Antibody response to lipopolysaccharides and recombinant proteins of Shiga toxin (STX)‐producing Escherichia coli (STEC) in children with haemolytic uraemic syndrome in Poland

Abstract

Significance and Impact of the Study: This study showed that serological analysis greatly complements bacterial isolation and helps in the diagnosis and confirmation of Shiga toxin (verotoxin)-producing Escherichia coli (STEC) infections. Serological tests can be performed to qualify the patient for the typical haemolytic uraemic syndrome (STEC-HUS). In Poland, STEC-HUS in children is mostly caused by the E. coli serotype O26, which indicates that there is an increasing number of non-O157 STEC infections associated with human diseases in Europe. AbstractTypical haemolytic uraemic syndrome (STEC-HUS), caused by Shiga toxin (Stx)-producing Escherichia coli (STEC), is a serious, life-threating disease that mainly affects children. Bacteriological and genetic tests are commonly used in the routine laboratory diagnosis of STEC-HUS; however, serological methods have emerged as useful and reliable diagnostic tools, especially when bacterial isolation fails. In this study, we present the results of the serological investigation of 72 paediatric patients suspected for HUS, hospitalized during 2011-2019 at the Department of Pediatrics and Nephrology of Children's Hospitals in Poland. During the routine laboratory investigation STEC strains were isolated only from nine stool samples. However, serological investigations confirmed 45 cases of STEC infections in children with HUS. In this study, 22 (48Á9%) paediatric patients were infected by E. coli serotype O26, 11 (24Á4%) by serotype O145, 9 (20Á0%) by serotype O157, and 3 (6Á7%) by E. coli serotype O111. In the majority of these patients, in addition to a high level of IgA, IgG and IgM antibodies to lipopolysaccharide of particular E. coli serotypes, antibodies to recombinant proteins Tir, Stx2b and intimin were detected. Our results confirm that serological tests are useful in the diagnosis of STEC-HUS.

Thrombotic microangiopathy in children

“…There were 90 cases in children with one death and the outcomes were similar to previous case series, although mean age was higher (most children were older than 10 years) [14]. In Europe, non-O157 serotypes of E. coli have become more common [15].…”

“…In Europe, non-O157 serotypes of E . coli have become more common [ 15 ]. In a prospective study in northern Italy, incidence of STEC-HUS among patients with shigatoxin-positive bloody diarrhea stool tests was 15.9% [ 16 ].…”

“…When available, IgA, IgG, and IgM antibodies to E . coli lipopolysaccharide (LPS) can be detected later in the course of the disease especially when stool specimens fail to detect the presence of shigatoxin [ 15 ]. Specifically for E .…”

“…We reiterate that it is essential to collect material for shigatoxin in all cases of TMA and to discuss with local health authorities the availability of sending material for the detection of shigatoxin in feces in specialized laboratories. When available, IgA, IgG, and IgM antibodies to E. coli lipopolysaccharide (LPS) can be detected later in the course of the disease especially when stool specimens fail to detect the presence of shigatoxin [15]. Specifically for E. coli O157 serotype, the Glyco-iELISA to detect IgM antibodies has significantly increased accurate diagnosis of STEC-HUS [24].…”

Diagnosis and Treatment for Shiga Toxin-Producing Escherichia coli Associated Hemolytic Uremic Syndrome

“…Among them, Stxs, Tir protein, and intimin are more reliable markers of STEC infections [ 41 , 42 ]. Clinically, Stx2 is a virulence factor that is highly relevant to HUS pathogenesis [ 43 , 44 ].…”