Haemolytic-uraemic syndrome in childhood: surveillance and case-control studies in Italy

Gianviti, Alessandra; Rosmini, Francesco; Caprioli, Alfredo; Corona, Rosamaria; Matteucci, Maria Chiara; Principato, F.; Luzzi, Ida; Rizzoni, Gianfranco

doi:10.1007/bf00869095

Cited by 47 publications

(26 citation statements)

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“…It is possible that some patients did not develop a detectable immune response [41] and that others may have been infected by a STEC strain belonging to a serogroup not included in the panel of antigens used in this study. We first reported STEC infection in HUS cases without D [4,30] and this finding was recently confirmed by other European studies [40,42]. These data suggest that Shiga toxins are able to translocate across the intestinal mucosa and reach the target endothelial cells even if the STEC infection does not result in overt D. Therefore, D STEC + HUS cases exist and carry a prognosis similar to D + STEC + HUS.…”

Section: Discussionsupporting

confidence: 67%

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Risk factors for poor renal prognosis in children with hemolytic uremic syndrome

Gianviti

Tozzi

Petris

et al. 2003

Pediatric Nephrology

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Many factors have been proposed as predictors of poor renal prognosis in children with hemolytic uremic syndrome (HUS), but their role is still controversial. Our aim was to detect the most reliable early predictors of poor renal prognosis to promptly identify children at major risk of bad outcome who could eventually benefit from early specific treatments, such as plasmapheresis. Prognostic factors identifiable at onset of HUS were evaluated by survival analysis and a proportional hazard model. These included age at onset, prodromal diarrhea (D), leukocyte count, central nervous system (CNS) involvement, and evidence of Shiga toxin-producing Escherichia coli (STEC) infection. Three hundred and eighty-seven HUS cases were reported; 276 were investigated for STEC infection and 189 (68%) proved positive. Age at onset, leukocyte count, and CNS involvement were not associated with the time to recovery. Absence of prodromal D and lack of evidence of STEC infection were independently associated with a poor renal prognosis; only 34% of patients D(-)STEC(- )recovered normal renal function compared with 65%-76% of D(+)STEC(+), D(+)STEC(-) and D(-)STEC(+ )patients. In conclusion, absence of both D and evidence of STEC infection are needed to identify patients with HUS and worst prognosis, while D(-) but STEC(+) patients have a significantly better prognosis.

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Section: Discussionsupporting

confidence: 67%

“…Positivity for STEC infection was first introduced as a possible prognostic factor and was associated with a good outcome [30]. However, this evaluation was performed on a small group of patients who were followed for only 1 year.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for poor renal prognosis in children with hemolytic uremic syndrome

Gianviti

Tozzi

Petris

et al. 2003

Pediatric Nephrology

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“…Vomiting, the only sign associated with HUS risk, was not previously noted to be a factor for progression of E coli O157:H7 infection to HUS 8,9,11,18,19 . Vomiting may indicate severe gastrointestinal injury, higher intestinal concentrations of Shiga toxin (Stx), host susceptibility, or systemic toxemia with central nervous system effects.…”

Section: Discussionmentioning

confidence: 73%

Predictors of Hemolytic Uremic Syndrome in Children During a Large Outbreak of Escherichia coli O157:H7 Infections

et al. 1997

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ABSTRACT. Objective. To evaluate risk factors for progression of Escherichia coli O157:H7 infection to the hemolytic uremic syndrome (HUS).Study Design. We conducted a retrospective cohort study among 278 Washington State children <16 years old who developed symptomatic culture-confirmed E coli O157:H7 infection during a large 1993 outbreak. The purpose of the study was to determine the relative risk (RR) of developing HUS according to demographic characteristics, symptoms, laboratory test results, and medication use in the first 3 days of illness.Results. Thirty-seven (14%) children developed HUS. In univariate analysis, no associations were observed between HUS risk and any demographic characteristic, the presence of bloody diarrhea or of fever, or medication use. In multivariate analysis, HUS risk was associated with, in the first 3 days of illness, use of antimotility agents (odds ratio [OR] ‫؍‬ 2.9; 95% confidence interval [CI] 1.2-7.5) and, among children <5.5 years old, vomiting (OR ‫؍‬ 4.2; 95% CI 1.4 -12.7). Among the 128 children tested, those whose white blood cell (WBC) count was 13 000/L in the first 3 days of illness had a 7-fold increased risk of developing HUS (RR 7.2; 95% CI 2.8 -18.5). Thirteen (38%) of the 34 patients with a WBC count 13 000/L developed HUS, but only 5 (5%) of the 94 children whose initial WBC count was <13 000/L progressed to HUS. Among children who did not develop HUS, use of antimotility agents in the first 3 days of illness was associated with longer duration of bloody diarrhea.Conclusions. Prospective studies are needed to further evaluate measures to prevent the progression of E coli O157:H7 infection to HUS and to assess further clinical and laboratory risk factors. These data argue against the use of antimotility agents in acute childhood diarrhea. Our finding that no intervention decreased HUS risk underscores the importance of preventing E coli O157:H7 infections. Pediatrics 1997;100(1). URL: http:// www.pediatrics.org/cgi/content/full/100/1/e12; antibiotics, antimotility agents, Escherichia coli O157:H7, kidney failure, leukocytosis.ABBREVIATIONS. HUS, hemolytic uremic syndrome; BUN, blood urea nitrogen; RR, relative risk; CI, confidence interval; TMP/SMZ, trimethoprim/sulfamethoxazole; OR, odds ratio; WBC, white blood cell; Stx, Shiga toxin. E scherichia coli O157:H7 causes bloody and nonbloody diarrhea that progresses to hemolytic uremic syndrome (HUS) in a subset of patients.1,2 Though the gastrointestinal manifestations of infection with E coli O157:H7 can be severe, HUS accounts for the major acute and chronic morbidity and mortality caused by this organism.Associations between certain host-specific factors and the risk of progression of enteric infection with E coli O157:H7 to HUS have been reported. In population-based studies of HUS, age-specific incidence was highest among children Ͻ5 years of age, but these studies did not evaluate risk factors for progression of diarrhea or hemorrhagic colitis to HUS. [3][4][5][6] In some studies of children with E coli O...

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“…EHEC infection diarrhea is still one of the major public health problems world-wide and some previous studies have investigated the EHEC O157:H7 human infection causing mortality rate ranging between 0 to 10% [Mckee & O'Brien, 1995;Gianviti et al, 1994;Bell et al, 1997]. After the fi rst US outbreak of EHEC O157:H7 infection in 1982, many outbreaks and sporadic cases caused by the bacteria have been reported.…”

Section: Introductionmentioning

confidence: 99%

Rapid and Specific Detection of Escherichia coli O157:H7 in Ground Beef Using Immunomagnetic Separation Combined with Loop-Mediated Isothermal Amplification

Qin¹,

Puthiyakunnon²,

Zhang³

et al. 2018

Pol. J. Food Nutr. Sci.

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Escherichia coli O157:H7 is well known for many foodborne outbreaks that lead to fatal infections in human being worldwide. The objective of this study was to develop a rapid and sensitive method for detection of EHEC O157:H7 from ground beef using a method that combined immunomagnetic separation (IMS) with loop-mediated isothermal amplifi cation (LAMP). The EHEC O157:H7 cells were separated with Dynabeads coated with anti-EHEC O157:H7 after a short enrichment for 4 h. Then, EHEC O157:H7 was identifi ed by LAMP assay for amplifying and detecting the rfbE gene, which is highly conserved in all EHEC O157:H7 strains and exhibits strain-specifi c gene expression. The LAMP method results analyzed with real time turbidity measurements showed a high specifi city and sensitivity, with a positive detection rate of amplifi cation of EHEC O157:H7 DNA diluted to a minimum equivalent concentration of 1.8 × 10 1 CFU/mL, which was 10 times more sensitive than the conventional PCR assay. The IMS followed with LAMP could capture and detect a bacterial concentration as low as 3×10 1 CFU/mL from the meat samples, which was close to the sensitivity of LAMP assay with pure culture. IMS combined with realistic LAMP method is a simple, rapid, highly specifi c gene amplifi cation technology that is suitable for implementing as a screening assay in basic laboratory and fi eld test for detecting food contamination. Unauthenticated Download Date | 5/11/18 5:54 AM

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Haemolytic-uraemic syndrome in childhood: surveillance and case-control studies in Italy

Cited by 47 publications

References 23 publications

Risk factors for poor renal prognosis in children with hemolytic uremic syndrome

Risk factors for poor renal prognosis in children with hemolytic uremic syndrome

Predictors of Hemolytic Uremic Syndrome in Children During a Large Outbreak of Escherichia coli O157:H7 Infections

Rapid and Specific Detection of Escherichia coli O157:H7 in Ground Beef Using Immunomagnetic Separation Combined with Loop-Mediated Isothermal Amplification

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