Shiga toxin producing Escherichia coli-associated diarrhea and hemolytic uremic syndrome in young children in Romania

Abstract

Background Diarrheagenic Escherichia coli (E. coli) is an important cause of diarrheal diseases in both developing countries and industrialized countries. An outbreak of hemolytic uremic syndrome (HUS) in young children from southern Romania was reported in early 2016 and was attributed to Shiga toxin producing E. coli (STEC) O26 infection. The aim of this study was to determine the prevalence, demographic and clinical characteristics of STEC infections in children hospitalized with diarrhea in Brașov in the central region of Romania. We also described the occurrence of HUS among hospitalized children, close in time to the 2016 HUS outbreak in southern Romania. Methods A prospective study was conducted between March and December 2016 among 722 children aged 1–30 months hospitalized with acute diarrhea. Stool samples obtained from patients with diarrhea were tested for the presence of Shiga toxin type 1 (STX1) and type 2 (STX2) by an immunochromatographic assay, and other enteropathogens. Demographic and clinical information on cases of HUS diagnosed in the same hospital was obtained from medical records. Results Overall 46/722 (6.4%) children (mean age 10.3 months, 32.6% females) hospitalized with diarrhea tested positive for STX1 or STX2; of these 79% were positive for both STX1 and STX2, 16% for STX2 only, and 5% for STX1 only. Bloody diarrhea, vomiting and fever were documented in 32.6%, 52.1% and 50.0%, respectively of patients with STEC infection. Eleven confirmed HUS cases (mean age 20 months, five females) were identified between 2014 and 2016 with prodromal diarrhea reported in 10 of them. Three of the 11 HUS patients required hemodialysis. Conclusions STEC prevalence among young children with diarrhea in Romania was high and the risk of HUS is emerging. The establishment of a systematic laboratory-based surveillance program including identification of the circulating STEC strains coupled with epidemiological investigation of HUS patients is warranted to determine the source and mode of transmission of STEC and prevent of STEC-associated diarrhea and HUS.

Prevalence, antimicrobial resistance, and genotyping of Shiga toxin-producing Escherichia coli in foods of cattle origin, diarrheic cattle, and diarrheic humans in Egypt

“…Most (60-69.2%) of the food and human isolates displayed the genotype with both stx genes. Similarly, the same genotype predominated in human isolates from Canada [38] and Europe [37]. However, our findings differed from reports of food isolates [32,34] and human isolates [36] found elsewhere.…”

“…STEC isolates were found in 12% of diarrheic cattle samples; higher rates (18.7-53.2%) were reported from another location in Egypt [18] and elsewhere [31,35]. The prevalence rate in humans was 10%, which was higher than that in other reports (0.7-6.4%) in Africa [36], Europe [37], and Asia [35]. Most (60-69.2%) of the food and human isolates displayed the genotype with both stx genes.…”

Çocuk Yoğun Bakımda Diyare İlişkili Hemolitik Üremik Sendrom: Tek Merkez Deneyimi

“…Olguların başvuru öncesinde belirttikleri ortalama semptom süreleri 4,53±1,5 gün olarak hesaplandı. Yukarıda da belirtildiği üzere D+HÜS çocukluk çağında sıklıkla 5 yaş altında görülmektedir (2,11,(17)(18)(19)(20). Ülkemizde 2011 yılında görülen HÜS salgını sonrasında Ekinci ve arkadaşları ( 21) tarafından gerçekleştirilen çok merkezli çalışmada yaş ortalaması salgın bölgesinde 7,3 yıl ve salgın bölgesi dışında 6,7 yıl olarak hesaplanmıştır.…”

“…Bizim çalışma grubumuzun ortanca yaşı literatür ile uyumlu olup 18 ay olarak hesaplandı (Tablo 1). Diyare ilişkili HÜS için cinsler arasında bir fark tanımlanmamıştır (2)(3)(4)(5)(6)(7)(8)11,(15)(16)(17)(18)(19). Çalışmamızda 9 (%60) erkek hasta olup cinsler arasında anlamlı fark görülmedi.…”

“…2010 yılından sonra diğer suşlar da (O26:H11, O145:H28, O103:H2, O111:H8, O104:H4) artan sıklıklarda bildirilmektedir (3,4,9). Şiga toksin üreten E.coli kaynaklı enteritlerin sonrasında %10-15 oranında HÜS gelişmektedir (3,4,7,(9)(10)(11). Hemolitik üremik sendrom sıklıkla enterit sonrasındaki 7-14 gün içerisinde gelişmektedir.…”