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Varrone E, Carnicelli D, He X, Grasse M, Stampfer K, Huber S, Kellnerová S, Tazzari PL, Ricci F, Paterini P, Ardissino G, Morabito S, Orth-Höller D, Würzner R, Brigotti M. Detection of Cleaved Stx2a in the Blood of STEC-Infected Patients. Toxins (Basel) 2023; 15:690. [PMID: 38133194 PMCID: PMC10747961 DOI: 10.3390/toxins15120690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/24/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Typical hemolytic uremic syndrome (HUS) is mainly caused by Shiga toxin-producing Escherichia coli (STEC) releasing Shiga toxin 2 (Stx2). Two different structures of this AB5 toxin have been described: uncleaved, with intact B and A chains, and cleaved, with intact B and a nicked A chain consisting of two fragments, A1 and A2, connected by a disulfide bond. Despite having the same toxic effect on sensitive cells, the two forms differ in their binding properties for circulating cells, serum components and complement factors, thus contributing to the pathogenesis of HUS differently. The outcome of STEC infections and the development of HUS could be influenced by the relative amounts of uncleaved or cleaved Stx2 circulating in patients' blood. Cleaved Stx2 was identified and quantified for the first time in four out of eight STEC-infected patients' sera by a method based on the inhibition of cell-free translation. Cleaved Stx2 was present in the sera of patients with toxins bound to neutrophils and in two out of three patients developing HUS, suggesting its involvement in HUS pathogenesis, although in association with other bacterial or host factors.
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Affiliation(s)
- Elisa Varrone
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via San Giacomo 14, 40126 Bologna, Italy; (E.V.); (D.C.); (P.P.)
| | - Domenica Carnicelli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via San Giacomo 14, 40126 Bologna, Italy; (E.V.); (D.C.); (P.P.)
| | - Xiaohua He
- Western Regional Research Center, U.S. Department of Agriculture, Agricultural Research Service, 800 Buchanan Street, Albany, CA 94710, USA;
| | - Marco Grasse
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (K.S.); (S.H.); (S.K.); (R.W.)
| | - Karin Stampfer
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (K.S.); (S.H.); (S.K.); (R.W.)
| | - Silke Huber
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (K.S.); (S.H.); (S.K.); (R.W.)
| | - Sára Kellnerová
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (K.S.); (S.H.); (S.K.); (R.W.)
| | - Pier Luigi Tazzari
- Immunohematology and Transfusion Center, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy; (P.L.T.); (F.R.)
| | - Francesca Ricci
- Immunohematology and Transfusion Center, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy; (P.L.T.); (F.R.)
| | - Paola Paterini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via San Giacomo 14, 40126 Bologna, Italy; (E.V.); (D.C.); (P.P.)
- Center for Applied Biomedical Research-CRBA, University of Bologna, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Gianluigi Ardissino
- Center for HUS Control, Prevention and Management, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milano, Italy;
| | - Stefano Morabito
- European Reference Laboratory for Escherichia coli, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | | | - Reinhard Würzner
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (K.S.); (S.H.); (S.K.); (R.W.)
| | - Maurizio Brigotti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via San Giacomo 14, 40126 Bologna, Italy; (E.V.); (D.C.); (P.P.)
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2
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Freedman SB, van de Kar NCAJ, Tarr PI. Shiga Toxin-Producing Escherichia coli and the Hemolytic-Uremic Syndrome. N Engl J Med 2023; 389:1402-1414. [PMID: 37819955 DOI: 10.1056/nejmra2108739] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- Stephen B Freedman
- From the Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (S.B.F.); the Department of Pediatric Nephrology, Radboud Institute for Molecular Life Sciences, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands (N.C.A.J.K.); and the Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, and the Department of Molecular Microbiology, Washington University School of Medicine, St. Louis (P.I.T.)
| | - Nicole C A J van de Kar
- From the Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (S.B.F.); the Department of Pediatric Nephrology, Radboud Institute for Molecular Life Sciences, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands (N.C.A.J.K.); and the Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, and the Department of Molecular Microbiology, Washington University School of Medicine, St. Louis (P.I.T.)
| | - Phillip I Tarr
- From the Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (S.B.F.); the Department of Pediatric Nephrology, Radboud Institute for Molecular Life Sciences, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands (N.C.A.J.K.); and the Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, and the Department of Molecular Microbiology, Washington University School of Medicine, St. Louis (P.I.T.)
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3
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Rivas M, Pichel M, Colonna M, Casanello AL, Alconcher LF, Galavotti J, Principi I, Araujo SP, Ramírez FB, González G, Pianciola LA, Mazzeo M, Suarez Á, Oderiz S, Ghezzi LFR, Arrigo DJ, Paladini JH, Baroni MR, Pérez S, Tamborini A, Chinen I, Miliwebsky ES, Goldbaum F, Muñoz L, Spatz L, Sanguineti S. Surveillance of Shiga toxin-producing Escherichia coli associated bloody diarrhea in Argentina. Rev Argent Microbiol 2023; 55:345-354. [PMID: 37301652 DOI: 10.1016/j.ram.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/12/2022] [Accepted: 03/27/2023] [Indexed: 06/12/2023] Open
Abstract
In Argentina, hemolytic uremic syndrome (HUS) caused by Shiga toxin-producing Escherichia coli (STEC-HUS) infection is endemic, and reliable data about prevalence and risk factors have been available since 2000. However, information about STEC-associated bloody diarrhea (BD) is limited. A prospective study was performed during the period October 2018-June 2019 in seven tertiary-hospitals and 18 referral units from different regions, aiming to determine (i) the frequency of STEC-positive BD cases in 714 children aged 1-9 years of age and (ii) the rate of progression of bloody diarrhea to HUS. The number and regional distribution of STEC-HUS cases in the same hospitals and during the same period were also assessed. Twenty-nine (4.1%) of the BD patients were STEC-positive, as determined by the Shiga Toxin Quik Chek (STQC) test and/or the multiplex polymerase chain reaction (mPCR) assay. The highest frequencies were found in the Southern region (Neuquén, 8.7%; Bahía Blanca, 7.9%), in children between 12 and 23 month of age (8.8%), during summertime. Four (13.8%) cases progressed to HUS, three to nine days after diarrhea onset. Twenty-seven STEC-HUS in children under 5 years of age (77.8%) were enrolled, 51.9% were female; 44% were Stx-positive by STQC and all by mPCR. The most common serotypes were O157:H7 and O145:H28 and the prevalent genotypes, both among BD and HUS cases, were stx2a-only or -associated. Considering the endemic behavior of HUS and its high incidence, these data show that the rate of STEC-positive cases is low among BD patients. However, the early recognition of STEC-positive cases is important for patient monitoring and initiation of supportive treatment.
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Affiliation(s)
- Marta Rivas
- Inmunova S.A., Av. 25 de Mayo 1021, San Martín, 1650 Buenos Aires, Argentina.
| | - Mariana Pichel
- Inmunova S.A., Av. 25 de Mayo 1021, San Martín, 1650 Buenos Aires, Argentina
| | - Mariana Colonna
- Inmunova S.A., Av. 25 de Mayo 1021, San Martín, 1650 Buenos Aires, Argentina
| | | | - Laura F Alconcher
- Hospital Interzonal "Dr. José Penna", Av. Laínez 2401, B8000 Bahía Blanca, Buenos Aires, Argentina
| | - Jimena Galavotti
- Hospital Interzonal "Dr. José Penna", Av. Laínez 2401, B8000 Bahía Blanca, Buenos Aires, Argentina
| | - Iliana Principi
- Hospital de Niños "Dr. Humberto Notti", Av. Bandera de los Andes 2603, M5521 Guaymallén, Mendoza, Argentina
| | - Sofía Pérez Araujo
- Hospital de Niños "Dr. Humberto Notti", Av. Bandera de los Andes 2603, M5521 Guaymallén, Mendoza, Argentina
| | - Flavia B Ramírez
- Hospital Provincial Neuquén Dr. Castro Rendón, Buenos Aires 450, Q8300 Neuquén, Argentina
| | - Gladys González
- Hospital Provincial Neuquén Dr. Castro Rendón, Buenos Aires 450, Q8300 Neuquén, Argentina
| | - Luis A Pianciola
- Laboratorio Central, Gregorio Martínez 65, Q8300 Neuquén, Argentina
| | - Melina Mazzeo
- Laboratorio Central, Gregorio Martínez 65, Q8300 Neuquén, Argentina
| | - Ángela Suarez
- Hospital De Niños "Sor María Ludovica", Calle 14 1631 entre 65 y 66, B1904CSI La Plata, Buenos Aires, Argentina
| | - Sebastián Oderiz
- Hospital De Niños "Sor María Ludovica", Calle 14 1631 entre 65 y 66, B1904CSI La Plata, Buenos Aires, Argentina
| | - Lidia F R Ghezzi
- Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199AB, Buenos Aires, Argentina
| | - Diego J Arrigo
- Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199AB, Buenos Aires, Argentina
| | - José H Paladini
- Hospital Dr. Orlando Alassia, Mendoza 4151, 3000 Santa Fe, Argentina
| | - María R Baroni
- Hospital Dr. Orlando Alassia, Mendoza 4151, 3000 Santa Fe, Argentina
| | - Susana Pérez
- Hospital "Dr. Lucio Molas", Raúl B. Díaz Pilcomayo, 6300 Santa Rosa, La Pampa, Argentina
| | - Ana Tamborini
- Hospital "Dr. Lucio Molas", Raúl B. Díaz Pilcomayo, 6300 Santa Rosa, La Pampa, Argentina
| | - Isabel Chinen
- Servicio Fisiopatogenia, Instituto Nacional de Enfermedades Infecciosas, ANLIS "Dr. Carlos G. Malbrán", Av. Vélez Sarsfield 563, 1281 Buenos Aires, Argentina
| | - Elizabeth S Miliwebsky
- Servicio Fisiopatogenia, Instituto Nacional de Enfermedades Infecciosas, ANLIS "Dr. Carlos G. Malbrán", Av. Vélez Sarsfield 563, 1281 Buenos Aires, Argentina
| | - Fernando Goldbaum
- Inmunova S.A., Av. 25 de Mayo 1021, San Martín, 1650 Buenos Aires, Argentina
| | - Luciana Muñoz
- Inmunova S.A., Av. 25 de Mayo 1021, San Martín, 1650 Buenos Aires, Argentina
| | - Linus Spatz
- Inmunova S.A., Av. 25 de Mayo 1021, San Martín, 1650 Buenos Aires, Argentina
| | - Santiago Sanguineti
- Inmunova S.A., Av. 25 de Mayo 1021, San Martín, 1650 Buenos Aires, Argentina
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Tarr PI, Freedman SB. Why antibiotics should not be used to treat Shiga toxin-producing Escherichia coli infections. Curr Opin Gastroenterol 2022; 38:30-38. [PMID: 34871193 DOI: 10.1097/mog.0000000000000798] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW There has been much debate about treating Shiga toxin-producing Escherichia coli (STEC) infections with antibiotics. No data convincingly demonstrate that antibiotics are better than no antibiotic treatment at all, and many studies suggest antibiotics increase the risk of developing the hemolytic uremic syndrome (HUS). This topic is timely, because emerging technology enables rapid identification of STEC-infected patients, and we anticipate questions about management will increase. This review is designed to familiarize readers with the series of observations that underlie our recommendations. RECENT FINDINGS The long debate over antibiotics in STEC infections appears resolved by gradually accruing information that show that antibiotics do not benefit infected patients. In fact, they are associated with an increased likelihood of developing HUS. A meta-analysis published in 2016 demonstrated that low risk of bias studies find a clear association between antibiotic use and development of HUS. Subsequent publications do not refute these findings. SUMMARY In high-income countries, antibiotics should not routinely be given to patients with acute diarrhea unless testing demonstrates a pathogen for which antibiotics are indicated, and STEC infection has been excluded. Future work to prevent HUS should focus on preventing primary infections, and mitigating extraintestinal consequences of STEC gut infections.
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Affiliation(s)
- Phillip I Tarr
- Division of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Stephen B Freedman
- Alberta Children's Hospital Foundation Professor in Child Health and Wellness, Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital & Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
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5
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Hua Y, Chromek M, Frykman A, Jernberg C, Georgieva V, Hansson S, Zhang J, Marits AK, Wan C, Matussek A, Bai X. Whole-genome characterization of hemolytic uremic syndrome-causing Shiga toxin-producing Escherichia coli in Sweden. Virulence 2021; 12:1296-1305. [PMID: 33939581 PMCID: PMC8096335 DOI: 10.1080/21505594.2021.1922010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Shiga toxin-producing Escherichia coli, a foodborne bacterial pathogen, has been linked to a broad spectrum of clinical outcomes ranging from asymptomatic carriage to fatal hemolytic uremic syndrome (HUS). Here, we collected clinical data and STEC strains from HUS patients from 1994 through 2018, whole-genome sequencing was performed to molecularly characterize HUS-associated STEC strains, statistical analysis was conducted to identify bacterial genetic factors associated with severe outcomes in HUS patients. O157:H7 was the most predominant serotype (57%) among 54 HUS-associated STEC strains, followed by O121:H19 (19%) and O26:H11 (7%). Notably, some non-predominant serotypes such as O59:H17 (2%) and O109:H21 (2%) also caused HUS. All O157:H7 strains with one exception belonged to clade 8. During follow-up at a median of 4 years, 41% of the patients had renal sequelae. Fifty-nine virulence genes were found to be statistically associated with severe renal sequelae, these genes encoded type II and type III secretion system effectors, chaperones, and other factors. Notably, virulence genes associated with severe clinical outcomes were significantly more prevalent in O157:H7 strains. In contrast, genes related to mild symptoms were evenly distributed across all serotypes. The whole-genome phylogeny indicated high genomic diversity among HUS-STEC strains. No distinct cluster was found between HUS and non-HUS STEC strains. The current study showed that O157:H7 remains the main cause of STEC-associated HUS, despite the rising importance of other non-O157 serotypes. Besides, O157:H7 is associated with severe renal sequelae in the follow-up, which could be a risk factor for long-term prognosis in HUS patients.
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Affiliation(s)
- Ying Hua
- Department of Microbiology, School of Public Health, Southern Medical University, Guangzhou, China.,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Milan Chromek
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Anne Frykman
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Valya Georgieva
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Sverker Hansson
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ji Zhang
- Molecular Epidemiology and Public Health Laboratory, School of Veterinary Sciences, Massey University, Palmerston North, New Zealand
| | - Ann Katrine Marits
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Chengsong Wan
- Department of Microbiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Andreas Matussek
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Sweden.,Laboratory Medicine, Jönköping Region County, Department of Clinical and Experimental Medicine, Linköping University, Jönköping, Sweden.,Oslo University Hospital, Oslo, Norway.,Division of Laboratory Medicine, Institute of Clinical Medicine, University of Oslo, Norway
| | - Xiangning Bai
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Sweden.,Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Huddinge, Sweden.,State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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6
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Varrone E, Carnicelli D, Brigotti M. Extracellular Vesicles and Renal Endothelial Cells: A Fatal Attraction in Hemolytic Uremic Syndrome. THE AMERICAN JOURNAL OF PATHOLOGY 2021; 191:795-804. [PMID: 33652019 DOI: 10.1016/j.ajpath.2021.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/22/2021] [Accepted: 02/10/2021] [Indexed: 12/14/2022]
Abstract
This review focuses on typical hemolytic uremic syndrome (HUS), a life-threatening sequela of human infections caused, particularly in children, by Shiga toxin-producing Escherichia coli strains. Thrombotic microangiopathy of the brain and the kidney is the end point of toxin action, resulting in the hallmarks of HUS (ie, thrombocytopenia, anemia, and acute renal failure). A growing body of evidence points to the role of extracellular vesicles released in the blood of patients by toxin-challenged circulating cells (monocytes, neutrophils, and erythrocytes) and platelets, as a key factor in the pathogenesis of HUS. This review provides i) an updated description of the pathogenesis of Shiga toxin-producing E. coli infections; ii) an analysis of blood cell-derived extracellular vesicles, and of their parent cells, as triggering factors in HUS; and iii) a model explaining why Shiga toxin-containing vesicles dock preferentially to the endothelia of target organs.
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Affiliation(s)
- Elisa Varrone
- Department of Experimental, Diagnostic and Specialty Medicine, School of Medicine, University of Bologna, Bologna, Italy
| | - Domenica Carnicelli
- Department of Experimental, Diagnostic and Specialty Medicine, School of Medicine, University of Bologna, Bologna, Italy
| | - Maurizio Brigotti
- Department of Experimental, Diagnostic and Specialty Medicine, School of Medicine, University of Bologna, Bologna, Italy.
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Rocchetti L, Munari B, Varrone E, Porcellini E, Orth-Höller D, Würzner R, Carnicelli D, Brigotti M. Method for the Detection of the Cleaved Form of Shiga Toxin 2a Added to Normal Human Serum. Toxins (Basel) 2021; 13:toxins13020094. [PMID: 33530614 PMCID: PMC7911550 DOI: 10.3390/toxins13020094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/14/2021] [Accepted: 01/21/2021] [Indexed: 11/16/2022] Open
Abstract
The pathogenesis of Escherichia coli-induced hemolytic uremic syndrome (eHUS) caused by infections with pathogenic Shiga toxin (Stx) producing E. coli (STEC) is centered on bacterial (e.g., Stx) and host factors (circulating cells, complement system, serum proteins) whose interaction is crucial for the immediate outcome and for the development of this life-threatening sequela. Stx2a, associated to circulating cells (early toxemia) or extracellular vesicles (late toxemia) in blood, is considered the main pathogenic factor in the development of eHUS. Recently, it was found that the functional properties of Stx2a (binding to circulating cells and complement components) change according to modifications of the structure of the toxin, i.e., after a single cleavage of the A subunit resulting in two fragments, A1 and A2, linked by a disulfide bridge. Herein, we describe a method to be used for the detection of the cleaved form of Stx2a in the serum of STEC-infected or eHUS patients. The method is based on the detection of the boosted inhibitory activity of the cleaved toxin, upon treatment with reducing agents, on a rabbit cell-free translation system reconstituted with human ribosomes. The method overcomes the technical problem caused by the presence of inhibitors of translation in human serum that have been stalled by the addition of RNAase blockers and by treatment with immobilized protein G. This method, allowing the detection of Stx2a at concentrations similar to those found by ELISA in the blood of STEC-infected patients, could be a useful tool to study the contribution of the cleaved form of Stx2a in the pathogenesis of eHUS.
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Affiliation(s)
- Lucrezia Rocchetti
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via San Giacomo 14, 40126 Bologna, Italy; (L.R.); (B.M.); (E.V.); (E.P.); (D.C.)
| | - Beatrice Munari
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via San Giacomo 14, 40126 Bologna, Italy; (L.R.); (B.M.); (E.V.); (E.P.); (D.C.)
| | - Elisa Varrone
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via San Giacomo 14, 40126 Bologna, Italy; (L.R.); (B.M.); (E.V.); (E.P.); (D.C.)
| | - Elisa Porcellini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via San Giacomo 14, 40126 Bologna, Italy; (L.R.); (B.M.); (E.V.); (E.P.); (D.C.)
| | - Dorothea Orth-Höller
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, A-6020 Innsbruck, Austria; (D.O.-H.); (R.W.)
| | - Reinhard Würzner
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, A-6020 Innsbruck, Austria; (D.O.-H.); (R.W.)
| | - Domenica Carnicelli
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via San Giacomo 14, 40126 Bologna, Italy; (L.R.); (B.M.); (E.V.); (E.P.); (D.C.)
| | - Maurizio Brigotti
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via San Giacomo 14, 40126 Bologna, Italy; (L.R.); (B.M.); (E.V.); (E.P.); (D.C.)
- Correspondence: ; Tel.: +39-051-209-4716
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8
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McKee RS, Schnadower D, Tarr PI, Xie J, Finkelstein Y, Desai N, Lane RD, Bergmann KR, Kaplan RL, Hariharan S, Cruz AT, Cohen DM, Dixon A, Ramgopal S, Rominger A, Powell EC, Kilgar J, Michelson KA, Beer D, Bitzan M, Pruitt CM, Yen K, Meckler GD, Plint AC, Bradin S, Abramo TJ, Gouin S, Kam AJ, Schuh A, Balamuth F, Hunley TE, Kanegaye JT, Jones NE, Avva U, Porter R, Fein DM, Louie JP, Freedman SB. Predicting Hemolytic Uremic Syndrome and Renal Replacement Therapy in Shiga Toxin-producing Escherichia coli-infected Children. Clin Infect Dis 2021; 70:1643-1651. [PMID: 31125419 DOI: 10.1093/cid/ciz432] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/23/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Shiga toxin-producing Escherichia coli (STEC) infections are leading causes of pediatric acute renal failure. Identifying hemolytic uremic syndrome (HUS) risk factors is needed to guide care. METHODS We conducted a multicenter, historical cohort study to identify features associated with development of HUS (primary outcome) and need for renal replacement therapy (RRT) (secondary outcome) in STEC-infected children without HUS at initial presentation. Children aged <18 years who submitted STEC-positive specimens between January 2011 and December 2015 at a participating study institution were eligible. RESULTS Of 927 STEC-infected children, 41 (4.4%) had HUS at presentation; of the remaining 886, 126 (14.2%) developed HUS. Predictors (all shown as odds ratio [OR] with 95% confidence interval [CI]) of HUS included younger age (0.77 [.69-.85] per year), leukocyte count ≥13.0 × 103/μL (2.54 [1.42-4.54]), higher hematocrit (1.83 [1.21-2.77] per 5% increase) and serum creatinine (10.82 [1.49-78.69] per 1 mg/dL increase), platelet count <250 × 103/μL (1.92 [1.02-3.60]), lower serum sodium (1.12 [1.02-1.23 per 1 mmol/L decrease), and intravenous fluid administration initiated ≥4 days following diarrhea onset (2.50 [1.14-5.46]). A longer interval from diarrhea onset to index visit was associated with reduced HUS risk (OR, 0.70 [95% CI, .54-.90]). RRT predictors (all shown as OR [95% CI]) included female sex (2.27 [1.14-4.50]), younger age (0.83 [.74-.92] per year), lower serum sodium (1.15 [1.04-1.27] per mmol/L decrease), higher leukocyte count ≥13.0 × 103/μL (2.35 [1.17-4.72]) and creatinine (7.75 [1.20-50.16] per 1 mg/dL increase) concentrations, and initial intravenous fluid administration ≥4 days following diarrhea onset (2.71 [1.18-6.21]). CONCLUSIONS The complex nature of STEC infection renders predicting its course a challenge. Risk factors we identified highlight the importance of avoiding dehydration and performing close clinical and laboratory monitoring.
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Affiliation(s)
- Ryan S McKee
- Section of Pediatric Emergency Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City
| | - David Schnadower
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Ohio
| | - Phillip I Tarr
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Jianling Xie
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary
| | - Yaron Finkelstein
- Divisions of Emergency Medicine, and Clinical Pharmacology and Toxicology, Hospital for Sick Children, University of Toronto, Ontario
| | - Neil Desai
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Roni D Lane
- Division of Pediatric Emergency Medicine, University of Utah School of Medicine, Salt Lake City
| | - Kelly R Bergmann
- Department of Emergency Medicine, Children's Minnesota, Minneapolis
| | - Ron L Kaplan
- Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle Children's Hospital
| | - Selena Hariharan
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Andrea T Cruz
- Sections of Pediatric Emergency Medicine and Pediatric Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - Daniel M Cohen
- Division of Emergency Medicine, Nationwide Children's Hospital and Ohio State University, Columbus
| | - Andrew Dixon
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Stollery Children's Hospital, Women and Children's Research Institute, University of Alberta, Edmonton, Canada
| | - Sriram Ramgopal
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine Children's Hospital, Pennsylvania
| | - Annie Rominger
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, Kentucky
| | - Elizabeth C Powell
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer Kilgar
- Department of Pediatrics and Division of Emergency Medicine, Children's Hospital, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Darcy Beer
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Martin Bitzan
- Division of Nephrology, Department of Pediatrics, McGill University Health Centre, Montreal, Québec, Canada
| | - Christopher M Pruitt
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham
| | - Kenneth Yen
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Texas Southwestern, Children's Health, Dallas
| | - Garth D Meckler
- Division of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, University of British Columbia, Vancouver
| | - Amy C Plint
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Ottawa, Ontario, Canada
| | - Stuart Bradin
- Departments of Pediatrics and Emergency Medicine, University of Michigan Health System, Ann Arbor
| | - Thomas J Abramo
- Departments of Pediatrics and Emergency Medicine, University of Arkansas School of Medicine, Arkansas Children's Hospital Research Institute, Little Rock
| | - Serge Gouin
- Departments of Pediatric Emergency Medicine and Pediatrics, Université de Montréal, Québec
| | - April J Kam
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Abigail Schuh
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee
| | - Fran Balamuth
- University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia
| | - Tracy E Hunley
- Division of Pediatric Nephrology, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John T Kanegaye
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla.,Rady Children's Hospital San Diego, California
| | - Nicholas E Jones
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Georgia
| | - Usha Avva
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Hackensack Meridian School of Medicine at Seton Hall, Joseph M. Sanzari Children's Hospital, New Jersey
| | - Robert Porter
- Discipline of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Daniel M Fein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Jeffrey P Louie
- Department of Pediatrics, Division of Emergency Medicine, University of Minnesota, Masonic Children's Hospital, Minneapolis
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
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9
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Hamilton D, Cullinan J. A practical composite risk score for the development of Haemolytic Uraemic Syndrome from Shiga toxin-producing Escherichia coli. Eur J Public Health 2020; 29:861-868. [PMID: 31326985 DOI: 10.1093/eurpub/ckz132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Haemolytic Uraemic Syndrome (HUS) is a serious complication of Shiga toxin-producing Escherichia coli (STEC) infection and the key reason why intensive health protection against STEC is required. However, although many potential risk factors have been identified, accurate estimation of risk of HUS from STEC remains challenging. Therefore, we aimed to develop a practical composite score to promptly estimate the risk of developing HUS from STEC. METHODS This was a retrospective cohort study where data for all confirmed STEC infections in Ireland during 2013-15 were subjected to statistical analysis with respect to predicting HUS. Multivariable logistic regression was used to develop a composite risk score, segregating risk of HUS into 'very low risk' (0-0.4%), 'low risk' (0.5-0.9%), 'medium risk' (1.0-4.4%), 'high risk' (4.5-9.9%) and 'very high risk' (10.0% and over). RESULTS There were 1397 STEC notifications with complete information regarding HUS, of whom 5.1% developed HUS. Young age, vomiting, bloody diarrhoea, Shiga toxin 2, infection during April to November, and infection in Eastern and North-Eastern regions of Ireland, were all statistically significant independent predictors of HUS. Demonstration of a risk gradient provided internal validity to the risk score: 0.2% in the cohort with 'very low risk' (1/430), 1.1% with 'low risk' (2/182), 2.3% with 'medium risk' (8/345), 3.1% with 'high risk' (3/98) and 22.2% with 'very high risk' (43/194) scores, respectively, developed HUS. CONCLUSION We have developed a composite risk score which may be of practical value, once externally validated, in prompt estimation of risk of HUS from STEC infection.
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Affiliation(s)
| | - John Cullinan
- Discipline of Economics, National University of Ireland, Galway, Ireland
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10
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Shimamura Y, Shinke M, Hiraishi M, Tsuchiya Y, Egawa M, Ohashi N, Masuda S. Influence of Muscle Fiber Direction on Migration of Salmonella Enteritidis, Staphylococcus aureus, and Escherichia coli into Raw Chicken Breast. J Food Prot 2020; 83:928-934. [PMID: 32428935 DOI: 10.4315/0362-028x.jfp-19-278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 01/02/2020] [Indexed: 11/11/2022]
Abstract
ABSTRACT The influence of muscle fiber direction (parallel or perpendicular) in relation to the inoculation surface on migration of Salmonella Enteritidis, Staphylococcus aureus, and Escherichia coli into raw chicken breasts was examined. Chicken breast samples with two types of surface fibers (running parallel or perpendicular to the surface) were inoculated with cultures of each bacterium. Inoculated samples were stored for 5 min, 1 h, or 24 h at 4°C. After storage, the samples were divided into segments, and bacterial counts were determined in different regions (inoculation surface, inoculation surface to 1 cm, 1 to 2 cm, 2 to 4 cm, and 4 to 6 cm). The migration of bacteria did not change at 5 min or 1 h regardless of fiber direction. However, after 24 h each bacterium was detected at 4 to 6 cm in the pieces of sample with a perpendicular muscle fiber surface cut. Although these bacteria were detected at 4 to 6 cm in samples with muscle fibers perpendicular to the inoculated surface, these results do not clearly indicate that bacteria migrated into the chicken breast. To monitor actual migration of bacteria into the chicken breast, the tops of the perpendicular muscle fibers of the breast sample were inoculated with bioluminescent E. coli Xen-14. Various regions of the breast sample (inoculation surface and cut surfaces at 1, 2, 4, and 6 cm) were stamped directly on growth medium. Culture revealed that the bacteria migrated directly under the contaminated site and dispersed along the surface of the chicken breast segments. More bacteria distributed laterally than migrated directly below the contamination site. These results suggest that the direction of the muscle fibers is a major factor influencing migration of pathogenic bacteria into chicken breast. HIGHLIGHTS
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Affiliation(s)
- Yuko Shimamura
- School of Food and Nutritional Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan.,(ORCID: https://orcid.org/0000-0003-0801-483X [Y.S.])
| | - Momoka Shinke
- School of Food and Nutritional Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan
| | - Miki Hiraishi
- School of Food and Nutritional Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan
| | - Yusuke Tsuchiya
- School of Food and Nutritional Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan
| | - Mizuki Egawa
- School of Food and Nutritional Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan
| | - Norio Ohashi
- School of Food and Nutritional Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan
| | - Shuichi Masuda
- School of Food and Nutritional Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan
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11
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Bimodal Response to Shiga Toxin 2 Subtypes Results from Relatively Weak Binding to the Target Cell. Infect Immun 2019; 87:IAI.00428-19. [PMID: 31527121 DOI: 10.1128/iai.00428-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 09/07/2019] [Indexed: 01/15/2023] Open
Abstract
There are two major antigenic forms of Shiga toxin (Stx), Stx1 and Stx2, which bind the same receptor and act on the same target but nonetheless differ in potency. Stx1a is more toxic to cultured cells, but Stx2 subtypes are more potent in animal models. To understand this phenomenon in cultured cells, we used a system that combines flow cytometry with a fluorescent reporter to monitor the Stx-induced inhibition of protein synthesis in single cells. We observed that Vero cells intoxicated with Stx1a behave differently than those intoxicated with Stx2 subtypes: cells challenged with Stx1a exhibited a population-wide loss of protein synthesis, while cells exposed to Stx2a or Stx2c exhibited a dose-dependent bimodal response in which one subpopulation of cells was unaffected (i.e., no loss of protein synthesis). Cells challenged with a hybrid toxin containing the catalytic subunit of Stx1a and the cell-binding subunit of Stx2a also exhibited a bimodal response to intoxication, while cells challenged with a hybrid toxin containing the catalytic subunit of Stx2a and the cell-binding subunit of Stx1a exhibited a population-wide loss of protein synthesis. Other experiments further supported a primary role for the subtype of the B subunit in the outcome of host-Stx interactions. Our collective observations indicate that the bimodal response to Stx2 subtypes is due to relatively weak binding between Stx2 and the host cell that reduces the total functional pool of Stx2 in comparison to that of Stx1a. This explains, in part, the molecular basis for the differential cellular toxicity between Stx1a and Stx2 subtypes.
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12
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Brigotti M, Orth-Höller D, Carnicelli D, Porcellini E, Galassi E, Tazzari PL, Ricci F, Manoli F, Manet I, Talasz H, Lindner HH, Speth C, Erbeznik T, Fuchs S, Posch W, Chatterjee S, Würzner R. The structure of the Shiga toxin 2a A-subunit dictates the interactions of the toxin with blood components. Cell Microbiol 2019; 21:e13000. [PMID: 30578712 PMCID: PMC6492301 DOI: 10.1111/cmi.13000] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/06/2018] [Accepted: 12/17/2018] [Indexed: 12/29/2022]
Abstract
Hemolytic uremic syndrome (eHUS) is a severe complication of human infections with Shiga toxins (Stxs)-producing Escherichia coli. A key step in the pathogenesis of eHUS is the interaction of Stxs with blood components before the targeting of renal endothelial cells. Here, we show that a single proteolytic cleavage in the Stx2a A-subunit, resulting into two fragments (A1 and A2) linked by a disulfide bridge (cleaved Stx2a), dictates different binding abilities. Uncleaved Stx2a was confirmed to bind to human neutrophils and to trigger leukocyte/platelet aggregate formation, whereas cleaved Stx2a was ineffective. Conversely, binding of complement factor H was confirmed for cleaved Stx2a and not for uncleaved Stx2a. It is worth noting that uncleaved and cleaved Stx2a showed no differences in cytotoxicity for Vero cells or Raji cells, structural conformation, and contaminating endotoxin. These results have been obtained by comparing two Stx2a batches, purified in different laboratories by using different protocols, termed Stx2a(cl; cleaved toxin, Innsbruck) and Stx2a(uncl; uncleaved toxin, Bologna). Stx2a(uncl) behaved as Stx2a(cl) after mild trypsin treatment. In this light, previous controversial results obtained with purified Stx2a has to be critically re-evaluated; furthermore, characterisation of the structure of circulating Stx2a is mandatory to understand eHUS-pathogenesis and to develop therapeutic approaches.
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Affiliation(s)
- Maurizio Brigotti
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Sede di Patologia Generale, Università di Bologna, Bologna, Italy
| | - Dorothea Orth-Höller
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Domenica Carnicelli
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Sede di Patologia Generale, Università di Bologna, Bologna, Italy
| | - Elisa Porcellini
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Sede di Patologia Generale, Università di Bologna, Bologna, Italy
| | - Elisabetta Galassi
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Sede di Patologia Generale, Università di Bologna, Bologna, Italy
| | - Pier Luigi Tazzari
- Servizio di Immunoematologia e Trasfusionale, Ospedale S. Orsola-Malpighi, Bologna, Italy
| | - Francesca Ricci
- Servizio di Immunoematologia e Trasfusionale, Ospedale S. Orsola-Malpighi, Bologna, Italy
| | - Francesco Manoli
- Istituto per la Sintesi Organica e la Fotoreattività, Consiglio Nazionale delle Ricerche, Bologna, Italy
| | - Ilse Manet
- Istituto per la Sintesi Organica e la Fotoreattività, Consiglio Nazionale delle Ricerche, Bologna, Italy
| | - Heribert Talasz
- Division of Clinical Biochemistry, Biocentre, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert H Lindner
- Division of Clinical Biochemistry, Biocentre, Medical University of Innsbruck, Innsbruck, Austria
| | - Cornelia Speth
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Erbeznik
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Fuchs
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wilfried Posch
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sneha Chatterjee
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Reinhard Würzner
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
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13
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Brigotti M, Carnicelli D, Arfilli V, Porcellini E, Galassi E, Valerii MC, Spisni E. Human monocytes stimulated by Shiga toxin 1a via globotriaosylceramide release proinflammatory molecules associated with hemolytic uremic syndrome. Int J Med Microbiol 2018; 308:940-946. [PMID: 29983334 DOI: 10.1016/j.ijmm.2018.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 06/22/2018] [Accepted: 06/28/2018] [Indexed: 11/26/2022] Open
Abstract
The life-threatening sequela of hemorrhagic colitis induced by Shiga toxins (Stx)-producing Escherichia coli (STEC) infections in humans is hemolytic uremic syndrome (HUS), the main cause of acute renal failure in early childhood. The key step in the pathogenesis of HUS is the appearance of Stx in the blood of infected patients because these powerful virulence factors are capable of inducing severe microangiopathic lesions in the kidney. During precocious toxemia, which occurs in patients before the onset of HUS during the intestinal phase, Stx bind to several different circulating cells. An early response of these cells might include the release of proinflammatory mediators associated with the development of HUS. Here, we show that primary human monocytes stimulated with Shiga toxin 1a (Stx1a) through the glycolipid receptor globotriaosylceramide released larger amounts of proinflammatory molecules (IL-1β, TNFα, IL-6, G-CSF, CXCL8, CCL2, CCL4) than Stx1a-treated neutrophils. The mediators (except IL-1β) are among the top six proinflammatory mediators found in the sera from patients with HUS in different studies. The molecules appear to be involved in different pathogenetic steps of HUS, i.e. sensitization of renal endothelial cells to the toxin actions (IL-1β, TNFα), activation of circulating monocytes and neutrophils (CXCL8, CCL2, CCL4) and increase in neutrophil counts in patients with poor prognosis (G-CSF). Hence, a role of circulating monocytes in the very early phases of the pathogenetic process culminating with HUS can be envisaged. Impairment of the events of precocious toxemia would prevent or reduce the risk of HUS in STEC-infected children.
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Affiliation(s)
- Maurizio Brigotti
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, sede di Patologia Generale, Università di Bologna, Bologna, Italy.
| | - Domenica Carnicelli
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, sede di Patologia Generale, Università di Bologna, Bologna, Italy
| | - Valentina Arfilli
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, sede di Patologia Generale, Università di Bologna, Bologna, Italy
| | - Elisa Porcellini
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, sede di Patologia Generale, Università di Bologna, Bologna, Italy
| | - Elisabetta Galassi
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, sede di Patologia Generale, Università di Bologna, Bologna, Italy
| | - Maria C Valerii
- Dipartimento di Scienze Biologiche, Geologiche e Ambientali, Università di Bologna, Bologna, Italy
| | - Enzo Spisni
- Dipartimento di Scienze Biologiche, Geologiche e Ambientali, Università di Bologna, Bologna, Italy
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14
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An Improved Method for the Sensitive Detection of Shiga Toxin 2 in Human Serum. Toxins (Basel) 2018; 10:toxins10020059. [PMID: 29385045 PMCID: PMC5848160 DOI: 10.3390/toxins10020059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/12/2018] [Accepted: 01/29/2018] [Indexed: 11/21/2022] Open
Abstract
Shiga toxins (Stx) released by Stx-producing E. coli (STEC) are virulence factors that are most closely associated with hemolytic uremic syndrome (HUS), a life-threatening complication of intestinal infections by STEC. Stx have to enter into the circulatory system before they are delivered to target organs and cause damage. The presence of Stx in sera could be a risk indicator for HUS development. However, the detection of Stx, particularly Stx2, has been difficult due to the presence of Stx2-binding components in human serum. Here, we report new ELISA-based methods for the detection of Stx1 and Stx2 in human serum and the effect of guanidinium chloride on enhancing the sensitivity for the detection of Stx2. The recovery rate for Stx2 was 62% when Stx2-spiked serum samples were treated with guanidinium chloride at a concentration of 200 mM, in contrast to 17% without guanidinium chloride treatment. The effectiveness of guanidinium chloride treatment for the detection of Stx2 in human serum was validated using sera from STEC-infected patients. Coimmunoprecipitation results indicated a specific physical interaction between Stx2 and the human serum amyloid P component (HuSAP) in human serum samples. Our in vitro study demonstrated that the inhibition from HuSAP alone for the detection of Stx2 was only 20%, much less than 69.6% from human serum at Stx2 level 10 ng/mL, suggesting that there may be other factors that bind Stx2 in human serum. This study indicates that treatment of serum samples with guanidinium chloride may be useful for the early and sensitive detection of Stx2 in sera of STEC-infected patients, so preventive measures can be adopted in a timely manner.
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15
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Oderiz S, Leotta GA, Galli L. [Detection and characterization of Shiga toxin-producing Escherichia coli in children treated at an inter-zonal pediatric hospital in the city of La Plata]. Rev Argent Microbiol 2018; 50:341-350. [PMID: 29336911 DOI: 10.1016/j.ram.2017.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/08/2017] [Accepted: 08/03/2017] [Indexed: 11/19/2022] Open
Abstract
Shiga toxin-producing Escherichia coli (STEC) is a foodborne pathogen that can cause watery diarrhea, bloody diarrhea (BD), and hemolytic uremic syndrome (HUS). The objective of this study was to determine the phenotypic and genotypic profiles of STEC strains isolated from children with BD and HUS treated at a pediatric hospital in the city of La Plata in the period 2006-2012, and to establish the clonal relationship of O157:H7 isolates by pulsed field electrophoresis. The percentage of positive samples was 4.9% and 39.2% in patients with BD and HUS, respectively. Seventy-seven STEC strains from 10 different serotypes were isolated, with 100% colony recovery, O157:H7 being the most frequent (71.4%) serotype, followed by O145:NM (15.6%). An average of 98.2% of O157:H7 isolates belonged to biotype C and were sensitive to all the antibiotics tested. All of them (100%) carried genotype stx2, eae, fliCH7, ehxA, iha, efa, toxB, lpfA1-3 and lpfA2-2. When the clonal relationship of the O157:H7 strains was studied, a total of 42 patterns with at least 88% similarity were identified, and 6 clusters with identical profiles were established. The eae-negative isolates belonged to serotypes O59:H19, O102:H6, O174:NM and O174:H21. The strains O59:H19 and O174:H21 were positive for the aggR gene. This study shows that STEC of different serotypes and genotypes circulate in the city of La Plata and surroundings. Despite the genetic diversity observed between the O157:H7 isolates, some were indistinguishable by the subtyping techniques used.
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Affiliation(s)
- Sebastián Oderiz
- Sala de Microbiología, Hospital Interzonal de Agudos Especializado en Pediatría Superiora Sor María Ludovica, La Plata, Buenos Aires, Argentina.
| | - Gerardo A Leotta
- Instituto de Genética Veterinaria Ing. Fernando N. Dulout (IGEVET) (UNLP-CONICET, La Plata), Facultad de Ciencias Veterinarias, La Plata, Buenos Aires, Argentina
| | - Lucía Galli
- Instituto de Genética Veterinaria Ing. Fernando N. Dulout (IGEVET) (UNLP-CONICET, La Plata), Facultad de Ciencias Veterinarias, La Plata, Buenos Aires, Argentina
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16
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Freedman SB, Eltorki M, Chui L, Xie J, Feng S, MacDonald J, Dixon A, Ali S, Louie M, Lee BE, Osterreicher L, Thull-Freedman J. Province-Wide Review of Pediatric Shiga Toxin-Producing Escherichia coli Case Management. J Pediatr 2017; 180:184-190.e1. [PMID: 27745751 DOI: 10.1016/j.jpeds.2016.09.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/27/2016] [Accepted: 09/08/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To identify the gaps in the care of children infected with Shiga toxin-producing Escherichia coli (STEC), we sought to quantitate care received and management timelines. Such knowledge is crucial to the design of interventions to prevent the development of hemolytic uremic syndrome (HUS). STUDY DESIGN We conducted a retrospective case-series study of 78 children infected with STEC in Alberta, Canada, through the linkage of microbiology and laboratory results, telephone health advice records, hospital charts, physician billing submissions, and outpatient antimicrobial dispensing databases. Outcomes were the time intervals between initial presentation and reporting of positive culture result and symptom onset to HUS and to describe the proportions that had baseline blood work performed and received antibiotics. RESULTS Seventy-eight children infected with STEC were identified; 13% (10/78) developed HUS. Median time from initial presentation to laboratory stool sample receipt was 33 hours (IQR 18, 42); time to positive culture was 120 hours (IQR 86, 205). Time from symptom onset to HUS diagnosis was 188 ± 37 hours. Baseline blood tests were obtained in 74% (58/78) of infected children. Antibiotics were administered to 50% (5/10) of those who developed HUS and 22% (15/78) of those who did not; P = .11. The provincial telephone advice system received 31 calls regarding 24 children infected with STEC; 23% (7/31) of callers were recommended to seek emergency department care. CONCLUSIONS A significant proportion of children developed HUS following multiple interactions with the health care system. Delays in the confirmation of STEC infection occurred. There are numerous opportunities to improve the timing, monitoring, and interventions in children infected with STEC.
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Affiliation(s)
- Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
| | - Mohamed Eltorki
- Division of Pediatric Emergency Medicine, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Linda Chui
- Provincial Laboratory for Public Health, Edmonton, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Jianling Xie
- Section of Pediatric Emergency Medicine, Alberta Children's Hospital, Department of Pediatrics, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sharon Feng
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Judy MacDonald
- Population, Public and Indigenous Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Dixon
- Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta
| | - Marie Louie
- Provincial Laboratory for Public Health, Edmonton, Alberta, Canada; Department of Microbiology Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Bonita E Lee
- Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta
| | - Lara Osterreicher
- Provincial Clinical Programs, Health Link, Alberta Health Services, Edmonton, Alberta, Canada
| | - Jennifer Thull-Freedman
- Section of Pediatric Emergency Medicine, Alberta Children's Hospital, Department of Pediatrics, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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17
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Abstract
Post-infectious hemolytic uremic syndrome (HUS) is caused by specific pathogens in patients with no identifiable HUS-associated genetic mutation or autoantibody. The majority of episodes is due to infections by Shiga toxin (Stx) producing Escherichia coli (STEC). This chapter reviews the epidemiology and pathogenesis of STEC-HUS, including bacterial-derived factors and host responses. STEC disease is characterized by hematological (microangiopathic hemolytic anemia), renal (acute kidney injury) and extrarenal organ involvement. Clinicians should always strive for an etiological diagnosis through the microbiological or molecular identification of Stx-producing bacteria and Stx or, if negative, serological assays. Treatment of STEC-HUS is supportive; more investigations are needed to evaluate the efficacy of putative preventive and therapeutic measures, such as non-phage-inducing antibiotics, volume expansion and anti-complement agents. The outcome of STEC-HUS is generally favorable, but chronic kidney disease, permanent extrarenal, mainly cerebral complication and death (in less than 5 %) occur and long-term follow-up is recommended. The remainder of this chapter highlights rarer forms of (post-infectious) HUS due to S. dysenteriae, S. pneumoniae, influenza A and HIV and discusses potential interactions between these pathogens and the complement system.
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Affiliation(s)
- Denis F. Geary
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario Canada
| | - Franz Schaefer
- Division of Pediatric Nephrology, University of Heidelberg, Heidelberg, Germany
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He X, Quiñones B, Loo MT, Loos S, Scavia G, Brigotti M, Levtchenko E, Monnens L. Serum Shiga toxin 2 values in patients during acute phase of diarrhoea-associated haemolytic uraemic syndrome. Acta Paediatr 2015; 104:e564-8. [PMID: 26361237 DOI: 10.1111/apa.13211] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/23/2015] [Accepted: 09/08/2015] [Indexed: 12/25/2022]
Abstract
AIM Shiga toxins are delivered via systemic circulation and are considered to be the cause of diarrhoea-associated haemolytic uraemic syndrome (HUS), as they injure endothelial cells, particularly in the glomeruli. This study measured Shiga toxin 2 (Stx2) in the serum of children affected in by HUS due to Stx2 producing Escherichia coli. METHODS The concentration of free Stx2 was measured in the serum of 16 children, collected immediately after admission to the clinic in the acute phase of HUS, using a sandwich enzyme-linked immunosorbent assay. The family members of two children were also investigated, with the relative toxicity of Stx2 assessed by a Vero cell-based fluorescent assay. RESULTS Stx2 was found in the serum of eight of the 16 children who were investigated. It was also detected in four of the six family members not showing symptomatic HUS, with an extremely high level in two. CONCLUSION An absent or rather low concentration of Stx2 was found in the serum of children admitted to the clinic with diarrhoea-associated HUS. The high concentration of Stx2 in family members without HUS, but mostly with watery diarrhoea and raised functional activity, was in line with the concept of early injury by Stx2.
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Affiliation(s)
- Xiaohua He
- US Department of Agriculture; ARS; WRRC; Foodborne Toxin Detection and Prevention Unit; Albany NY USA
| | - Beatriz Quiñones
- US Department of Agriculture; ARS; WRRC; Produce Safety and Microbiology Unit; Albany NY USA
| | - Maroeska Te Loo
- Department of Pediatrics; Radboud University Nijmegen Medical Center; Nijmegen The Netherlands
| | - Sebastian Loos
- Division of Pediatric Nephrology; Department of Pediatrics; University Medical Center; Hamburg Germany
| | - Gaia Scavia
- EU Reference Laboratory for E. coli; Instituto Superiore di Sanita; Rome Italy
| | - Maurizio Brigotti
- Dipartimento di Medicina Specialistica Diagnostica e Sperimentale; Sede di Patologia Generale; Universita di Bologna; Bologna Italy
| | - Elena Levtchenko
- Department of Pediatric Nephrology and Growth and Regeneration; University Hospitals Leuven; Leuven Belgium
| | - Leo Monnens
- Department of Physiology; Radboud University; Nijmegen Medical Center; Nijmegen The Netherlands
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A rapid and sensitive method to measure the functional activity of Shiga toxins in human serum. Toxins (Basel) 2015; 7:4564-76. [PMID: 26556372 PMCID: PMC4663520 DOI: 10.3390/toxins7114564] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 10/26/2015] [Accepted: 10/26/2015] [Indexed: 11/17/2022] Open
Abstract
Shiga toxins (Stx) have a definite role in the development of hemolytic uremic syndrome in children with hemorrhagic colitis caused by pathogenic Stx-producing Escherichia coli (STEC) strains. The dramatic effects of these toxins on the microvasculature of different organs, particularly of the kidney, are well known, whereas there is no consensus on the mechanism by which Stx reach the endothelia of target organs and/or indirectly injure these body sites. We hereby describe a quick (4 h), radioactive, Raji cell-based method designed for the detection of Stx in human sera. The assay monitors the translation impairment induced by these powerful inhibitors of protein synthesis, which are identified properly by neutralizing their activity with specific monoclonal antibodies. By this method, we detected for the first time the functional activity of Stx in sera of STEC-infected patients during hemorrhagic colitis. Recent research has pointed to a dynamic process of Stx-induced renal intoxication in which concurrent and interactive steps are involved. Our rapid and specific method could be useful for studying the kinetics of Stx during the natural course of STEC infection and the interplay between Stx activity in serum and Stx presence in different blood fractions (neutrophils, monocytes, platelets, leukocyte-platelet aggregates, microvesicles, lipoproteins).
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Ford L, Kirk M, Glass K, Hall G. Sequelae of foodborne illness caused by 5 pathogens, Australia, circa 2010. Emerg Infect Dis 2015; 20:1865-71. [PMID: 25340885 PMCID: PMC4214289 DOI: 10.3201/eid2011.131316] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Foodborne gastroenteritis results in a substantial amount of severe and disabling sequelae. In Australia circa 2010, 4.1 million (90% credible interval [CrI] 2.3–6.4 million) episodes of foodborne gastroenteritis occurred, many of which might have resulted in sequelae. We estimated the number of illnesses, hospitalizations, and deaths from Guillain-Barré syndrome, hemolytic uremic syndrome, irritable bowel syndrome, and reactive arthritis that were associated with contaminated food in Australia. Data from published studies, hospital records, and mortality reports were combined with multipliers to adjust for different transmission routes. We used Monte Carlo simulation to estimate median estimates and 90% CrIs. In Australia, circa 2010, we estimated that 35,840 (90% CrI 25,000–54,000) illnesses, 1,080 (90% CrI 700–1,600) hospitalizations, and 10 (90% CrI 5–14) deaths occurred from foodborne gastroenteritis–associated sequelae. Campylobacter spp. infection was responsible for 80% of incident cases. Reducing the incidence of campylobacteriosis and other foodborne diseases would minimize the health effects of sequelae.
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Mayer CL, Parello CSL, Lee BC, Itagaki K, Kurosawa S, Stearns-Kurosawa DJ. Pro-Coagulant Endothelial Dysfunction Results from EHEC Shiga Toxins and Host Damage-Associated Molecular Patterns. Front Immunol 2015; 6:155. [PMID: 25904918 PMCID: PMC4387861 DOI: 10.3389/fimmu.2015.00155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/23/2015] [Indexed: 11/13/2022] Open
Abstract
Hemolytic uremic syndrome (HUS) from enterohemorrhagic Escherichia coli infection is a leading cause of kidney failure in otherwise healthy U.S. children. The bacterial Shiga toxins (Stx) induce the characteristic coagulopathy of HUS, but the damage to toxin-receptor expressing cells and organ injury due to ischemia likely also releases inflammatory damage-associated molecular patterns (DAMPs), which may exacerbate injury along with the toxins. To examine this, human aortic and renal glomerular cell anti-coagulant and barrier functions were studied after in vitro challenge with Stx1, Stx2, and DAMPs. There was significant loss of surface anti-coagulant protein C pathway molecules, increased expression of pro-thrombotic PAR1 and reduced protein C activation capability by 15-27%. Histones nearly completely prevented the activated protein C protection of endothelial cells from thrombin-induced permeability. In mice, lethal Stx2 challenge elevated plasma HMGB1 (day 2, 321 ± 118%; p < 0.01) and extracellular histones (day 3, 158 ± 62%; p < 0.01). Mice colonized with Stx2-expressing Citrobacter rodentium developed increased HMGB1 (day 5, 155 ± 55%; p < 0.01) and histones (day 3, 378 ± 188%; p < 0.01). Anti-histone antibody reduced both DAMPs to baseline, but was not sufficient to improve survival outcome or kidney function. Together, these data suggest a potential role Stx to produce DAMPs, and DAMPs to produce endothelial injury and a pro-thrombotic environment.
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Affiliation(s)
- Chad L Mayer
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine , Boston, MA , USA
| | - Caitlin S L Parello
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine , Boston, MA , USA
| | - Benjamin C Lee
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine , Boston, MA , USA
| | - Kiyoshi Itagaki
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA
| | - Shinichiro Kurosawa
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine , Boston, MA , USA
| | - Deborah J Stearns-Kurosawa
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine , Boston, MA , USA
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Kurosawa S, Stearns-Kurosawa DJ. Complement, thrombotic microangiopathy and disseminated intravascular coagulation. J Intensive Care 2014; 2:65. [PMID: 25705421 PMCID: PMC4336180 DOI: 10.1186/s40560-014-0061-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 10/17/2014] [Indexed: 02/07/2023] Open
Abstract
In the blurring boundaries between clinical practice and scientific observations, it is increasingly attractive to propose shared disease mechanisms that could explain clinical experience. With the advent of available therapeutic options for complement inhibition, there is a push for more widespread application in patients, despite a lack of clinically relevant research. Patients with disseminated intravascular coagulation (DIC) and thrombotic microangiopathies (TMA) frequently exhibit complement activation and share the clinical consequences of thrombocytopenia, microangiopathic hemolytic anemia, and microvascular thrombosis. However, they arise from very different molecular etiologies giving rise to cautious questions about inclusive treatment approaches because most clinical observations are associative and not cause-and-effect. Complement inhibition is successful in many cases of atypical hemolytic uremic syndrome, greatly reducing morbidity and mortality of patients by minimizing thrombocytopenia, microangiopathic hemolytic anemia, and microvascular thrombosis. But is this success due to targeting disease etiology or because complement is a sufficiently systemic target or both? These questions are important because complement activation and similar clinical features also are observed in many DIC patients, and there are mounting calls for systemic inhibition of complement mediators despite the enormous differences in the primary diseases complicated by DIC. We are in great need of thoughtful and standardized assessment with respect to both beneficial and potentially harmful consequences of complement activation in these patient populations. In this review, we discuss about what needs to be done in terms of establishing the strategy for complement inhibition in TMA and DIC, based on the current knowledge.
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Affiliation(s)
- Shinichiro Kurosawa
- Boston University School of Medicine, 670 Albany Street, Boston, MA 02118 USA
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23
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Effects of Shiga toxin type 2 on a bioengineered three-dimensional model of human renal tissue. Infect Immun 2014; 83:28-38. [PMID: 25312954 DOI: 10.1128/iai.02143-14] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Shiga toxins (Stx) are a family of cytotoxic proteins that can cause hemolytic-uremic syndrome (HUS), a thrombotic microangiopathy, following infections by Shiga toxin-producing Escherichia coli (STEC). Renal failure is a key feature of HUS and a major cause of childhood renal failure worldwide. There are currently no specific therapies for STEC-associated HUS, and the mechanism of Stx-induced renal injury is not well understood primarily due to a lack of fully representative animal models and an inability to monitor disease progression on a molecular or cellular level in humans at early stages. Three-dimensional (3D) tissue models have been shown to be more in vivo-like in their phenotype and physiology than 2D cultures for numerous disease models, including cancer and polycystic kidney disease. It is unknown whether exposure of a 3D renal tissue model to Stx will yield a more in vivo-like response than 2D cell culture. In this study, we characterized Stx2-mediated cytotoxicity in a bioengineered 3D human renal tissue model previously shown to be a predictor of drug-induced nephrotoxicity and compared its response to Stx2 exposure in 2D cell culture. Our results demonstrate that although many mechanistic aspects of cytotoxicity were similar between 3D and 2D, treatment of the 3D tissues with Stx resulted in an elevated secretion of the kidney injury marker 1 (Kim-1) and the cytokine interleukin-8 compared to the 2D cell cultures. This study represents the first application of 3D tissues for the study of Stx-mediated kidney injury.
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Shiga Toxin/Verocytotoxin-Producing
Escherichia coli
Infections: Practical Clinical Perspectives. Microbiol Spectr 2014; 2:EHEC-0025-2014. [DOI: 10.1128/microbiolspec.ehec-0025-2014] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
ABSTRACT
Escherichia coli
strains that produce Shiga toxins/verotoxins are rare, but important, causes of human disease. They are responsible for a spectrum of illnesses that range from the asymptomatic to the life-threatening hemolytic-uremic syndrome; diseases caused by
E. coli
belonging to serotype O157:H7 are exceptionally severe. Each illness has a fairly predictable trajectory, and good clinical practice at one phase can be inappropriate at other phases. Early recognition, rapid and definitive microbiology, and strategic selection of tests increase the likelihood of good outcomes. The best management of these infections consists of avoiding antibiotics, antimotility agents, and narcotics and implementing aggressive intravenous volume expansion, especially in the early phases of illness.
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Geelen J, van den Biggelaar M, Linssen P, van der Velden T, Mertens K, Monnens L. The effect of shiga toxin on weibel-palade bodies in primary human endothelial cells. NEPHRON EXTRA 2014; 4:101-7. [PMID: 25177338 PMCID: PMC4130816 DOI: 10.1159/000363299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background/Aims Diarrhea-associated hemolytic uremic syndrome is associated with the presence of Shiga toxin (Stx1, Stx2 and several variants) in the circulation. The aim of this study is to examine the possible triggering effect of Stx1 on the exocytosis of Weibel-Palade bodies (WPbs). Methods Cultured human umbilical venous endothelial cells (HUVECs) and glomerular microvascular endothelial cells (GMVECs) were stimulated by thrombin and Stx1 in both static and flowing conditions. The amount of secreted von Willebrand factor (VWF) in the supernatant as well as the remaining intracellular fraction was determined. Results In HUVECs and in 2 out of 4 GMVECs, the stimulation of Stx1 in flow at 1 dyne/cm2 resulted in a decrease of intracellular VWF. This is contrary to the results of Stx1 applied in static conditions. At a higher flow rate of 5 dyne/cm2, no effect in GMVECs was observed. Conclusion Stx1 can contribute, via an effect on WPbs, to the exocytosis of WPbs in flow conditions in HUVECs and probably in GMVECs. This results in the release of VWF, suggesting an initiating role of the coagulation system in the pathogenesis.
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Affiliation(s)
- Joyce Geelen
- Department of Paediatric Nephrology, The Netherlands
| | - Maartje van den Biggelaar
- Department of Plasma Proteins, Sanquin Research, Amsterdam, The Netherlands ; Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - Peter Linssen
- Central Hematology Laboratory, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Koen Mertens
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - Leo Monnens
- Department of Paediatric Nephrology, The Netherlands
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26
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Majowicz SE, Scallan E, Jones-Bitton A, Sargeant JM, Stapleton J, Angulo FJ, Yeung DH, Kirk MD. Global incidence of human Shiga toxin-producing Escherichia coli infections and deaths: a systematic review and knowledge synthesis. Foodborne Pathog Dis 2014; 11:447-55. [PMID: 24750096 DOI: 10.1089/fpd.2013.1704] [Citation(s) in RCA: 282] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Shiga toxin-producing Escherichia coli (STEC) are an important cause of foodborne disease, yet global estimates of disease burden do not exist. Our objective was to estimate the global annual number of illnesses due to pathogenic STEC, and resultant hemolytic uremic syndrome (HUS), end-stage renal disease (ESRD), and death. MATERIALS We searched Medline, Scopus, SIGLE/OpenGrey, and CABI and World Health Organization (WHO) databases for studies of STEC incidence in the general population, published between January 1, 1990 and April 30, 2012, in all languages. We searched health institution websites for notifiable disease data and reports, cross-referenced citations, and consulted international knowledge experts. We employed an a priori hierarchical study selection process and synthesized results using a stochastic simulation model to account for uncertainty inherent in the data. RESULTS We identified 16 articles and databases from 21 countries, from 10 of the 14 WHO Sub-Regions. We estimated that STEC causes 2,801,000 acute illnesses annually (95% Credible Interval [Cr.I.]: 1,710,000; 5,227,000), and leads to 3890 cases of HUS (95% Cr.I.: 2400; 6700), 270 cases of ESRD (95% Cr.I.: 20; 800), and 230 deaths (95% Cr.I.: 130; 420). Sensitivity analyses indicated these estimates are likely conservative. CONCLUSIONS These are the first estimates of the global incidence of STEC-related illnesses, which have not been explicitly included in previous global burden of disease estimations. Compared to other pathogens with a foodborne transmission component, STEC appears to cause more cases than alveolar echinococcosis each year, but less than typhoid fever, foodborne trematodes, and nontyphoidal salmonellosis. APPLICATIONS Given the persistence of STEC globally, efforts aimed at reducing the burden of foodborne disease should consider the relative contribution of STEC in the target population.
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Affiliation(s)
- Shannon E Majowicz
- 1 School of Public Health and Health Systems, University of Waterloo , Waterloo, Ontario, Canada
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Serodiagnosis using microagglutination assay during the food-poisoning outbreak in Japan caused by consumption of raw beef contaminated with enterohemorrhagic Escherichia coli O111 and O157. J Clin Microbiol 2014; 52:1112-8. [PMID: 24452161 DOI: 10.1128/jcm.03469-13] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A microagglutination (MA) assay to identify antibodies to Escherichia coli O111 and O157 was conducted in sera collected from 60 patients during a food-poisoning outbreak affecting 181 patients in Japan which was caused by the consumption of contaminated raw beef. Enterohemorrhagic E. coli (EHEC) O111:H8 and/or O157:H7 was isolated from the stools of some of the patients, but the total rate of positivity for antibodies to O111 (45/60, 75.0%) was significantly higher than that for antibodies to O157 (10/60, 16.7%). The MA titers of antibodies to O111 measured in patients with hemolytic-uremic syndrome and bloody diarrhea were higher than those measured in patients with only diarrhea. In patients from whose stool no isolates of E. coli O111 and O157 were obtained, the positive antibody detection rates were 12/19 (63.2%) for O111 and 2/19 (10.5%) for O157, and the MA titers of antibodies to O111 measured were higher than those to O157. Similarly, the MA titers of antibodies to O111 were significantly higher than those to O157, regardless of the other groups, including groups O111, O111 and O157, and O157. These serodiagnosis results suggest that EHEC O111:H8 stx2 played a primary role in the pathogenesis of this outbreak. Furthermore, our findings suggest that the isolates from the patients' stool specimens were not always the major causative pathogen in patients with multiple EHEC infections, because the sera from patients from whose stools only O157 was isolated were positive for antibodies to O111. Measuring antibodies to E. coli O antigen is helpful especially in cases with multiple EHEC infections, even with a non-O157 serotype.
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Davis TK, McKee R, Schnadower D, Tarr PI. Treatment of Shiga toxin-producing Escherichia coli infections. Infect Dis Clin North Am 2013; 27:577-97. [PMID: 24011831 DOI: 10.1016/j.idc.2013.05.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The management of Shiga toxin-producing Escherichia coli (STEC) infections is reviewed. Certain management practices optimize the likelihood of good outcomes, such as avoidance of antibiotics during the pre-hemolytic uremic syndrome phase, admission to hospital, and vigorous intravenous volume expansion using isotonic fluids. The successful management of STEC infections is based on recognition that a patient might have an STEC infection, and appropriate use of the microbiology laboratory. The timeliness of STEC identification cannot be overemphasized, because it avoids therapies prompted by inappropriate additional testing and directs the clinician to focus on effective management strategies. The opportunities during STEC infections to avert the worst outcomes are brief, and this article emphasizes practical matters relevant to making a diagnosis, anticipating the trajectory of illness, and optimizing care.
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Affiliation(s)
- T Keefe Davis
- Division of Nephrology, Department of Pediatrics, Washington University School of Medicine, 660 South Euclid, St Louis, MO 63110, USA
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Page AV, Liles WC. Enterohemorrhagic Escherichia coli Infections and the Hemolytic-Uremic Syndrome. Med Clin North Am 2013; 97:681-95, xi. [PMID: 23809720 DOI: 10.1016/j.mcna.2013.04.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Enterohemorrhagic Escherichia coli (EHEC; Shiga toxin/verotoxin-producing E. coli) can cause bloody diarrhea and the hemolytic-uremic syndrome (HUS), typically following consumption of contaminated food (including ground beef, leafy greens, and sprouts) and water. Often associated with foodborne outbreaks, EHEC possess unique virulence factors that facilitate effective colonization of the human gastrointestinal tract and subsequent release of Shiga toxin. This article reviews the epidemiology, pathogenesis, clinical presentation, treatment, and prevention of EHEC infections, focusing on E. coli O157:H7, the serotype most common in North America, and E. coli O104:H4, the serotype responsible for the EHEC outbreak in Germany in 2011.
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Affiliation(s)
- Andrea V Page
- Division of Infectious Diseases, Department of Medicine, Mount Sinai Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada.
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Page AV, Tarr PI, Watkins SL, Rajwans N, Petruzziello-Pellegrini TN, Marsden PA, Kain KC, Liles WC. Dysregulation of angiopoietin 1 and 2 in Escherichia coli O157:H7 infection and the hemolytic-uremic syndrome. J Infect Dis 2013; 208:929-33. [PMID: 23801605 DOI: 10.1093/infdis/jit268] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Escherichia coli O157:H7-associated hemolytic-uremic syndrome (HUS) is characterized by profound prothrombotic abnormalities. Endothelial dysfunction, manifested as dysregulation of angiopoietins 1 and 2 (Ang-1/2), could underlie HUS pathophysiology. We measured Ang-1/2 in 77 children with E. coli O157:H7 infection. Ang-1, Ang-2, and the Ang-2/Ang-1 ratio were significantly different in HUS vs the pre-HUS phase of illness or uncomplicated infection. Angiopoietin dysregulation preceded HUS and worsened as HUS developed. In vitro exposure of human microvascular endothelial cells to Shiga toxin recapitulated the in vivo observations. Angiopoietin regulation is profoundly affected before and during HUS, reflecting that subclinical endothelial dysfunction precedes overt microangiopathy.
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Affiliation(s)
- Andrea V Page
- Department of Medicine, Sandra A. Rotman, Laboratory for Global Health, Mount Sinai Hospital-University Health Network, University of Toronto, Ontario, Canada
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Quiescent complement in nonhuman primates during E coli Shiga toxin-induced hemolytic uremic syndrome and thrombotic microangiopathy. Blood 2013; 122:803-6. [PMID: 23733336 DOI: 10.1182/blood-2013-03-490060] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Enterohemorrhagic Escherichia coli (EHEC) produce ribosome-inactivating Shiga toxins (Stx1, Stx2) responsible for development of hemolytic uremic syndrome (HUS) and acute kidney injury (AKI). Some patients show complement activation during EHEC infection, raising the possibility of therapeutic targeting of complement for relief. Our juvenile nonhuman primate (Papio baboons) models of endotoxin-free Stx challenge exhibit full spectrum HUS, including thrombocytopenia, hemolytic anemia, and AKI with glomerular thrombotic microangiopathy. There were no significant increases in soluble terminal complement complex (C5b-9) levels after challenge with lethal Stx1 (n = 6) or Stx2 (n = 5) in plasma samples from T0 to euthanasia at 49.5 to 128 hours post-challenge. d-dimer and cell injury markers (HMGB1, histones) confirmed coagulopathy and cell injury. Thus, complement activation is not required for the development of thrombotic microangiopathy and HUS induced by EHEC Shiga toxins in these preclinical models, and benefits or risks of complement inhibition should be studied further for this infection.
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Karch H, Müthing J, Dobrindt U, Mellmann A. [Evolution and infection biology of hemolytic-uremic syndrome (HUS) associated E. coli (HUSEC)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56:8-14. [PMID: 23275950 DOI: 10.1007/s00103-012-1586-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Shiga toxin (Stx)-producing Escherichia coli (STEC), which cause hemolytic-uremic syndrome (HUS), are designated as HUSEC. Their exceptional genome variability driven by evolutionary diversification permits fast adaptation to changed environmental conditions. The HUSEC collection (http://www.ehec.org), which has been established at the Institute for Hygiene in Münster, contains 42 EHEC reference strains (HUSEC001-HUSEC042). It represents a unique repository collection of pathogens and is extremely helpful for the analysis of evolutionary changes and fixed properties in the STEC that cause the most severe host injury. Such genomic attributes include slowly evolving loci, mobile genetic elements that often encode virulence factors and are assimilated via horizontal gene transfer. Current evolutionary models indicate that numerous outbreak strains evolved recently and that highly pathogenic HUSEC descend from less pathogenic progenitors. However, additional data suggest that HUSEC have small effective population sizes. The HUSEC collection is also a valuable resource with which to study important non-Shiga toxin virulence factors.
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Affiliation(s)
- H Karch
- Institut für Hygiene und Nationales Konsiliarlaboratorium für Hämolytisch-Urämisches Syndrom, Universitätsklinikum Münster, Robert-Koch-Str. 41, 48149, Münster, Deutschland.
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Wong CS, Mooney JC, Brandt JR, Staples AO, Jelacic S, Boster DR, Watkins SL, Tarr PI. Risk factors for the hemolytic uremic syndrome in children infected with Escherichia coli O157:H7: a multivariable analysis. Clin Infect Dis 2012; 55:33-41. [PMID: 22431799 PMCID: PMC3493180 DOI: 10.1093/cid/cis299] [Citation(s) in RCA: 184] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Escherichia coli O157:H7 is the leading cause of hemolytic uremic syndrome (HUS). Risk factors for development of this complication warrant identification. METHODS We enrolled children infected with E. coli O157:H7 within 1 week of the onset of diarrhea in this prospective cohort study. The study was conducted in 5 states over 9.5 years . The primary and secondary outcomes were HUS (hematocrit <30% with smear evidence of hemolysis, platelet count <150 × 10(3)/µL, and serum creatinine concentration > upper limit of normal for age) and oligoanuric HUS. Univariate and multivariable and ordinal multinomial regression analyses were used to test associations between factors apparent during the first week of illness and outcomes. RESULTS Of the 259 children analyzed, 36 (14%) developed HUS. Univariate analysis demonstrated that children who received antibiotics during the diarrhea phase more frequently developed HUS than those who did not (36% vs 12%; P = .001). The higher rate of HUS was observed across all antibiotic classes used. In multivariable analysis, a higher leukocyte count (adjusted odds ratios [aOR] 1.10; 95% CI, 1.03-1.19), vomiting (aOR 3.05; 95% CI, 1.23-7.56), and exposure to antibiotics (aOR 3.62; 95% CI, 1.23-10.6) during the first week of onset of illness were each independently associated with development of HUS. Multinomial ordinal logistic regression confirmed that initial leukocyte count and antibiotic use were independently associated with HUS and, additionally, these variables were each associated with the development of oligoanuric HUS. CONCLUSIONS Antibiotic use during E. coli O157:H7 infections is associated with a higher rate of subsequent HUS and should be avoided.
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Affiliation(s)
- Craig S Wong
- Department of Pediatrics, Division of Nephrology, University of New Mexico Children's Hospital, Albuquerque, USA
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Tarr PI, Karpman D. Editorial commentary: Escherichia coli O104:H4 and hemolytic uremic syndrome: the analysis begins. Clin Infect Dis 2012; 55:760-3. [PMID: 22670035 DOI: 10.1093/cid/cis533] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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The interactions of human neutrophils with shiga toxins and related plant toxins: danger or safety? Toxins (Basel) 2012; 4:157-90. [PMID: 22741061 PMCID: PMC3381930 DOI: 10.3390/toxins4030157] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 02/11/2012] [Accepted: 02/19/2012] [Indexed: 11/16/2022] Open
Abstract
Shiga toxins and ricin are well characterized similar toxins belonging to quite different biological kingdoms. Plant and bacteria have evolved the ability to produce these powerful toxins in parallel, while humans have evolved a defense system that recognizes molecular patterns common to foreign molecules through specific receptors expressed on the surface of the main actors of innate immunity, namely monocytes and neutrophils. The interactions between these toxins and neutrophils have been widely described and have stimulated intense debate. This paper is aimed at reviewing the topic, focusing particularly on implications for the pathogenesis and diagnosis of hemolytic uremic syndrome.
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