Background and Aims
Shiga-toxin associated hemolytic-uremic syndrome (STEC-HUS) is a thrombotic microangiopathy (TMA) followed by intestinal infection caused by shiga-toxin-producing E. coli. Endothelium damage of the microvasculature leads to the formation of platelet-fibrin thrombi and occlusion of small vessels. The aim of our study was a retrospective analysis of thrombotic complications in children with STEC-HUS.
Method
We retrospectively analyzed the case histories of patients in the dialysis department of St. Vladimir's Children's City Clinical Hospital from 2009 to 2019. The study included patients with STEC-HUS with the development of thrombotic complications.
Results
Among 410 patients with STEC-HUS, 16 patients with thrombotic complications were identified. Equally boys and girls, mean age 3.5 ± 2.4 g. Respiratory support was required in 6 cases. The duration of anuria was 9.9 +/- 6.2 days, in 2 cases only oliguria was noted. In all patients blood transfusion, fresh frozen plasma were needed, antibiotics were used. In all cases, continuous venovenous hemodiafiltration (CVVHDF) was performed with 2-way catheters, usually in the femoral vein. Thrombotic complications in all cases were associated with therapy. In 11 children, thrombosis was localized in the femoral, iliac veins and vena cava inferior. Clinical manifestations in the form of limb edema, cyanosis were noted in 4 patients, in other cases the diagnosis was made by ultrasound. 3 patients with thrombosis of the branches of the central retinal vein, vena cava superior, mesenteric thrombosis. 1 patient was diagnosed with dissecting femoral vein aneurysm. In 3 cases, CVVGDF had to be stopped due to catheter thrombosis. Before the current thrombosis, these children were not prescribed anicoagulants. Coagulation tests indices indicated hypercoagulability and were characterized by higher thrombin time, increased levels of D-dimer, and increased fibrinolysis time.
Conclusion
Large vessel thrombosis in children with STEC-HUS is a rare complication. The provoking factor for the implementation of thrombotic events in all cases was femoral vein catheterization. When managing patients with STEC-HUS monitoring of coagulation status is needed for the purpose of timely administration of anticoagulants.
TLR are providing a launch of an infectious process when a macroorganism contacts with pathogenic OM and their communities. During the chlamydial infection different levels of TLR-2 and TLR-4 activation depend on qualitative composition of microbial communities present on the mucosa of UGT. Activation of TLR-2 and TLR-4 gene expression is occurring more pronounced in response to pathogens of STI, OM and less pronounced during contact with normoflora. The highest levels of TLR gene expression correspond to the higher OM contamination degree of cervical canal, urethra and vagina. TLR-2 and TLR-4 gene expression is taking place in response to OM in vagina and to OM and STI in cervical canal and urethra. Increase of TLR-2 and TLR-4 expression into urethra, cervical canal, and vagina correlates with severity of clinical manifestations of UGC depending on a pathogen, as well as on pathogenicity of associates (pathogens of STI and OM). Diagnostic and prognostic significance of the TLR-2 and TLR-4 gene expression levels assessment during urogenital chlamydiosis in women is determined. The assessment of levels of TLR-2 and TLR-4 gene expressions in scraping material of the cervix and urethra of patients with urogenital chlamydial infection allows to distinguish chronic and acute forms of chlamydiosis (chronic urogenital chlamydiosis is diagnosed with levels of expression of TL-receptor-2 not more than 5 units and TL-receptor-4 not more than 5 units in scraping material from the urethra), as well as to reveal the beginning of chronization of an infectious process. During acute urogenital chlamydiosis reduction of the TLR-2 and TLR-4 gene expression levels along with direct methods of detecting the pathogen can indirectly indicate an eradication of chlamydia.
Ключевые слова TLR-рецепторы врождённого клеточного иммунитета, урогенитальные инфекции. инфицирование, клинические проявления. infections TLR-8 level above 28 is a predictor of pregnancy termination and miscarriage.
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