STEC:O111‐HUS complicated by acute encephalopathy in a young girl was successfully treated with a set of hemodiafiltration, steroid pulse, and soluble thrombomodulin under plasma exchange

Yada, Noritaka; Fujioka, Masayuki; Bennett, Charles L.; Inoki, Kazuya; Miki, Toyokazu; Watanabe, Akihiko; Yoshida, Toshiko; Hayakawa, Masaki; Matsumoto, Masanori; Fujimura, Yoshihiro

doi:10.1002/ccr3.196

Cited by 10 publications

(9 citation statements)

References 16 publications

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“…In our study, we found only one strain belonging to the addressed serogroups, corresponding to an O111 strain isolated from a pig. The detection of O111 strains in cattle and swine feces, as well as their association with severe illness in humans, is not surprising and was previously reported [70,71,72,73]. However, O111 STEC strains isolated from humans with moderate to severe illness are mainly associated with the presence of stx 1 type, together with eae and ehx A genes [72,73,74,75].…”

Section: Discussionmentioning

confidence: 77%

Virulence Genes, Shiga Toxin Subtypes, Serogroups, and Clonal Relationship of Shiga Toxin-Producing Escherichia Coli Strains Isolated from Livestock and Companion Animals

Galarce

Escobar

Sánchez

et al. 2019

Animals

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Simple SummaryShiga toxin-producing Escherichia coli is a zoonotic pathogen that can cause severe illness in humans, and its circulating strains in the animal-human-environment interface exhibit great variability in terms of virulence and serotypes, where diverse animal species, mainly ruminants, play a fundamental role as reservoirs. Thus, the aim of this study was to characterize strains of this pathogen present in cattle, swine, dogs, and cats in the Región Metropolitana, Chile, based on virulence, serogroups, and population diversity. Based on findings, the circulating strains isolated exhibit high variability and harbor genetic determinants associated with severe illness in humans, thus highlighting that preventive and control strategies should not be focused on detecting serogroups, but instead, on detecting their determinants of virulence.AbstractShiga toxin-producing Escherichia coli (STEC) is a zoonotic pathogen that causes severe illness in humans and is an important cause of foodborne disease. In Chile, there is limited information on the virulence characteristics of this pathogen in livestock, and none in companion animals. The aim of this study was to characterize STEC strains isolated from cattle, swine, dogs, and cats, in Chile, in terms of the presence of Shiga toxin types and subtypes, virulence genes, serogroups, and clonality. One-thousand two-hundred samples were collected, isolating 54 strains (4.5%), where stx1a (68.5%) and ehxA (74.1%) were the most frequently detected virulence genes. Only one strain belonging to the most clinically relevant serogroups was identified. Pulsed field gel electrophoresis analysis showed high clonal diversity among strains isolated from cattle, while those from swine showed the same pattern. This study provides further evidence regarding cattle and swine in Chile as a potential source of a wide variety of STEC strains that could potentially cause severe illness in humans, and that companion animals do not seem to represent a relevant reservoir. It also argues that preventive and control strategies should not be focused on detecting serogroups, but instead, on detecting their determinants of virulence.

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Section: Discussionmentioning

confidence: 77%

Virulence Genes, Shiga Toxin Subtypes, Serogroups, and Clonal Relationship of Shiga Toxin-Producing Escherichia Coli Strains Isolated from Livestock and Companion Animals

Galarce

Escobar

Sánchez

et al. 2019

Animals

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“…In this study, we observed that steroids or DAG analogues, which have been used in clinical medicine 37 or clinical trials 24 , have a suppressive effect on SubAB- or Stx-induced cytotoxicity. Stx is a major virulence factor that is responsible for severe gastrointestinal diseases caused by both LEE-positive and -negative STEC infections.…”

Section: Discussionmentioning

confidence: 78%

“…Recent studies showed that steroid pulse therapy was an effective treatment for severe STEC infection 18 , 37 . However, it remains unknown why steroids improve severe damage caused by STEC infection.…”

Section: Discussionmentioning

confidence: 99%

Mechanism of inhibition of Shiga-toxigenic Escherichia coli SubAB cytotoxicity by steroids and diacylglycerol analogues

Yahiro

Ichimura

Takeuchi

et al. 2018

Cell Death Discovery

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Shiga toxigenic Escherichia coli (STEC) are responsible for a worldwide foodborne disease, which is characterized by severe bloody diarrhea and hemolytic uremic syndrome (HUS). Subtilase cytotoxin (SubAB) is a novel AB5 toxin, which is produced by Locus for Enterocyte Effacement (LEE)-negative STEC. Cleavage of the BiP protein by SubAB induces endoplasmic reticulum (ER) stress, followed by induction of cytotoxicity in vitro or lethal severe hemorrhagic inflammation in mice. Here we found that steroids and diacylglycerol (DAG) analogues (e.g., bryostatin 1, Ingenol-3-angelate) inhibited SubAB cytotoxicity. In addition, steroid-induced Bcl-xL expression was a key step in the inhibition of SubAB cytotoxicity. Bcl-xL knockdown increased SubAB-induced apoptosis in steroid-treated HeLa cells, whereas SubAB-induced cytotoxicity was suppressed in Bcl-xL overexpressing cells. In contrast, DAG analogues suppressed SubAB activity independent of Bcl-xL expression at early time points. Addition of Shiga toxin 2 (Stx2) with SubAB to cells enhanced cytotoxicity even in the presence of steroids. In contrast, DAG analogues suppressed cytotoxicity seen in the presence of both toxins. Here, we show the mechanism by which steroids and DAG analogues protect cells against SubAB toxin produced by LEE-negative STEC.

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“…Furthermore, no brain imaging studies were done to assess the cause of somnolence, which may have been attributable to reversible encephalopathy, presumably resulting from increased vascular permeability. 17 However, the significance of the current report should be evaluated carefully with respect to several management concerns described below.…”

Section: Discussionmentioning

confidence: 99%

Hemolytic Uremic Syndrome: An Increasingly Recognized Public Health Problem

Murakami

Akimoto

Yamazaki

et al. 2018

Clin Med Insights Case Rep

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A 28-year-old man was referred and admitted to our hospital due to Escherichia coli O157–mediated hemorrhagic colitis with severe thrombocytopenia. A systemic workup concluded that the patient had acute pancreatitis as well as hemolytic uremic syndrome. The patient was ultimately discharged, with his platelet count having recovered. Our case serves an illustrative example of potentially serious complications of an increasingly recognized public health problem. Systemic studies on this topic are insufficient, and we strongly recommend the further accumulation of more experiences like ours. Several diagnostic and management concerns that emerged in this case are also discussed.

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STEC:O111‐HUS complicated by acute encephalopathy in a young girl was successfully treated with a set of hemodiafiltration, steroid pulse, and soluble thrombomodulin under plasma exchange

Cited by 10 publications

References 16 publications

Virulence Genes, Shiga Toxin Subtypes, Serogroups, and Clonal Relationship of Shiga Toxin-Producing Escherichia Coli Strains Isolated from Livestock and Companion Animals

Virulence Genes, Shiga Toxin Subtypes, Serogroups, and Clonal Relationship of Shiga Toxin-Producing Escherichia Coli Strains Isolated from Livestock and Companion Animals

Mechanism of inhibition of Shiga-toxigenic Escherichia coli SubAB cytotoxicity by steroids and diacylglycerol analogues

Hemolytic Uremic Syndrome: An Increasingly Recognized Public Health Problem

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