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. 2023 Mar;38(3):739-748.
doi: 10.1007/s00467-022-05671-6. Epub 2022 Jul 8.

Etiological diagnosis of post-diarrheal hemolytic uremic syndrome (HUS): humoral response contribution

Gabriela A Fiorentino  1   2 , Elizabeth Miliwebsky  3 , María Victoria Ramos  2 , Gisela Zolezzi  3 , Isabel Chinen  3 , Glenda Guzmán  1 , Rubén Nocera  1 , Romina Fernández-Brando  2 , Adriana Santiago  4 , Ramón Exeni  4 , Marina S Palermo  5
Affiliations

Etiological diagnosis of post-diarrheal hemolytic uremic syndrome (HUS): humoral response contribution

Gabriela A Fiorentino et al. Pediatr Nephrol. 2023 Mar.

Abstract

Background: Hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolysis, thrombocytopenia, and thrombus formation leading to tissue injury. HUS is classified according to its etiology as post-diarrheal or atypical HUS. Differential diagnosis of both entities continues to be a challenge for pediatric physicians.

Methods: The aim was to improve the rapid etiological diagnosis of post-diarrheal HUS cases based on the detection of Shiga toxin (Stx)-producing Escherichia coli (STEC) infection by screening of stx1/stx2 and rfbO157 in cultured stools by multiplex PCR, and the additional detection of anti-lipopolysaccharide (anti-LPS) O157, O145, and O121 antibodies by Glyco-iELISA test. In addition, we studied patients' relatives to detect circulating pathogenic strains that could contribute to HUS diagnosis and/or lead to the implementation of measures to prevent dissemination of familial outbreaks. This study describes the diagnosis of 31 HUS patients admitted to Hospital Municipal de Niños Prof Dr Ramón Exeni during the 2017-2020 period.

Results: Stool PCR confirmed the diagnosis of STEC associated with HUS in 38.7% of patients (12/31), while anti-LPS serology did in 88.9% (24/27). In those patients in which both methods were carried out (n = 27), a strong association between the results obtained was found. We found that 30.4% of HUS patients had at least one relative positive for STEC.

Conclusions: We could identify 96.3% (26/27) of HUS cases as secondary to STEC infections when both methods (genotyping and serology) were used. The results demonstrated a high circulation of STEC in HUS families and the prevalence of the STEC O157 serotype (83%) in our pediatric cohort. A higher-resolution version of the Graphical abstract is available as Supplementary information.

Keywords: Acute kidney injury; Antibodies; HUS; LPS; PCR; STEC; Shiga toxin.

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References

    1. Sheerin NS, Glover E (2019) Haemolytic uremic syndrome: diagnosis and management. F1000Res 8:F1000 Faculty Rev-1690. https://doi.org/10.12688/f1000research.19957.1
    1. Bommer M, Wölfle-Guter M, Bohl S, Kuchenbauer F (2018) The differential diagnosis and treatment of thrombotic microangiopathies. Dtsch Arztebl Int 115:327–334
    1. Rivas M, Miliwebsky E, Chinen I, Deza N, Leotta GA (2006) The epidemiology of hemolytic uremic syndrome in Argentina. Diagnosis of the etiologic agent, reservoirs and routes of transmission. Medicina (B Aires) 66(Suppl 3):27–32
    1. Rivas M, Chinen I, Miliwebsky E, Masana M (2014) Risk factors for Shiga toxin-producing Escherichia coli-associated human diseases. Microbiol Spectr 2:5. https://doi.org/10.1128/microbiolspec.EHEC-0002-2013 - DOI
    1. Rivas M, Miliwebsky E, Chinen I, Roldán CD, Balbi L, García B, Fiorilli G, Sosa-Estani S, Kincaid J, Rangel J, Griffin PM, Case Control Study Group (2006) Characterization and epidemiologic subtyping of Shiga toxin-producing Escherichia coli strains isolated from hemolytic uremic syndrome and diarrhea cases in Argentina. Foodborne Pathog Dis 3:88–96. https://doi.org/10.1089/fpd.2006.3.88 - DOI

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