The role of <i>Escherichia coli</i> O 157 infections in the classical (enteropathic) haemolytic uraemic syndrome: Results of a Central European, multicentre study

Bitzan, Martin; Ludwig, Kerstin U.; Klemt, M.; König, H.; Burén, Jonas

doi:10.1017/s0950268800068102

Cited by 127 publications

(85 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It has been reported by some workers that the main humoral response to LPS in VTEC infections is an IgM response [21], but in other studies IgM plus IgA [28], IgG alone [29], or either IgM or IgG [19] were more important. In our initial analysis, when convalescent patients were viewed as a whole, they did not have signi®cantly higher levels of serum IgM or IgG antibodies to either antigen than the healthy volunteers (data not presented).…”

Section: Discussionmentioning

confidence: 99%

Mucosal and systemic antibody responses to the lipopolysaccharide of Escherichia coli O157 in health and disease*

Currie

McCALLUM

Poxton

2001

Journal of Medical Microbiology

View full text Add to dashboard Cite

Mucosal immunity in the gastrointestinal (GI) tract is a primary defence against GI pathogens. We hypothesise that a mucosal response to lipopolysaccharide (LPS), especially to the common (core) determinants of GI pathogenic Escherichia coli strains, is protective. The aims of this study were to investigate the speci®cities, levels and development of humoral responses in health and GI disease to the R3 LPS core and O-polysaccharide of E. coli O157. The purpose was to try to predict whether vaccination or passive immunisation might induce protection. Wherever possible, paired whole gut lavage¯uid (WGLF) and serum samples were collected for comparison of the mucosal and systemic responses. Matched saliva samples were also collected from some study groups. The patient groups included those with acute E. coli O157 disease (serum only), patients convalescing after E. coli O157 infections, and patients undergoing routine investigation for GI conditions but subsequently shown to be immunologically normal. Some samples of WGLF from patients with Crohn's disease (CRO) and ulcerative colitis (UC) were included to allow comparisons with patients with in¯ammatory conditions known to alter antibody secretion in the GI tract. The healthy groups from whom serum and saliva only were taken included blood donors, healthy volunteers and a group of slaughterhouse workers. This latter group was likely to have been exposed regularly to faecal bacteria from animals and antibody speci®cities might have been expected to be different from other healthy individuals. Levels and classes of antibodies were determined by ELISA with microtitration plates coated with polymyxin complexes of whole LPS extracted from E. coli O157 and LPS from the E. coli R3 rough mutant. Antibodies of IgG and IgM classes were measured in serum and IgA was measured in WGLF and saliva. IgG antibodies to the O157 LPS and the R3 core oligosaccharide were detected in the serum of healthy blood donors. Patients with acute E. coli O157 disease showed elevated levels of serum IgM to O157 LPS and R3, with IgG levels raised only to R3. In serum from convalescent patients, IgG to O157 LPS was signi®cantly above the control groups only in the period 6±16 weeks after infection. Total IgA levels were similar in WGLF specimens from all groups, except the patients with UC, whose levels were much higher. Speci®c IgA levels were higher in the E. coli O157 convalescent group, but there were no signi®cant correlations overall. UC patients had signi®cantly lower levels of IgA to O157 and CRO patients had higher O157 IgA levels than UC patients and healthy volunteers. In serum, inhibition of ELISA showed that the response to the O157 LPS was due in part to a response to the R3 oligosaccharide component. This response was much more pronounced in the healthy and non-O157 groups than in convalescent patients. There was no correlation between speci®c IgA antibody levels in saliva and matched specimens of WGLF, and levels in sequential saliva specimens¯uctuated widely. The signi®cant IgG an...

show abstract

Section: Discussionmentioning

confidence: 99%

Mucosal and systemic antibody responses to the lipopolysaccharide of Escherichia coli O157 in health and disease*

Currie

McCALLUM

Poxton

2001

Journal of Medical Microbiology

View full text Add to dashboard Cite

show abstract

“…Children and elderly people have been more susceptible to STEC infections than healthy adults (32). It is estimated that the incidence of HUS varies from 2.0 to 3.0 cases per 100,000 children under 5 years of age (15) and from 0.9 to 1.2 cases per 100,000 in children under 18 years of age (5,43).…”

mentioning

confidence: 99%

Clinical Escherichia coli Strains Carrying stx Genes: stx Variants and stx -Positive Virulence Profiles

2002

View full text Add to dashboard Cite

Altogether, 173 Shiga toxin-producing Escherichia coli (STEC) serotype O157 (n ‫؍‬ 111) and non-O157 (n ‫؍‬ 62) isolates from 170 subjects were screened by PCR-restriction fragment length polymorphism for eight different stx genes. The results were compiled according to serotypes, phage types of O157, production of Stx toxin and enterohemolysin, and the presence of eae. The stx genes occurred in 11 combinations; the most common were stx 2 with stx 2c (42%), stx 2 alone (21%), and stx 1 alone (16%). Of the O157 strains, 64% carried stx 2 with stx 2c versus 2% of the non-O157 strains (P < 0.001). In the non-O157 strains, the prevailing gene was stx 1 (99% versus 1% in O157 strains; P < 0.001). In addition, one strain (O Rough:H4:stx 2c ) which has not previously been described as associated with hemolytic-uremic syndrome (HUS) was found. Ten stx-positive virulence profiles were responsible for 71% of all STEC infections. Of these profiles, five accounted for 71% of the 21 strains isolated from 20 patients with HUS or thrombotic thrombocytopenic purpura (TTP). The strains having the virulence profile that caused mainly HUS or TTP or bloody diarrhea produced Stx with titers of >1:128 (90%) more commonly than did other strains (51%; P < 0.001). These strains were also more commonly enterohemolytic (98% versus 68% for other strains; P < 0.001) and possessed the eae gene (100%) more commonly than did other strains (74%; P < 0.001). A particular virulence profile, O157:H7:PT2:stx 2 :stx 2c :eae: Ehly, was significantly more frequently associated with HUS and bloody diarrhea than were other profiles (P ‫؍‬ 0.02) and also caused the deaths of two children. In this study, the risk factors for severe symptoms were an age of <5 years and infection by the strain of O157:H7:PT2 mentioned above.Shiga toxin-producing Escherichia coli (STEC) cells have emerged as new food-borne pathogens of clinical and public health concern (35). The most epidemic STEC serogroup has been O157, but about 200 other STEC serogroups have been identified (http://www.microbionet.com.au/frames/feature /vtec/brief01.html). Shiga toxins (Stx1 and/or Stx2) have a prominent role in the pathogenesis of STEC bacteria (15,20,26). The clinical picture of a STEC infection may vary from an asymptomatic state to bloody diarrhea and severe life-threatening complications such as hemolytic-uremic syndrome (HUS) or thrombotic thrombocytopenic purpura (TTP) (35). Children and elderly people have been more susceptible to STEC infections than healthy adults (32). It is estimated that the incidence of HUS varies from 2.0 to 3.0 cases per 100,000 children under 5 years of age (15) and from 0.9 to 1.2 cases per 100,000 in children under 18 years of age (5, 43).The pathogenesis of STEC infection in humans is not fully understood. It is considered to be multifactorial and dependent on several bacterial virulence factors such as enterohemolysin (Ehly) and the eae gene, in addition to host factors (6,35). A recent discovery of a quorum-sensing system, mediated by self-produced...

show abstract

“…Infection by E. coli O157 induces a vigorous immune response that is reflected in an acute rise of serum levels of O-group-specific IgA, IgM and, although less consistently, IgG antibodies (8,10,11,28). Here we show that children with E. coli O157-associated HUS also demonstrate easily detectable salivary IgM and IgA class antibodies.…”

Section: Discussionmentioning

confidence: 99%

“…LPS ELISA plates were interchangeably used for saliva and serum antibody studies. Serum samples were diluted 1:500 in PBS containing 0.1% Tween-20 (Merck, Darmstadt, Germany) and 2% fetal bovine serum (Linaris, Bettingen am Main, Germany) and were tested for IgM and IgA antibodies against E. coli O157 LPS as published previously (10).…”

Section: Patients and Controlsmentioning

confidence: 99%

“…To establish the sensitivity and specificity of the ELISA, homologous anti-O157 LPS and heterologous non-O157 LPS sera from rabbits were used, respectively. The breakpoints were defined as the mean absorbency plus 3 SD of the control specimens as described previously (10,11). Previously defined serum and saliva samples were run with each assay as positive and negative controls.…”

Section: Patients and Controlsmentioning

confidence: 99%

See 1 more Smart Citation

Saliva IgM and IgA Are a Sensitive Indicator of the Humoral Immune Response to Escherichia coli O157 Lipopolysaccharide in Children with Enteropathic Hemolytic Uremic Syndrome

Ludwig

2002

Pediatric Research

Self Cite

View full text Add to dashboard Cite

Saliva antibodies to Escherichia coli O157 were investigated as markers of the immune response in children with enteropathic hemolytic uremic syndrome (HUS). Paired serum and saliva samples were collected from 22 children with HUS during acute disease and convalescence and were tested for E. coli O157 lipopolysaccharide (LPS)-specific IgM and IgA antibodies by ELISA. Serum and saliva samples from 44 age-matched controls were used to establish the cut-off values. Elevated levels of IgM and/or IgA antibodies to O157 LPS were detected in saliva of 13/13 HUS patients with Shiga toxin-producing E. coli (STEC) O157 in stool culture and from 4 of 5 HUS patients in whom STEC were not detected. These results closely mirrored the results obtained with paired serum samples. In contrast, saliva and serum samples from four children with STEC isolates belonging to O-groups O26, O145 (n ϭ 2), and O165 lacked detectable O157 LPS-specific antibodies. The specificity of the ELISA was confirmed by western blotting. In STEC O157 culture-confirmed cases, the sensitivity of the ELISA was 92% for saliva IgM and IgA, based on the first available sample, and 100% and 92%, respectively, when subsequent samples were included. The specificity was 98% for IgM and 100% for IgA. Children with E. coli O157 HUS demonstrate a brisk, easily detectable immune response as reflected by the presence of specific antibodies in their saliva. Saliva-based immunoassays offer a reliable, noninvasive method for the diagnosis of E. coli O157 infection in patients with enteropathic HUS. The clinical spectrum of STEC, especially of prototypic E. coli O157 strains, includes mild diarrhea, hemorrhagic colitis, and the classical (enteropathic) HUS (E ϩ HUS) (1-3). E ϩ HUS occurs predominantly in young children and in the elderly possibly because of a lack of immunity in these age groups (3, 4). It is characterized by a prodrome of gastroenteritis, frequently with bloody diarrhea, followed by acute microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. Occasionally, other organs are also affected (4, 5). E ϩ HUS accounts for approximately 50% of acute renal failure in young children (4, 6). Outbreaks and sporadic infections by E. coli O157 have been reported from all inhabited continents (6). The largest recorded outbreak of E. coli O157 to date occurred in Sakai City (Japan) in 1996. It led to 12,680 cases of diarrhea and 121 of HUS and dramatically illustrated the pathogenic potential and public health importance of this organism (7). It also demonstrated the continuing need for simple and rapid diagnostic techniques.The detection of IgM and IgA, and IgG antibodies to STEC LPS O157, but also to non-O157 LPS in serum samples, has emerged as a useful and reliable diagnostic method (8 -13), especially when the bacterial isolation fails (13, 14). Two preliminary reports proposed the measurement of saliva anti-

show abstract

The role of Escherichia coli O 157 infections in the classical (enteropathic) haemolytic uraemic syndrome: Results of a Central European, multicentre study

Cited by 127 publications

References 37 publications

Mucosal and systemic antibody responses to the lipopolysaccharide of Escherichia coli O157 in health and disease*

Mucosal and systemic antibody responses to the lipopolysaccharide of Escherichia coli O157 in health and disease*

Clinical Escherichia coli Strains Carrying stx Genes: stx Variants and stx -Positive Virulence Profiles

Saliva IgM and IgA Are a Sensitive Indicator of the Humoral Immune Response to Escherichia coli O157 Lipopolysaccharide in Children with Enteropathic Hemolytic Uremic Syndrome

Contact Info

Product

Resources

About