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Müller T, Krieg N, Lange-Polovinkin AI, Wissuwa B, Gräler MH, Dennhardt S, Coldewey SM. Deletion of Sphingosine Kinase 2 Attenuates Acute Kidney Injury in Mice with Hemolytic-Uremic Syndrome. Int J Mol Sci 2024; 25:7683. [PMID: 39062926 PMCID: PMC11277509 DOI: 10.3390/ijms25147683] [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: 05/30/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Typical hemolytic uremic syndrome (HUS) can occur as a severe systemic complication of infections with Shiga toxin (Stx)-producing Escherichia coli. Its pathology can be induced by Stx types, resulting in toxin-mediated damage to renal barriers, inflammation, and the development of acute kidney injury (AKI). Two sphingosine kinase (SphK) isozymes, SphK1 and SphK2, have been shown to be involved in barrier maintenance and renal inflammatory diseases. Therefore, we sought to determine their role in the pathogenesis of HUS. Experimental HUS was induced by the repeated administration of Stx2 in wild-type (WT) and SphK1 (SphK1-/-) or SphK2 (SphK2-/-) null mutant mice. Disease severity was evaluated by assessing clinical symptoms, renal injury and dysfunction, inflammatory status and sphingolipid levels on day 5 of HUS development. Renal inflammation and injury were found to be attenuated in the SphK2-/- mice, but exacerbated in the SphK1-/- mice compared to the WT mice. The divergent outcome appeared to be associated with oppositely altered sphingolipid levels. This study represents the first description of the distinct roles of SphK1-/- and SphK2-/- in the pathogenesis of HUS. The identification of sphingolipid metabolism as a potential target for HUS therapy represents a significant advance in the field of HUS research.
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Affiliation(s)
- Tina Müller
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, 07743 Jena, Germany; (T.M.); (N.K.)
- ZIK Septomics Research Center, Jena University Hospital, 07743 Jena, Germany
| | - Nadine Krieg
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, 07743 Jena, Germany; (T.M.); (N.K.)
- ZIK Septomics Research Center, Jena University Hospital, 07743 Jena, Germany
| | - Antonia I. Lange-Polovinkin
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, 07743 Jena, Germany; (T.M.); (N.K.)
- ZIK Septomics Research Center, Jena University Hospital, 07743 Jena, Germany
| | - Bianka Wissuwa
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, 07743 Jena, Germany; (T.M.); (N.K.)
- ZIK Septomics Research Center, Jena University Hospital, 07743 Jena, Germany
| | - Markus H. Gräler
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, 07743 Jena, Germany; (T.M.); (N.K.)
- Center for Molecular Biomedicine (CMB) and Center for Sepsis Control and Care (CSCC), Jena University Hospital, 07743 Jena, Germany
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, 07743 Jena, Germany
| | - Sophie Dennhardt
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, 07743 Jena, Germany; (T.M.); (N.K.)
- ZIK Septomics Research Center, Jena University Hospital, 07743 Jena, Germany
| | - Sina M. Coldewey
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, 07743 Jena, Germany; (T.M.); (N.K.)
- ZIK Septomics Research Center, Jena University Hospital, 07743 Jena, Germany
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, 07743 Jena, Germany
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Vusirikala A, Rowell S, Dabke G, Fox G, Bell J, Manuel R, Jenkins C, Love N, McCarthy N, Sumilo D, Balasegaram S. Shedding and exclusion from childcare in children with Shiga toxin-producing Escherichia coli, 2018-2022. Epidemiol Infect 2024; 152:e42. [PMID: 38403892 PMCID: PMC10945940 DOI: 10.1017/s095026882400027x] [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: 09/14/2023] [Revised: 11/20/2023] [Accepted: 02/06/2024] [Indexed: 02/27/2024] Open
Abstract
Excluding children with Shiga toxin-producing Escherichia coli (STEC) from childcare until microbiologically clear of the pathogen, disrupts families, education, and earnings. Since PCR introduction, non-O157 STEC serotype detections in England have increased. We examined shedding duration by serotype and transmission risk, to guide exclusion advice. We investigated STEC cases aged <6 years, residing in England and attending childcare, with diarrhoea onset or sample date from 31 March 2018 to 30 March 2022. Duration of shedding was the interval between date of onset or date first positive specimen and earliest available negative specimen date. Transmission risk was estimated from proportions with secondary cases in settings attended by infectious cases. There were 367 cases (STEC O157 n = 243, 66.2%; STEC non-O157 n = 124, 33.8%). Median shedding duration was 32 days (IQR 20-44) with no significant difference between O157 and non-O157; 2% (n = 6) of cases shed for ≥100 days. Duration of shedding was reduced by 17% (95% CI 4-29) among cases reporting bloody diarrhoea. Sixteen settings underwent screening; four had secondary cases (close contacts' secondary transmission rate = 13%). Shedding duration estimates were consistent with previous studies (median 31 days, IQR 17-41). Findings do not warrant guidance changes regarding exclusion and supervised return of prolonged shedders, despite serotype changes.
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Affiliation(s)
- Amoolya Vusirikala
- Health Protection Operations, UK Health Security Agency, London, UK
- UK Field Epidemiology Training Programme, UK Health Security Agency, London, UK
| | - Sam Rowell
- Health Protection Operations, UK Health Security Agency, London, UK
| | - Girija Dabke
- Health Protection Operations, UK Health Security Agency, London, UK
| | - Georgina Fox
- Health Protection Operations, UK Health Security Agency, London, UK
| | - Jade Bell
- Health Protection Operations, UK Health Security Agency, London, UK
| | - Rohini Manuel
- Health Protection Operations, UK Health Security Agency, London, UK
| | - Claire Jenkins
- Clinical and Public Health Group, UK Health Security Agency, London, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Gastrointestinal Infection at University of Liverpool, Liverpool, UK
| | - Nicola Love
- Health Protection Operations, UK Health Security Agency, London, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Gastrointestinal Infection at University of Liverpool, Liverpool, UK
| | - Noel McCarthy
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Gastrointestinal Infection at University of Liverpool, Liverpool, UK
- School of Medicine, Trinity College Dublin,Dublin, Ireland
| | - Dana Sumilo
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Gastrointestinal Infection at University of Liverpool, Liverpool, UK
- Warwick Medical School, School of Medicine, Warwick, UK
| | - Sooria Balasegaram
- Health Protection Operations, UK Health Security Agency, London, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Gastrointestinal Infection at University of Liverpool, Liverpool, UK
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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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Byrne L, Douglas A, Launders N, Godbole G, Lynn R, Inward C, Jenkins C. Haemolytic uraemic syndrome in children England, Wales, Northern Ireland, and Ireland: A prospective cohort study. Epidemiol Infect 2023; 151:e160. [PMID: 37655611 PMCID: PMC10600734 DOI: 10.1017/s0950268823001413] [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: 11/16/2022] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023] Open
Abstract
Haemolytic uraemic syndrome (HUS) caused by infection with Shiga toxin-producing Escherichia coli (STEC) is a relatively rare but potentially fatal multisystem syndrome clinically characterised by acute kidney injury. This study aimed to provide robust estimates of paediatric HUS incidence in England, Wales, Northern Ireland, and the Republic of Ireland by using data linkage and case reconciliation with existing surveillance systems, and to describe the characteristics of the condition. Between 2011 and 2014, 288 HUS patients were included in the study, of which 256 (89.5%) were diagnosed as typical HUS. The crude incidence of paediatric typical HUS was 0.78 per 100,000 person-years, although this varied by country, age, gender, and ethnicity. The majority of typical HUS cases were 1 to 4 years old (53.7%) and female (54.0%). Clinical symptoms included diarrhoea (96.5%) and/or bloody diarrhoea (71.9%), abdominal pain (68.4%), and fever (41.4%). Where STEC was isolated (59.3%), 92.8% of strains were STEC O157 and 7.2% were STEC O26. Comparison of the HUS case ascertainment to existing STEC surveillance data indicated an additional 166 HUS cases were captured during this study, highlighting the limitations of the current surveillance system for STEC for monitoring the clinical burden of STEC and capturing HUS cases.
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Affiliation(s)
- Lisa Byrne
- Gastro and Food Safety (One Health) Division, United Kingdom Health Security Agency, London, UK
| | - Amy Douglas
- Gastro and Food Safety (One Health) Division, United Kingdom Health Security Agency, London, UK
| | - Naomi Launders
- Gastro and Food Safety (One Health) Division, United Kingdom Health Security Agency, London, UK
| | - Gauri Godbole
- Gastro and Food Safety (One Health) Division, United Kingdom Health Security Agency, London, UK
| | - Richard Lynn
- British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, London, UK
| | - Carol Inward
- British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, London, UK
- University Hospitals Bristol and Weston, NHS Foundation Trust, Bristol, UK
| | - Claire Jenkins
- Gastro and Food Safety (One Health) Division, United Kingdom Health Security Agency, London, UK
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Cleary E, Boudou M, Garvey P, Aiseadha CO, McKeown P, O'Dwyer J, Hynds P. Spatiotemporal Dynamics of Sporadic Shiga Toxin-Producing Escherichia coli Enteritis, Ireland, 2013-2017. Emerg Infect Dis 2021; 27:2421-2433. [PMID: 34424163 PMCID: PMC8386769 DOI: 10.3201/eid2709.204021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The Republic of Ireland regularly reports the highest annual crude incidence rates of Shiga toxin–producing Escherichia coli (STEC) enteritis in the European Union, ≈10 times the average. We investigated spatiotemporal patterns of STEC enteritis in Ireland using multiple statistical tools. Overall, we georeferenced 2,755 cases of infection during January 2013–December 2017; we found >1 case notified in 2,340 (12.6%) of 18,641 Census Small Areas. We encountered the highest case numbers in children 0–5 years of age (n = 1,101, 39.6%) and associated with serogroups O26 (n = 800, 29%) and O157 (n = 638, 23.2%). Overall, we identified 17 space-time clusters, ranging from 2 (2014) to 5 (2017) clusters of sporadic infection per year; we detected recurrent clustering in 3 distinct geographic regions in the west and mid-west, all of which are primarily rural. Our findings can be used to enable targeted epidemiologic intervention and surveillance.
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Beczkiewicz ATE, Scharff RL, Kowalcyk BB. Facilitating Evaluation of Hemolytic Uremic Syndrome Long-Term Health Outcomes Through Social Media Support Groups. Front Public Health 2020; 8:544154. [PMID: 33330302 PMCID: PMC7719744 DOI: 10.3389/fpubh.2020.544154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 10/22/2020] [Indexed: 11/13/2022] Open
Abstract
Individual burden and cost of hemolytic uremic syndrome (HUS)-a medical condition characterized by acute kidney failure-can be substantial when accounting for long-term health outcomes (LTHOs). Because of the low incidence of HUS, evaluation of associated LTHOs is often restricted to physician and outbreak cohorts, both of which may not be representative of all HUS cases. This exploratory study recruited participants from private social media support groups for families of HUS cases to identify potential LTHOs and costs of HUS that are not currently measured. Additionally, this study sought to identify case characteristics that may confound or modify these LTHOs and costs of HUS. Respondents self-selected to complete an online cross-sectional survey on acute and chronic illness history, treatments, and public health follow-up for HUS cases. Posttraumatic stress among respondents (typically case parents) was also evaluated. Responses were received for 74 HUS cases from 71 families representing all geographic regions, and levels of urbanicity within the US self-reported symptoms were typical for HUS, while 35.1% of cases reported antibiotic treatment at any point during the acute illness. Hospital transfers were reported by 71.6% of cases introducing possible delays to care. More than 70% of cases reported experiencing at least one LTHO, with 45% of cases reporting renal sequelae. Posttraumatic stress symptoms were frequently reported by respondents indirectly affected by HUS. Potentially large economic costs that are not addressed in existing analyses were identified including both financial and more general welfare losses (lost utility). While biases in the study design limit the generalizability of results to all HUS cases, this study provides new insights into unmeasured LTHOs and costs associated with HUS. These results suggest that robustly designed cohort studies on HUS should include measures of psychosocial impacts on both the affected individual and their family members.
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Affiliation(s)
- Aaron T E Beczkiewicz
- Department of Food Science and Technology, The Ohio State University, Columbus, OH, United States
| | - Robert L Scharff
- Department of Human Sciences, The Ohio State University, Columbus, OH, United States
| | - Barbara B Kowalcyk
- Department of Food Science and Technology, The Ohio State University, Columbus, OH, United States
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Loconsole D, Giordano M, Centrone F, Accogli M, Casulli D, De Robertis AL, Morea A, Quarto M, Parisi A, Scavia G, Chironna M. Epidemiology of Shiga Toxin-Producing Escherichia coli Infections in Southern Italy after Implementation of Symptom-Based Surveillance of Bloody Diarrhea in the Pediatric Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5137. [PMID: 32708640 PMCID: PMC7400587 DOI: 10.3390/ijerph17145137] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/08/2020] [Accepted: 07/14/2020] [Indexed: 12/30/2022]
Abstract
Shiga toxin-producing Escherichia coli (STEC) infections result in a significant public health impact because of the severity of the disease that, in young children especially, can lead to hemolytic-uremic syndrome (HUS). A rise in the number of HUS cases was observed in the Apulia region of Italy from 2013 to 2017, and so, in 2018, a symptom-based surveillance system for children with bloody diarrhea (BD) was initiated in order to detect and manage STEC infections. The objective of the study was to describe the epidemiology of STEC infections in children from June 2018 to August 2019. Children <15 years old with BD were hospitalized and tested for STEC. Real-time PCR for virulence genes (stx1, stx2, eae) and serogroup identification tests were performed on stool samples/rectal swabs of cases. STEC infection was detected in 87 (10.6%) BD cases. The median age of STEC cases was 2.7 years, and 60 (68.9%) were <4. Of these 87 cases, 12 (13.8%) came from households with diarrhea. The reporting rate was 14.2/100,000, with the highest incidence in cases from the province of Bari (24.2/100,000). Serogroups O26 and O111 were both detected in 22/87 (25.3%) cases. Co-infections occurred in 12.6% of cases (11/87). Twenty-nine STEC were positive for stx1, stx2, and eae. Five cases (5.7%) caused by O26 (n = 2), O111 (n = 2), and O45 (n = 1) developed into HUS. A risk-oriented approach based on the testing of children with BD during the summer may represent a potentially beneficial option to improve the sensitivity of STEC surveillance, not only in Italy but also in the context of Europe as a whole.
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Affiliation(s)
- Daniela Loconsole
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy; (D.L.); (F.C.); (M.A.); (D.C.); (A.L.D.R.); (A.M.); (M.Q.)
| | - Mario Giordano
- Pediatric Nephrology and Dialysis Unit, Pediatric Hospital “Giovanni XXIII”, Via Giovanni Amendola, 207, 70126 Bari, Italy;
| | - Francesca Centrone
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy; (D.L.); (F.C.); (M.A.); (D.C.); (A.L.D.R.); (A.M.); (M.Q.)
| | - Marisa Accogli
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy; (D.L.); (F.C.); (M.A.); (D.C.); (A.L.D.R.); (A.M.); (M.Q.)
| | - Daniele Casulli
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy; (D.L.); (F.C.); (M.A.); (D.C.); (A.L.D.R.); (A.M.); (M.Q.)
| | - Anna Lisa De Robertis
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy; (D.L.); (F.C.); (M.A.); (D.C.); (A.L.D.R.); (A.M.); (M.Q.)
| | - Anna Morea
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy; (D.L.); (F.C.); (M.A.); (D.C.); (A.L.D.R.); (A.M.); (M.Q.)
| | - Michele Quarto
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy; (D.L.); (F.C.); (M.A.); (D.C.); (A.L.D.R.); (A.M.); (M.Q.)
| | - Antonio Parisi
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Via Manfredonia, 20, 71121 Foggia, Italy;
| | - Gaia Scavia
- Food Safety, Nutrition and Veterinary Public Health Department, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy;
| | - Maria Chironna
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy; (D.L.); (F.C.); (M.A.); (D.C.); (A.L.D.R.); (A.M.); (M.Q.)
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