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Bloody Diarrhea and Shiga Toxin-Producing Escherichia coli Hemolytic Uremic Syndrome in Children: Data from the ItalKid-HUS Network.
J Pediatr. 2021 Oct; 237:34-40.e1.JPed

Abstract

OBJECTIVE

To analyze the results of an enhanced laboratory-surveillance protocol for bloody diarrhea aimed at identifying children with Shiga toxin-producing Escherichia coli (STEC) infection early in the course of the disease toward the early identification and management of patients with hemolytic uremic syndrome (HUS).

STUDY DESIGN

The study (2010-2019) involved a referral population of 2.3 million children. Stool samples of patients with bloody diarrhea were screened for Shiga toxin (Stx) genes. Positive patients were rehydrated and monitored for hemoglobinuria until diarrhea resolved or STEC-HUS was diagnosed.

RESULTS

A total of 4767 children were screened; 214 (4.5%) were positive for either Stx1 (29.0%) or Stx2 (45.3%) or both Stx1+2 (25.7%); 34 patients (15.9%) developed STEC-HUS (0.71% of bloody diarrheas). Hemoglobinuria was present in all patients with HUS. Patients with Stx2 alone showed a greater risk of STEC-HUS (23.7% vs 12.7%) and none of the patients with Stx1 alone developed HUS. During the same period of time, 95 other patients were diagnosed STEC-HUS but were not captured by the screening program (26 had nonbloody diarrhea, 11 came from areas not covered by the screening program, and 58 had not been referred to the screening program, although they did meet the inclusion criteria). At HUS presentation, serum creatinine of patients identified by screening was significantly lower compared with that of the remaining patients (median 0.9 vs 1.51 mg/dL).

CONCLUSIONS

Nearly 1% of children with bloody diarrhea developed STEC-HUS, and its diagnosis was anticipated by the screening program for Stx. The screening of bloody diarrhea for Stx is recommended, and monitoring patients carrying Stx2 with urine dipstick for hemoglobinuria is suggested to identify the renal complication as early as possible.

Authors+Show Affiliations

Center for HUS Prevention Control and Management, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano. Electronic address: ardissino@centroseu.org.Laboratory of Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano.Laboratory of Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano.Center for HUS Prevention Control and Management, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano.Laboratory of Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano.Department of Pediatrics, Vittore Buzzi Children's Hospital, Milano.Laboratory of Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano.Center for HUS Prevention Control and Management, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano.Laboratory of Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano.Center for HUS Prevention Control and Management, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano.Lombardia and Emilia Romagna Experimental Zootechnic Institute (IZSLER), Lodi; Institute of Agricultural Biology and Biotechnology, National Research Council, Lodi.Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna.ASL 1 Imperiese: Azienda Sanitaria Locale 1 Imperiese - Ospedale di Sanremo, Sanremo.Pediatric Unit, Ospedale Pia Luvini, ASST-Sette Laghi-Università Insubria, Cittiglio.Department of Laboratory Medicine, Fondazione Poliambulanza Istituto Ospedaliero, Brescia.Department of Laboratory Medicine, Azienda Ospedaliera Carlo Poma, Mantova.Department of Pediatrics, Vittore Buzzi Children's Hospital, Milano.Pediatric Unit, Ospedale Infantile C. Arrigo, Alessandria.Nephrology and Dialysis Unit, Center for HUS Prevention Control and Management, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano.Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano.Center for HUS Prevention Control and Management, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano; Department of Clinical Sciences and Community Health, University of Milan, Milano.Azienda socio sanitaria territoriale (ASST) Melegnano e della Martesana - Vizzolo Predabissi, Milano, Italy.No affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

34197890

Citation

Ardissino, Gianluigi, et al. "Bloody Diarrhea and Shiga Toxin-Producing Escherichia Coli Hemolytic Uremic Syndrome in Children: Data From the ItalKid-HUS Network." The Journal of Pediatrics, vol. 237, 2021, pp. 34-40.e1.
Ardissino G, Vignati C, Masia C, et al. Bloody Diarrhea and Shiga Toxin-Producing Escherichia coli Hemolytic Uremic Syndrome in Children: Data from the ItalKid-HUS Network. J Pediatr. 2021;237:34-40.e1.
Ardissino, G., Vignati, C., Masia, C., Capone, V., Colombo, R., Tel, F., Daprai, L., Testa, S., Dodaro, A., Paglialonga, F., Luini, M., Brigotti, M., Picicco, D., Baldioli, C., Pagani, F., Ceruti, R., Tommasi, P., Possenti, I., Cresseri, D., ... Arghittu, M. (2021). Bloody Diarrhea and Shiga Toxin-Producing Escherichia coli Hemolytic Uremic Syndrome in Children: Data from the ItalKid-HUS Network. The Journal of Pediatrics, 237, 34-e1. https://doi.org/10.1016/j.jpeds.2021.06.048
Ardissino G, et al. Bloody Diarrhea and Shiga Toxin-Producing Escherichia Coli Hemolytic Uremic Syndrome in Children: Data From the ItalKid-HUS Network. J Pediatr. 2021;237:34-40.e1. PubMed PMID: 34197890.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bloody Diarrhea and Shiga Toxin-Producing Escherichia coli Hemolytic Uremic Syndrome in Children: Data from the ItalKid-HUS Network. AU - Ardissino,Gianluigi, AU - Vignati,Chiara, AU - Masia,Carla, AU - Capone,Valentina, AU - Colombo,Rosaria, AU - Tel,Francesca, AU - Daprai,Laura, AU - Testa,Sara, AU - Dodaro,Antonella, AU - Paglialonga,Fabio, AU - Luini,Mario, AU - Brigotti,Maurizio, AU - Picicco,Damiano, AU - Baldioli,Carlo, AU - Pagani,Franca, AU - Ceruti,Rossella, AU - Tommasi,Paola, AU - Possenti,Ilaria, AU - Cresseri,Donata, AU - Consonni,Dario, AU - Montini,Giovanni, AU - Arghittu,Milena, AU - ,, Y1 - 2021/06/29/ PY - 2021/02/10/received PY - 2021/06/03/revised PY - 2021/06/22/accepted PY - 2021/7/2/pubmed PY - 2021/11/27/medline PY - 2021/7/1/entrez KW - Shiga toxin KW - bloody diarrhea KW - children KW - diarrhea KW - hemolytic uremic syndrome SP - 34 EP - 40.e1 JF - The Journal of pediatrics JO - J Pediatr VL - 237 N2 - OBJECTIVE: To analyze the results of an enhanced laboratory-surveillance protocol for bloody diarrhea aimed at identifying children with Shiga toxin-producing Escherichia coli (STEC) infection early in the course of the disease toward the early identification and management of patients with hemolytic uremic syndrome (HUS). STUDY DESIGN: The study (2010-2019) involved a referral population of 2.3 million children. Stool samples of patients with bloody diarrhea were screened for Shiga toxin (Stx) genes. Positive patients were rehydrated and monitored for hemoglobinuria until diarrhea resolved or STEC-HUS was diagnosed. RESULTS: A total of 4767 children were screened; 214 (4.5%) were positive for either Stx1 (29.0%) or Stx2 (45.3%) or both Stx1+2 (25.7%); 34 patients (15.9%) developed STEC-HUS (0.71% of bloody diarrheas). Hemoglobinuria was present in all patients with HUS. Patients with Stx2 alone showed a greater risk of STEC-HUS (23.7% vs 12.7%) and none of the patients with Stx1 alone developed HUS. During the same period of time, 95 other patients were diagnosed STEC-HUS but were not captured by the screening program (26 had nonbloody diarrhea, 11 came from areas not covered by the screening program, and 58 had not been referred to the screening program, although they did meet the inclusion criteria). At HUS presentation, serum creatinine of patients identified by screening was significantly lower compared with that of the remaining patients (median 0.9 vs 1.51 mg/dL). CONCLUSIONS: Nearly 1% of children with bloody diarrhea developed STEC-HUS, and its diagnosis was anticipated by the screening program for Stx. The screening of bloody diarrhea for Stx is recommended, and monitoring patients carrying Stx2 with urine dipstick for hemoglobinuria is suggested to identify the renal complication as early as possible. SN - 1097-6833 UR - https://cancerres.unboundmedicine.com/medline/citation/34197890/Bloody_Diarrhea_and_STEC-HUS_in_Children:_Data_from_the_ItalKid-HUS_Network. L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3476(21)00630-2 DB - PRIME DP - Unbound Medicine ER -