.org/10.1111/petr.13763 - DOI - PubMed
    1. Ylinen E, Salmenlinna S, Halkilahti J, Jahnukainen T, Korhonen L, Virkkala T, Rimhanen-Finne R, Nuutinen M, Kataja J, Arikoski P, Linkosalo L, Bai X, Matussek A, Jalanko H, Saxén H (2020) Hemolytic uremic syndrome caused by Shiga toxin-producing Escherichia coli in children: incidence, risk factors, and clinical outcome. Pediatr Nephrol 35:1749–1759. https://doi.org/10.1007/s00467-020-04560-0 - DOI - PubMed - PMC

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