A large Great Britain-wide outbreak of STEC O157 phage type 8 linked to handling of raw leeks and potatoes.

Between December 2010 and July 2011, 252 cases of STEC O157 PT8 stx1 + 2 infection were reported in England, Scotland and Wales. This was the largest outbreak of STEC reported in England and the second largest in the UK to date. Eighty cases were hospitalized, with two cases of haemolytic uraemic syndrome and one death reported. Routine investigative data were used to generate a hypothesis but the subsequent case-control study was inconclusive. A second, more detailed, hypothesis generation exercise identified consumption or handling of vegetables as a potential mode of transmission. A second case-control study demonstrated that cases were more likely than controls to live in households whose members handled or prepared leeks bought unwrapped [odds ratio (OR) 40, 95% confidence interval (CI) 2·08-769·4], and potatoes bought in sacks (OR 13·13, 95% CI 1·19-145·3). This appears to be the first outbreak of STEC O157 infection linked to the handling of leeks.

Pathophysiology and treatment of typical and atypical hemolytic uremic syndrome.

Hemolytic uremic syndrome is a rare disease, frequently responsible for renal insufficiency in children. Recent findings have led to renewed interest in this pathology. The discovery of new gene mutations in the atypical form of HUS and the experimental data suggesting the involvement of the complement pathway in the typical form, open new perspectives for treatment. This review summarizes the current state of knowledge on both typical and atypical hemolytic uremic syndrome pathophysiology and examines new perspectives for treatment.

Acute kidney injury in Latin America: a view on renal replacement therapy resources.

BACKGROUND: Acute kidney injury (AKI) has increasingly been recognized as an important public health issue due to its rising frequency, its associations with early and late adverse outcomes and its economic burden. METHODS: Given the importance of determining the available resources to address this serious issue, the AKI Committee of SLANH conducted a survey to obtain information about infrastructure, human resources and equipment devoted to the treatment of AKI in Latin America RESULTS: A total of 246 units from 14 countries participated in the survey, the majority of them pertaining to nephrology divisions in teaching hospitals. Intermittent hemodialysis was universally performed by all of the units, and less frequently, slow extended dialysis (40%) and continuous renal replacement therapy (23%) were performed. Seventy-nine units (30%) perform peritoneal dialysis, but only 51 (19%) of them reported having treated at least 1 patient with this technique in the last 3 months pre-survey. The vast majority of the units reported adequate water treatment and use of modern filter membranes. Most of the patients received renal replacement therapy (RRT) in the intensive care unit. Specific causes of AKI were reported in different frequencies, with a heterogeneous pattern among the countries. Septic abortion, hemolytic-uremic syndrome, community-acquired diarrhea and leptospirosis were the etiologies most frequently associated with AKI. CONCLUSIONS: To our knowledge, this report was the first available study of the equipment and human resources utilized for RRT in AKI patients in Latin America.

Contribution of polyunsaturated fatty acids to Shiga toxin cytotoxicity in human renal tubular epithelium-derived cells.

Shiga toxin (Stx) produced by enterohemorrhagic Escherichia coli is a critical factor in the onset of hemolytic uremic syndrome. The current study was designed to assess whether n-3 and (or) n-6 polyunsaturated fatty acids (PUFA) act as a valuable adjunct to prevent the cell injury of renal tubule cells in the emergence of HUS. The target cells, ACHN cells derived from human tubule epithelium, were cultured with each PUFA, then exposed to Stx-1 or Stx-2. The rank order of potency of PUFA to inhibit the cell death caused by each toxin was as follows: EPA > AA = DHA >> LNA. There were dose-response relations in the efficacy of each PUFA. No prophylactic effect was found in the cultures with LA. Immunofluorescence assays revealed that both the expression of the toxin receptor on ACHN cells and binding between the toxin and cells were unaffected by the PUFA. These results suggest that EPA is the most efficacious PUFA against the renal tubule cell injury caused by Stx, which may be assigned to an alteration in the intracellular pathway leading to cell death.

[Dyslipidemia and reduced fibrinolysis in a child with hemolytic-uremic syndrome]. / Dislipidemia e ridotta fibrinolisi in un bambino con sindrome emolitico-uremica.

Many pathogenetic factors may enhance coagulation process and induce thrombosis. The Authors report a case of hemolytic-uremic syndrome, with marked evidence of macroscopic kidney thrombotic involvement, in which an important dyslipidemia (hypertriglyceridemia and hypercholesterolemia) was detected during the phase of clinical improvement. These findings, and the contemporary marked reduction of fibrinolytic activity, seem to be relevant pathogenetic factors in this case. The treatment with polyunsaturated fatty acids Omega 3 may have been helpful in modifying these serum abnormalities and maybe could have brought to the clinical improvement.