Shiga toxin-producing Escherichia coli haemolytic uraemic syndrome (STEC-HUS): diagnosis, surveillance and public-health management in England

Jenkins, Claire; Byrne, Lisa; Vishram, Bhavita; Sawyer, Clare; Balasegaram, Sooria; Ahyow, Laura; Johnson, Sally

doi:10.1099/jmm.0.001215

Cited by 17 publications

(15 citation statements)

References 16 publications

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“…If food histories indicate that contaminated food is unlikely to be the vehicle, testing faecal specimens from household pets may identify the transmission vector. Most importantly, this investigation highlighted the need for more widespread use of rapid, diagnosis of STEC-HUS, and has been a driver in the move towards implementing commercial gastrointestinal PCR assays in local and regional hospital laboratories in England [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiological investigation of recurrent outbreaks of haemolytic uraemic syndrome caused by Shiga toxin-producingEscherichia coliserotype O55:H7 in England, 2014–2018

et al. 2021

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Recurrent outbreaks of haemolytic ureamic syndrome (HUS) caused by Shiga toxinproducing Escherichia coli (STEC) serotype O55:H7 occurred in England between 2014 and 2018. We reviewed the epidemiological evidence to identify potential source(s) and transmission routes of the pathogen, and to assess the on-going risk to public health. Over the five-year period, there were 43 confirmed and three probable cases of STEC O55:H7. The median age of cases was 4 years old (range 6 months to 69 years old) and over half of all cases were female (28/46, 61%). There were 36/46 (78.3%) symptomatic cases, and over half of these developed HUS (20/36, 54%), including two fatal cases. No common food or environmental exposures were identified, although the majority of cases lived in rural or semi-rural environments and reported contact with both wild and domestic animals. This investigation informed policy on the clinical and public health management of HUS caused by STEC other than serotype O157:H7 (non-O157 STEC) in England, including comprehensive testing of all household contacts and household pets and more widespread use of PCR assays for the rapid diagnosis of STEC-HUS.

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Section: Discussionmentioning

confidence: 99%

Epidemiological investigation of recurrent outbreaks of haemolytic uraemic syndrome caused by Shiga toxin-producingEscherichia coliserotype O55:H7 in England, 2014–2018

et al. 2021

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“…Clinically, the diagnosis of STEC-HUS mainly relies on prior potential infections or exposure history, corresponding clinical symptoms, and auxiliary examinations that indicate thrombotic microangiopathy, such as nonimmune hemolytic anemia (hematocrit < 30%, with fragmented erythrocytes in peripheral blood smear and a negative Coombs test), thrombocytopenia (platelet count < 150,000 mm 3 ), and abnormal renal function (a serum creatinine concentration that exceeds the upper limit of the reference range for age) with or without hypocomplementemia. If the occurrence of STEC-HUS is suspected, fecal and serological tests are required to determine whether there is evidence of a STEC infection [ 21 ] ( Figure 2 ).…”

Section: Stec-hus Diagnosismentioning

confidence: 99%

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

Liu

Thaker

Wang

et al. 2022

Toxins

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Shiga toxin-producing Escherichia coli (STEC)-associated hemolytic uremic syndrome (STEC-HUS) is a clinical syndrome involving hemolytic anemia (with fragmented red blood cells), low levels of platelets in the blood (thrombocytopenia), and acute kidney injury (AKI). It is the major infectious cause of AKI in children. In severe cases, neurological complications and even death may occur. Treating STEC-HUS is challenging, as patients often already have organ injuries when they seek medical treatment. Early diagnosis is of great significance for improving prognosis and reducing mortality and sequelae. In this review, we first briefly summarize the diagnostics for STEC-HUS, including history taking, clinical manifestations, fecal and serological detection methods for STEC, and complement activation monitoring. We also summarize preventive and therapeutic strategies for STEC-HUS, such as vaccines, volume expansion, renal replacement therapy (RRT), antibiotics, plasma exchange, antibodies and inhibitors that interfere with receptor binding, and the intracellular trafficking of the Shiga toxin.

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“…In England, a sub-set of laboratories, approximately 20%, use commercial PCR assays for the detection of gastrointestinal pathogens, including STEC other than serotype O157:H7 (non-O157 STEC) ( [14], Public Health England (PHE) in-house data). Faecal specimens from patients where there is a clinical suspicion of HUS and/or those testing positive for STEC by PCR and culture-negative for STEC O157:H7 on cefixime-tellurite sorbitol MacConkey agar are submitted to the Gastrointestinal Bacteria Reference Unit at PHE for confirmation by PCR and culture [15,16]. In Scotland, all faecal specimens from patients with severe gastrointestinal symptoms, specifically bloody diarrhoea and HUS, are submitted to the SERL for PCR and culture.…”

Section: Microbiology Investigationsmentioning

confidence: 99%

Epidemiological investigations identified an outbreak of Shiga toxin-producing Escherichia coli serotype O26:H11 associated with pre-packed sandwiches

Butt

Allison²,

Vishram

et al. 2021

Epidemiol. Infect.

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In October 2019, public health surveillance systems in Scotland identified an increase in the number of reported infections of Shiga toxin-producing Escherichia coli (STEC) O26:H11 involving bloody diarrhoea. Ultimately, across the United Kingdom (UK) 32 cases of STEC O26:H11 stx1a were identified, with the median age of 27 years and 64% were male; six cases were hospitalised. Among food exposures there was an association with consuming pre-packed sandwiches purchased at outlets belonging to a national food chain franchise (food outlet A) [odds ratio (OR) = 183.89, P < 0.001]. The common ingredient identified as a component of the majority of the sandwiches sold at food outlet A was a mixed salad of Apollo and Iceberg lettuce and spinach leaves. Microbiological testing of food and environmental samples were negative for STEC O26:H11, although STEC O36:H19 was isolated from a mixed salad sample taken from premises owned by food outlet A. Contamination of fresh produce is often due to a transient event and detection of the aetiological agent in food that has a short-shelf life is challenging. Robust, statistically significant epidemiological analysis should be sufficient evidence to direct timely and targeted on-farm investigations. A shift in focus from testing the microbiological quality of the produce to investigating the processes and practices through the supply chain and sampling the farm environment is recommended.

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Shiga toxin-producing Escherichia coli haemolytic uraemic syndrome (STEC-HUS): diagnosis, surveillance and public-health management in England

Cited by 17 publications

References 16 publications

Epidemiological investigation of recurrent outbreaks of haemolytic uraemic syndrome caused by Shiga toxin-producingEscherichia coliserotype O55:H7 in England, 2014–2018

Epidemiological investigation of recurrent outbreaks of haemolytic uraemic syndrome caused by Shiga toxin-producingEscherichia coliserotype O55:H7 in England, 2014–2018

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

Epidemiological investigations identified an outbreak of Shiga toxin-producing Escherichia coli serotype O26:H11 associated with pre-packed sandwiches

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