Is Shigatoxin 1 protective for the development of Shigatoxin 2-related hemolytic uremic syndrome in children? Data from the ItalKid-HUS Network

Ardissino, Gianluigi; Possenti, Ilaria; Vignati, Chiara; Daprai, Laura; Capone, Valentina; Brigotti, Maurizio; Luini, M.; Consonni, Dario; Montini, Giovanni

doi:10.1007/s00467-020-04697-y

Cited by 13 publications

(5 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The type of Stx has a major bearing on the likelihood of developing HUS during the course of an infection with STEC. Stx2, and more specifically the subtype Stx2a, has been associated with HUS [78,86,91], whereas Stx1 [28], Stx2c [28,78] and the association of Stx1 and Stx2 [92] were found to be protective against HUS, consistent with in vitro models [93].…”

Section: Epidemiological Impact Of Microbiological Characteristicssupporting

confidence: 65%

Shiga Toxin-Associated Hemolytic Uremic Syndrome: Specificities of Adult Patients and Implications for Critical Care Management

Travert

Rafat

Mariani

et al. 2021

Toxins

View full text Add to dashboard Cite

Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC-HUS) is a form of thrombotic microangiopathy secondary to an infection by an enterohemorrhagic E. coli. Historically considered a pediatric disease, its presentation has been described as typical, with bloody diarrhea at the forefront. However, in adults, the clinical presentation is more diverse and makes the early diagnosis hazardous. In this review, we review the epidemiology, most important outbreaks, physiopathology, clinical presentation and prognosis of STEC-HUS, focusing on the differential features between pediatric and adult disease. We show that the clinical presentation of STEC-HUS in adults is far from typical and marked by the prevalence of neurological symptoms and a poorer prognosis. Of note, we highlight knowledge gaps and the need for studies dedicated to adult patients. The differences between pediatric and adult patients have implications for the treatment of this disease, which remains a public health threat and lack a specific treatment.

show abstract

Section: Epidemiological Impact Of Microbiological Characteristicssupporting

confidence: 65%

Shiga Toxin-Associated Hemolytic Uremic Syndrome: Specificities of Adult Patients and Implications for Critical Care Management

Travert

Rafat

Mariani

et al. 2021

Toxins

View full text Add to dashboard Cite

show abstract

“…However, only 39 patients (49%) underwent The secondary aim of our study was to assess whether some microbiological features, including E. coli serotypes and Stx variants, were associated with a greater risk of developing hepatopancreatic involvement. Some Stx variants (i.e., Stx2a) have been associated with greater virulence, carrying both a greater risk of causing HUS, as well as resulting more frequently as AKI and KRT [25,26].…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal involvement in STEC-associated hemolytic uremic syndrome: 10 years in a pediatric center

Giordano,

Iacoviello,

Santangelo

et al. 2024

Pediatr Nephrol

View full text Add to dashboard Cite

Background The gastrointestinal (GI) tract represents one of the main targets of typical hemolytic uremic syndrome (HUS) in children. In this observational study, we tried to establish (1) the main features of GI complications during STEC-HUS and (2) the relationship between Escherichia coli serotypes and Shiga toxin (Stx) variants with hepatopancreatic involvement. Methods A total of 79 STEC-HUS patients were admitted to our pediatric nephrology department between January 2012 and June 2021. Evidence of intestinal, hepatobiliary, and pancreatic involvements was reported for each patient, alongside demographic, clinical, and laboratory features. Frequency of gastrointestinal complications across groups of patients infected by specific E. coli serotypes and Stx gene variants was evaluated. Results Six patients developed a bowel complication: two developed rectal prolapse, and four developed bowel perforation which resulted in death for three of them and in bowel stenosis in one patient. Acute pancreatitis was diagnosed in 13 patients. An isolated increase in pancreatic enzymes and/or liver transaminases was observed in 41 and 15 patients, respectively. Biliary sludge was detected in three, cholelithiasis in one. Forty-seven patients developed direct hyperbilirubinemia. Neither E. coli serotypes nor Shiga toxin variants correlated with hepatic or pancreatic involvement. Conclusions During STEC-HUS, GI complications are common, ranging from self-limited elevation of laboratory markers to bowel perforation, a severe complication with a relevant impact on morbidity and mortality. Hepatopancreatic involvement is frequent, but usually short-lasting and self-limiting. Graphical abstract

show abstract

“…STEC may carry multiple copies of the same, or different, stx genes (55). The presence of additional stx genes may not have an additive relationship to virulence; a study of patient outcomes and presence of stx1 and stx2 in STEC isolates reported that STEC strains carrying both stx1 and stx2 had a lower correlation with HUS than strains with stx2 alone (83). STEC carrying the same stx subtype may differ in their levels of toxin expression (84).…”

Section: Discussionmentioning

confidence: 99%

Characterization of Atypical Shiga Toxin Gene Sequences and Description of Stx2j, a New Subtype

et al. 2022

View full text Add to dashboard Cite

Shiga toxin (Stx) is the definitive virulence factor of Shiga toxin-producing Escherichia coli (STEC). Stx variants are currently organised into a taxonomic system of three Stx1 (a,c,d) and seven Stx2 (a,b,c,d,e,f,g) subtypes. In this study, seven STEC isolates from food and clinical samples possessing stx2 sequences that do not fit current Shiga toxin taxonomy were identified. Genome assemblies of the STEC strains was created from Oxford Nanopore and Illumina sequence data. The presence of atypical stx2 sequences were confirmed by Sanger sequencing, as were Stx2 expression and cytotoxicity. A strain of O157:H7 was found to possess stx1a and a truncated stx2a , which were originally misidentified as an atypical stx2 . Two strains possessed unreported variants of Stx2a (O8:H28) and Stx2b (O146:H21). In four of the strains we found three Stx-subtypes that are not included in the current taxonomy. Stx2h (O170:H18) was identified in a Canadian sprout isolate; this subtype has only previously been reported in STEC from Tibetan Marmots. Stx2o (O85:H1) was identified in a clinical isolate. Finally, Stx2j (O158:H23 and O33:H14) was found in lettuce and clinical isolates. The results of this study expands the number of known Stx subtypes, the range of STEC serotypes, and isolation sources in which they may be found. The presence of the Stx2j and Stx2o in clinical isolates of STEC indicates that strains carrying these variants are potential human pathogens. Highlights Atypical Shiga toxin ( stx ) genes in Escherichia coli were sequenced. Two new variants of stx2a and stx2b are described. Two strains carried subtypes Stx2h and Stx2o, which have only one previous report. Two strains carried a previously undescribed subtype, Stx2j.

show abstract

Is Shigatoxin 1 protective for the development of Shigatoxin 2-related hemolytic uremic syndrome in children? Data from the ItalKid-HUS Network

Cited by 13 publications

References 13 publications

Shiga Toxin-Associated Hemolytic Uremic Syndrome: Specificities of Adult Patients and Implications for Critical Care Management

Shiga Toxin-Associated Hemolytic Uremic Syndrome: Specificities of Adult Patients and Implications for Critical Care Management

Gastrointestinal involvement in STEC-associated hemolytic uremic syndrome: 10 years in a pediatric center

Characterization of Atypical Shiga Toxin Gene Sequences and Description of Stx2j, a New Subtype

Contact Info

Product

Resources

About