Bloody Diarrhea and Shiga Toxin–Producing Escherichia coli Hemolytic Uremic Syndrome in Children: Data from the ItalKid-HUS Network - 22/09/21
, Chiara Vignati, MSc 2, Carla Masia, MSc 2, Valentina Capone, MD 1, Rosaria Colombo, MSc 2, Francesca Tel, MD 3, Laura Daprai, MSc 2, Sara Testa, MD 1, Antonella Dodaro, MSc 2, Fabio Paglialonga, MD 1, Mario Luini, VD 4, 5, Maurizio Brigotti, MD 6, Damiano Picicco, MSc 7, Carlo Baldioli, MD 8, Franca Pagani, MD 9, Rossella Ceruti, BS 10, Paola Tommasi, MD 3, Ilaria Possenti, MD 11, Donata Cresseri, MD 12, Dario Consonni, MD 13, Giovanni Montini, MD 1, 14, Milena Arghittu, MSc 15on behalf of the
ItalKid-HUS Network∗
Abstract |
Objective |
To analyze the results of an enhanced laboratory-surveillance protocol for bloody diarrhea aimed at identifying children with Shiga toxin–producing Escherichia coli (STEC) infection early in the course of the disease toward the early identification and management of patients with hemolytic uremic syndrome (HUS).
Study design |
The study (2010-2019) involved a referral population of 2.3 million children. Stool samples of patients with bloody diarrhea were screened for Shiga toxin (Stx) genes. Positive patients were rehydrated and monitored for hemoglobinuria until diarrhea resolved or STEC-HUS was diagnosed.
Results |
A total of 4767 children were screened; 214 (4.5%) were positive for either Stx1 (29.0%) or Stx2 (45.3%) or both Stx1+2 (25.7%); 34 patients (15.9%) developed STEC-HUS (0.71% of bloody diarrheas). Hemoglobinuria was present in all patients with HUS. Patients with Stx2 alone showed a greater risk of STEC-HUS (23.7% vs 12.7%) and none of the patients with Stx1 alone developed HUS. During the same period of time, 95 other patients were diagnosed STEC-HUS but were not captured by the screening program (26 had nonbloody diarrhea, 11 came from areas not covered by the screening program, and 58 had not been referred to the screening program, although they did meet the inclusion criteria). At HUS presentation, serum creatinine of patients identified by screening was significantly lower compared with that of the remaining patients (median 0.9 vs 1.51 mg/dL).
Conclusions |
Nearly 1% of children with bloody diarrhea developed STEC-HUS, and its diagnosis was anticipated by the screening program for Stx. The screening of bloody diarrhea for Stx is recommended, and monitoring patients carrying Stx2 with urine dipstick for hemoglobinuria is suggested to identify the renal complication as early as possible.
Le texte complet de cet article est disponible en PDF.Keywords : Shiga toxin, hemolytic uremic syndrome, diarrhea, bloody diarrhea, children
Abbreviations : eae, HUS, ipaH, PCR, sCr, STEC, Stx, TMA
Plan
| Financed by an unrestricted research grant from the “Progetto Alice ONLUS. Associazione per la lotta alla SEU.” The funder did not participate in the work. The authors declare no conflicts of interest. |
Vol 237
P. 34 - octobre 2021 Retour au numéro
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