Bloody Diarrhea and Shiga Toxin-Producing Escherichia coli Hemolytic Uremic Syndrome in Children: Data from the ItalKid-HUS Network

OBJECTIVE

To analyze the results of an enhanced laboratory-surveillance protocol for bloody diarrhea aimed at identifying children with Shiga toxin-producing Escherichia coli (STEC) infection early in the course of the disease toward the early identification and management of patients with hemolytic uremic syndrome (HUS).

STUDY DESIGN

The study (2010-2019) involved a referral population of 2.3 million children. Stool samples of patients with bloody diarrhea were screened for Shiga toxin (Stx) genes. Positive patients were rehydrated and monitored for hemoglobinuria until diarrhea resolved or STEC-HUS was diagnosed.

RESULTS

A total of 4767 children were screened; 214 (4.5%) were positive for either Stx1 (29.0%) or Stx2 (45.3%) or both Stx1+2 (25.7%); 34 patients (15.9%) developed STEC-HUS (0.71% of bloody diarrheas). Hemoglobinuria was present in all patients with HUS. Patients with Stx2 alone showed a greater risk of STEC-HUS (23.7% vs 12.7%) and none of the patients with Stx1 alone developed HUS. During the same period of time, 95 other patients were diagnosed STEC-HUS but were not captured by the screening program (26 had nonbloody diarrhea, 11 came from areas not covered by the screening program, and 58 had not been referred to the screening program, although they did meet the inclusion criteria). At HUS presentation, serum creatinine of patients identified by screening was significantly lower compared with that of the remaining patients (median 0.9 vs 1.51 mg/dL).

CONCLUSIONS

Nearly 1% of children with bloody diarrhea developed STEC-HUS, and its diagnosis was anticipated by the screening program for Stx. The screening of bloody diarrhea for Stx is recommended, and monitoring patients carrying Stx2 with urine dipstick for hemoglobinuria is suggested to identify the renal complication as early as possible.

Presence of Legionella spp. in human dental plaque

AIMS

The aim of this research is to verify the presence of Legionella in human dental plaque.

METHODS

65 adult patients not treated with systemic or local antibiotics at least 2 months before the time of sample collection were enrolled for plaque collection between September 2015 and December 2016. A brief questionnaire about lifestyle and health risks was administered. Legionella spp. detection has been executed by semi- nested PCR.

RESULTS

8 out of 65 plaque samples (12.3%) were positive for Legionella spp. As regards health risks and lifestyle aspects, no relevant difference was observed between patients involved in our study, except for two positive patients who have reported a COPD ongoing and a pneumonia in the past.

CONCLUSIONS

This study represents a step forward in the knowledge of reservoirs of the microorganism and richness of oral microbiota.

In vitroinhibition ofHelicobacter pyloriand interaction studies of lichen natural products with jack bean urease

The interaction between lichen metabolites and jack bean urease was investigated by molecular spectroscopy at pH 7.4 and kinetics assay.

Paclitaxel-releasing mesenchymal stromal cells inhibit in vitro proliferation of human mesothelioma cells

INTRODUCTION

Malignant pleural mesothelioma (MPM) is a rare fatal asbestos-related malignancy originating in the mesothelial cells of the pleura. A platinum-based doublet containing a third-generation antifolate is the front-line standard of care whilst there are no approved second-line treatments for MPM which remains a disease setting to test the efficacy of new therapeutic agents.

METHODS

Bone marrow mesenchymal stromal cells (BM-MSCs) were loaded with pemetrexed (PMX) and paclitaxel (PTX) according to a standardized procedure. Drug release by both PMX- and PTX-primed BM-MSCs (BM-MSCs/PMX and BM-MSCs/PTX) was tested on the in vitro proliferation of a panel of tumor cell lines including NCI-H28 mesothelioma.

RESULTS

The in vitro anticancer activity of pure PTX was significantly higher than that of PMX against all the cell lines tested (14.7 times higher than that of PMX against NCI-H28). Whereas BM-MSCs did not take up and release PMX in amounts effective on mesothelioma, PTX-loaded BM-MSCs dramatically inhibited mesothelioma proliferation.

CONCLUSIONS

PTX-primed mesenchymal stromal cells successfully inhibit the in vitro proliferation of human mesothelioma cells. Further studies and in vivo testing are required to confirm our preliminary in vitro results as a potential new mesothelioma therapy based on cell drug delivery.

Anti-Helicobacter Pylori Activity of Four Alchemilla Species (Rosaceae)

The present study evaluated the anti- Helicobacter pylori activity of Alchemilla glabra Neygenf. ( A. sect. Alchemilla), A. monticola Opiz ( A. sect. Plicatae S.E. Fröhner), A. fissa Günther & Schummel ( A. sect. Calycinae (Buser) Buser) and A. viridiflora Rothm. ( A. sect. Calycinae), and identified ellagic acid and quercetin-3- O-β-D-glucoside. Anti- H. pylori activity was tested against ten clinical isolates and one reference strain (ATCC 43504). The methanol extracts were more active than the dichloromethane and cyclohexane extracts. The ranges of concentrations were between 4 μg/mL for methanol extracts of A. viridiflora, A. glabra and A. monticola, and 256 μg/mL for cyclohexane extracts of A. viridiflora, A. glabra and A. fissa. The best overall activity was obtained with A. monticola extracts. No significant difference was found in the ellagic acid contents of the methanol extracts of the tested Alchemilla species (0.2–0.3 mg/mL), and anti- H. pylori activity was similar (4–32 μg/mL). Ellagic acid exhibited strong activity at very low concentrations (0.125–0.5 μg/mL), while the second identified compound, quercetin-3- O-β-D-glucoside, was also very active in concentration of 2–16 μg/mL.

Anti-Helicobacter pylori Activity of Four Alchemilla Species (Rosaceae)

The present study evaluated the anti-Helicobacterpylori activity of Alchemilla glabra Neygenf. (A. sect. Alchemilla), A. monticola Opiz (A. sect. Plicatae S.E. Fröhner), A. fissa Günther & Schummel (A. sect. Calycinae (Buser) Buser) and A. viridiflora Rothm. (A. sect. Calycinae), and identified ellagic acid and quercetin-3-O-β-glucoside. Anti-H. pylori activity was tested against ten clinical isolates and one reference strain (ATCC 43504). The methanol extracts were more active than the dichloromethane and cyclohexane extracts. The ranges of concentrations were between 4 μg/mL for methanol extracts of A. viridiflora, A. glabra and A. monticola, and 256 μg/mL for cyclohexane extracts of A. viridiflora, A. glabra and A. fissa. The best overall activity was obtained with A. monticola extracts. No significant difference was found in the ellagic acid contents of the methanol extracts of the tested Alchemilla species (0.2-0.3 mg/mL), and anti-H. pylori activity was similar (4-32 μg/mL). Ellagic acid exhibited strong activity at very low concentrations (0.125-0.5 μg/mL), while the second identified compound, quercetin-3-O-β-D-glucoside, was also very active in concentration of 2-16 μg/mL.

Efficacy of hepatitis B immunization with reduced intradermal doses

Intradermally (I.D.) administered reduced doses of HB-Vax and Hevac-B were tested against the standard protocols for administering these two vaccines. Immunogenicity, efficacy and possible side effects were evaluated. Four-hundred-sixty-two healthy subjects were vaccinated as follows: Fifty-two subjects received HB-Vax and 99 Hevac B according to the standard regimens. The remaining subjects received 3 I.D. injections in the deltoid region at one-month intervals in the following doses: 165 subjects with 2 micrograms doses of HB-Vax, 118 subjects with 1 microgram doses of Hevac-B and 28 subjects with 0.5 micrograms (minimal) doses of Hevac-B. Post-vaccination tests (anti-HBs titres and other serological markers for HBV) were to be performed 30, 60, 90, 180, 270 and 360 days after the first injections. Side effects seen with the experimental protocols were acceptable and limited to local reactions. It was found that, on the whole, reduced I.D. doses of both vaccines produced very high immune responses showing a consistently greater efficacy than those of the standard protocols, though the differences were not always statistically significant. Ninety days after the first injections, 80.8% and 82.7% of subjects vaccinated with reduced I.D. doses of HB-Vax showed seroconversion as opposed to only 62.0% of those receiving standard protocol HB-Vax. Seroconversion rates at 90 days in subjects receiving reduced I.D. doses of Hevac-B were 92.0% and 87.9% and for those receiving the minimal doses of this vaccine, 94.1%. The rate of seroconversion obtained with standard administration of Hevac-B was 83.8%.(ABSTRACT TRUNCATED AT 250 WORDS)