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Is Shigatoxin 1 protective for the development of Shigatoxin 2-related hemolytic uremic syndrome in children? Data from the ItalKid-HUS Network.
Pediatr Nephrol. 2020 10; 35(10):1997-2001.PN

Abstract

BACKGROUND

Shigatoxin (Stx)-producing Escherichia coli (STEC) are the most common causes of hemolytic uremic syndrome (STEC-HUS). The aim of our study is to compare the risk of developing STEC-HUS in relation to the type of Stx genes (Stx1, Stx2, or both).

METHODS

This is a prospective, observational, multicenter study involving 63 pediatric units in Northern Italy (ItalKid-HUS Network). STEC-infected children were identified within a screening program for bloody diarrhea during a 10-year period (2010-2019). Stx genes were detected by reverse dot blot or real-time PCR. After the identification of STEC infection, children were followed until diarrhea complete recovery for the possible development of STEC-HUS.

RESULTS

Of the 214 Stx-positive patients, 34 (15.9%) developed STEC-HUS. The risk of HUS in STEC-infected children with Stx1 (n: 62; 29.0%) and Stx2 (n: 97; 45.3%) was respectively 0% and 23.7%, while in patients carrying both Stx1 and Stx2 (n: 55; 25.7%), the risk was 12.7% (p: 0.001).

CONCLUSIONS

Our data confirm that Stx1 is a very rare cause of STEC-HUS and demonstrate that the risk of STEC-HUS halves in the case of Stx1+2-producing Escherichia coli infection compared with infections where Stx2 is present alone. This observation is helpful in assessing the risk of individual STEC-infected patients for the development of HUS and suggests that Stx1, in the presence of Stx2, might exert a protective role possibly by receptor competition.

Authors+Show Affiliations

Center for HUS Prevention, Control and Management, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Commenda 9, 20122, Milan, Italy. ardissino@centroseu.org.Pediatric Unit, Ospedale Infantile C.Arrigo, Spalto Marengo 46, 15121, Alessandria, Italy.Unit of Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Commenda 9, 20122, Milan, Italy.Unit of Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Commenda 9, 20122, Milan, Italy.Center for HUS Prevention, Control and Management, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Commenda 9, 20122, Milan, Italy.Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40126, Bologna, Italy.Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia-Romagna, 26900, Lodi, Italy.Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via San Barnaba 8, 20122, Milan, Italy.Center for HUS Prevention, Control and Management, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Commenda 9, 20122, Milan, Italy. Giuliana and Bernardo Caprotti Chair of Pediatrics, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

32734345

Citation

Ardissino, Gianluigi, et al. "Is Shigatoxin 1 Protective for the Development of Shigatoxin 2-related Hemolytic Uremic Syndrome in Children? Data From the ItalKid-HUS Network." Pediatric Nephrology (Berlin, Germany), vol. 35, no. 10, 2020, pp. 1997-2001.
Ardissino G, Possenti I, Vignati C, et al. Is Shigatoxin 1 protective for the development of Shigatoxin 2-related hemolytic uremic syndrome in children? Data from the ItalKid-HUS Network. Pediatr Nephrol. 2020;35(10):1997-2001.
Ardissino, G., Possenti, I., Vignati, C., Daprai, L., Capone, V., Brigotti, M., Luini, M. V., Consonni, D., & Montini, G. (2020). Is Shigatoxin 1 protective for the development of Shigatoxin 2-related hemolytic uremic syndrome in children? Data from the ItalKid-HUS Network. Pediatric Nephrology (Berlin, Germany), 35(10), 1997-2001. https://doi.org/10.1007/s00467-020-04697-y
Ardissino G, et al. Is Shigatoxin 1 Protective for the Development of Shigatoxin 2-related Hemolytic Uremic Syndrome in Children? Data From the ItalKid-HUS Network. Pediatr Nephrol. 2020;35(10):1997-2001. PubMed PMID: 32734345.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is Shigatoxin 1 protective for the development of Shigatoxin 2-related hemolytic uremic syndrome in children? Data from the ItalKid-HUS Network. AU - Ardissino,Gianluigi, AU - Possenti,Ilaria, AU - Vignati,Chiara, AU - Daprai,Laura, AU - Capone,Valentina, AU - Brigotti,Maurizio, AU - Luini,Mario Vittorio, AU - Consonni,Dario, AU - Montini,Giovanni, Y1 - 2020/07/30/ PY - 2020/02/28/received PY - 2020/06/25/accepted PY - 2020/06/16/revised PY - 2020/8/1/pubmed PY - 2021/7/3/medline PY - 2020/8/1/entrez KW - Children KW - Diarrhea KW - Hemolytic uremic syndrome KW - Shiga toxin SP - 1997 EP - 2001 JF - Pediatric nephrology (Berlin, Germany) JO - Pediatr Nephrol VL - 35 IS - 10 N2 - BACKGROUND: Shigatoxin (Stx)-producing Escherichia coli (STEC) are the most common causes of hemolytic uremic syndrome (STEC-HUS). The aim of our study is to compare the risk of developing STEC-HUS in relation to the type of Stx genes (Stx1, Stx2, or both). METHODS: This is a prospective, observational, multicenter study involving 63 pediatric units in Northern Italy (ItalKid-HUS Network). STEC-infected children were identified within a screening program for bloody diarrhea during a 10-year period (2010-2019). Stx genes were detected by reverse dot blot or real-time PCR. After the identification of STEC infection, children were followed until diarrhea complete recovery for the possible development of STEC-HUS. RESULTS: Of the 214 Stx-positive patients, 34 (15.9%) developed STEC-HUS. The risk of HUS in STEC-infected children with Stx1 (n: 62; 29.0%) and Stx2 (n: 97; 45.3%) was respectively 0% and 23.7%, while in patients carrying both Stx1 and Stx2 (n: 55; 25.7%), the risk was 12.7% (p: 0.001). CONCLUSIONS: Our data confirm that Stx1 is a very rare cause of STEC-HUS and demonstrate that the risk of STEC-HUS halves in the case of Stx1+2-producing Escherichia coli infection compared with infections where Stx2 is present alone. This observation is helpful in assessing the risk of individual STEC-infected patients for the development of HUS and suggests that Stx1, in the presence of Stx2, might exert a protective role possibly by receptor competition. SN - 1432-198X UR - https://cancerres.unboundmedicine.com/medline/citation/32734345/Is_Shigatoxin_1_protective_for_the_development_of_Shigatoxin_2_related_hemolytic_uremic_syndrome_in_children_Data_from_the_ItalKid_HUS_Network_ L2 - https://dx.doi.org/10.1007/s00467-020-04697-y DB - PRIME DP - Unbound Medicine ER -