Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 732
Filtrar
1.
Pediatrics ; 144(4)2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31519792

RESUMEN

BACKGROUND: In 2017, we conducted a multistate investigation to determine the source of an outbreak of Shiga toxin-producing Escherichia coli (STEC) O157:H7 infections, which occurred primarily in children. METHODS: We defined a case as infection with an outbreak strain of STEC O157:H7 with illness onset between January 1, 2017, and April 30, 2017. Case patients were interviewed to identify common exposures. Traceback and facility investigations were conducted; food samples were tested for STEC. RESULTS: We identified 32 cases from 12 states. Twenty-six (81%) cases occurred in children <18 years old; 8 children developed hemolytic uremic syndrome. Twenty-five (78%) case patients ate the same brand of soy nut butter or attended facilities that served it. We identified 3 illness subclusters, including a child care center where person-to-person transmission may have occurred. Testing isolated an outbreak strain from 11 soy nut butter samples. Investigations identified violations of good manufacturing practices at the soy nut butter manufacturing facility with opportunities for product contamination, although the specific route of contamination was undetermined. CONCLUSIONS: This investigation identified soy nut butter as the source of a multistate outbreak of STEC infections affecting mainly children. The ensuing recall of all soy nut butter products the facility manufactured, totaling >1.2 million lb, likely prevented additional illnesses. Prompt diagnosis of STEC infections and appropriate specimen collection aids in outbreak detection. Child care providers should follow appropriate hygiene practices to prevent secondary spread of enteric illness in child care settings. Firms should manufacture ready-to-eat foods in a manner that minimizes the risk of contamination.


Asunto(s)
Brotes de Enfermedades/estadística & datos numéricos , Infecciones por Escherichia coli/epidemiología , Escherichia coli O157 , Enfermedades Transmitidas por los Alimentos/epidemiología , Escherichia coli Shiga-Toxigénica , Alimentos de Soja/microbiología , Adolescente , Anciano , Niño , Jardines Infantiles/estadística & datos numéricos , Preescolar , Infecciones por Escherichia coli/microbiología , Comida Rápida/efectos adversos , Comida Rápida/microbiología , Femenino , Manipulación de Alimentos , Enfermedades Transmitidas por los Alimentos/microbiología , Síndrome Hemolítico-Urémico/epidemiología , Síndrome Hemolítico-Urémico/microbiología , Humanos , Lactante , Masculino , Recall y Retirada del Producto , Alimentos de Soja/efectos adversos , Estados Unidos/epidemiología
2.
Iran J Kidney Dis ; 13(3): 139-150, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-31209187

RESUMEN

Shiga toxin induced Escherichia Coli (STEC) is associated with chronic kidney disease or neurologic disability. The aim of this study is to determine the prevalence of STEC identified in human studies in Iran. Search engines of PubMed, EMBASE, OVID, SCOPUS, Web of Science, Google Scholar, IranMedex, MagIran, SID and ganj.irandoc were used. All human studies with stool or rectal swap samples evaluated for STEC and the outcome of HUS in Iran, which had been published between 1985 and 2017, were included. Chi-square and I2 statistic tests were applied to assess between-studies heterogeneity. Pooled prevalence and odd ratio were calculated using random effect models. A total of 30 articles containing 23379 samples were included for the final analysis. The design of study was cross sectional in 16, case control in 13 and one was cohort. The pooled prevalence of STEC was 7% (95% CI, 5 - 11; I2 = 98.3%). In subgroup analysis, the pooled prevalence was 8% (95% CI, 4 - 13; I2 = 97.55%) in children but 4% (95% CI, 2 - 7; I2 = 97.66%) in adults. The odds of patients with diarrhea having had STEC were 7.06 times the odds of healthy subjects (pooled OR = 7.06, 95% CI: 3.66-13.61). Patients with bloody diarrhea less likely to have positive STEC than patients with non-bloody diarrhea (pooled OR = 0.33, 95% CI: 0.10-1.02). STEC was prevalent in diarrheic patients and the rate increased in recent years. The highest contamination was seen in East-South of Iran. Public health intervention is mandatory to eliminate it effectively.


Asunto(s)
Infecciones por Escherichia coli/epidemiología , Gastroenteritis/epidemiología , Síndrome Hemolítico-Urémico/epidemiología , Escherichia coli Shiga-Toxigénica/aislamiento & purificación , Diarrea/diagnóstico , Diarrea/epidemiología , Diarrea/microbiología , Infecciones por Escherichia coli/diagnóstico , Infecciones por Escherichia coli/microbiología , Heces/microbiología , Gastroenteritis/diagnóstico , Gastroenteritis/microbiología , Síndrome Hemolítico-Urémico/diagnóstico , Síndrome Hemolítico-Urémico/microbiología , Humanos , Irán/epidemiología , Prevalencia
3.
Artículo en Inglés | MEDLINE | ID: mdl-31083597

RESUMEN

Shiga toxin-producing Escherichia Coli (STEC) infections routinely run as a common gastroenteritis, but in many cases they may evolve towards hemolytic uremic syndrome (HUS). HUS is a rare disease characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. Gut microorganisms have a fundamental impact on human physiology, because they modulate normal intestinal functions and play a pivotal role in influencing the local and systemic immune responses. Despite surveillance established in many countries and major progresses in the understanding of STEC-HUS mechanisms, no specific treatment is currently available. Targeting the gut microbiota could represent a new potential therapeutic strategy in STEC infection. In this paper, we reviewed the current knowledge about microbiota characteristics of patients with STEC infections, as well as in vitro and in vivo evidence of probiotic supplementation in managing STEC gastroenteritis and in HUS onset prevention.


Asunto(s)
Infecciones por Escherichia coli/tratamiento farmacológico , Gastroenteritis/tratamiento farmacológico , Microbioma Gastrointestinal , Síndrome Hemolítico-Urémico/tratamiento farmacológico , Probióticos/uso terapéutico , Escherichia coli Shiga-Toxigénica/fisiología , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/microbiología , Gastroenteritis/complicaciones , Gastroenteritis/epidemiología , Gastroenteritis/microbiología , Síndrome Hemolítico-Urémico/epidemiología , Síndrome Hemolítico-Urémico/microbiología , Humanos , Incidencia
4.
J Med Microbiol ; 68(6): 930-939, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30994441

RESUMEN

PURPOSE: This study describes the epidemiology of Shiga toxin-producing Escherichia coli (STEC) infections in a population in the South East of England. METHODS: From 1 November 2013 to 31 March 2017 participating diagnostic laboratories reported Shiga toxin gene (stx) positive real-time PCR results to local public health teams. Stx positive faecal samples/isolates were referred to the Gastrointestinal Bacteria Reference Unit (GBRU) for confirmation by culture and typing by whole genome sequencing (WGS). Key clinical information was collected by public health teams.Results/Key findings. Altogether, 548 faecal specimens (420 were non-travel associated) were stx positive locally, 535 were submitted to the GBRU. STEC were isolated from 42 %, confirmed by stx PCR in 21 % and 37 % were PCR negative. The most common non-travel associated STEC serogroups were O157, O26, O146 and O91. The annualized incidence of confirmed STEC infections (PCR or culture) was 5.8 per 100 000. The ratio of O157 to non-O157 STEC serogroups was 1:7. The annualized incidence of non-O157 haemolytic uraemic syndrome-associated Escherichia coli (HUSEC) strains was 0.4 per 100 000. Bloody diarrhoea was reported by 58 % of cases infected with E. coli O157, 33 % of cases infected with non-O157 HUSEC strains and 12 % of other lower risk non-O157 strains. Overall, 76 % of non-O157 HUSEC isolates possessed the eae virulence gene. CONCLUSIONS: HUSEC including serogroup O157 were uncommon and more likely to cause bloody diarrhoea than other STEC. The routine use of stx PCR testing can influence clinical management. Understanding the local epidemiology facilitates a proportionate public health response to STEC, based on clinical and microbiological characteristics including stx subtype(s).


Asunto(s)
Infecciones por Escherichia coli/epidemiología , Síndrome Hemolítico-Urémico/epidemiología , Toxina Shiga/metabolismo , Escherichia coli Shiga-Toxigénica/inmunología , Diarrea/epidemiología , Diarrea/microbiología , Inglaterra/epidemiología , Infecciones por Escherichia coli/microbiología , Heces/microbiología , Síndrome Hemolítico-Urémico/microbiología , Humanos , Incidencia , Salud Pública , Serogrupo , Escherichia coli Shiga-Toxigénica/aislamiento & purificación , Escherichia coli Shiga-Toxigénica/patogenicidad , Virulencia
5.
Pediatr Neonatol ; 60(1): 87-94, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-29807724

RESUMEN

BACKGROUND AND AIMS: To describe the epidemiologic, clinical, microbiological, therapeutic and outcome characteristics of a HUS outbreak occurring in southern Romania from 2015 to 2016. METHODS: We retrospectively collected data from the medical records of all HUS cases hospitalized at the pediatric nephrology department of Marie Curie Children's Hospital of Bucharest, Romania. RESULTS: There were 32 HUS cases (19 girls/13 boys, 87.6% <2 years), all associated with diarrhea (bloody in 13, 40.6%). Thirteen (40.6%) and 4 (12.5%) patients had oliguria and anuria at admission. Extreme pallor, generalized edema, vomiting, dehydration, fever and seizures were found in 100%, 56.3%, 31.3%, 31.3%, 25% and 9.4% of patients, respectively. E. coli and STEC were identified in the stools of 6 and 8 patients, respectively; E. coli O26 and O157 infection were documented serologically in 10 and 3 children, respectively. There were 15/32 (46.9%) patients with confirmed HUS. Eighteen (56.3%) patients were hypertensive; other complications included infections, left ventricular hypertrophy, cardiopulmonary arrest, seizures and encephalopathy in 62.5%, 37.5%, 28.3%, 18.8% and 12.5%, respectively. Peritoneal dialysis and hemodialysis were performed in 23 (72%) and 2 patients, respectively. Three patients (9.4%) died early during hospitalization. A 6-12-month follow-up of 26 patients revealed that 65.4% had post-HUS sequelae (persistent hypertension and chronic renal failure in 34.6% and 30.8%, respectively). CONCLUSIONS: The principal STEC serotype involved was O26:H11 and the number of confirmed HUS cases reached half of the patients. Compared with the medical literature, this outbreak had a higher rate of complications and renal sequelae and was associated with a high fatality rate.


Asunto(s)
Brotes de Enfermedades , Síndrome Hemolítico-Urémico/epidemiología , Adolescente , Niño , Preescolar , Femenino , Síndrome Hemolítico-Urémico/microbiología , Síndrome Hemolítico-Urémico/terapia , Humanos , Lactante , Masculino , Estudios Retrospectivos , Rumanía/epidemiología
6.
Clin Microbiol Infect ; 25(1): 111.e5-111.e8, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30076975

RESUMEN

OBJECTIVES: Recently a highly virulent Escherichia coli O80:H2 pathotype carrying Shiga toxin genes, the intimin subtype eaeξ, and genes associated with the extraintestinal pathogenic E. coli (ExPEC) pS88 plasmid was described in France. In this study we examine the relatedness of Belgian E. coli O80:H2 isolated from humans and diarrhoeic calves as well their similarities with the French pathotype. METHODS: Eighteen Belgian E. coli O80:H2 strains (nine human Shiga toxin-producing E. coli (STEC) (2008-2016), two bovine STEC (1987) and seven bovine atypical enteropathogenic E. coli (aEPEC) (2009-2015)) were characterized with conventional PCR, disc diffusion susceptibility testing and whole genome sequencing. RESULTS: Only nine sporadic human STEC O80:H2 cases have been detected in Belgium. All patients were female, just two of them suffered from haemolytic uremic syndrome. All studied strains had the eaeξ subtype, belonged to the multi-locus sequence type ST-301, and carried virulence genes associated with the type III secretion system and effectors not encoded by the locus of enterocyte effacement (LEE). Multiple genes of the pS88 plasmid were detected in all but two strains (one human and one calf STEC). The Shiga toxin subtypes stx1a (n = 3; one human, two calf), stx2a (n = 2) and stx2d (n = 6) were detected. All strains were multidrug resistant, two were extended-spectrum ß-lactamase positive. Core genome MLST revealed that some human and calf E. coli differed by only 22 loci. CONCLUSIONS: The STEC/ExPEC O80:H2 pathotype was present in calves in Belgium as early as 1987, but human infections have been rare and mostly mild. The human STEC and bovine aEPEC cluster together and have the potential to be as virulent as the French isolates, as shown by their similar gene content.


Asunto(s)
Enfermedades de los Bovinos/epidemiología , Diarrea/microbiología , Escherichia coli Enteropatógena/aislamiento & purificación , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/veterinaria , Escherichia coli Shiga-Toxigénica/aislamiento & purificación , Anciano , Animales , Antibacterianos/farmacología , Técnicas de Tipificación Bacteriana , Bovinos , Enfermedades de los Bovinos/microbiología , Preescolar , Femenino , Síndrome Hemolítico-Urémico/epidemiología , Síndrome Hemolítico-Urémico/veterinaria , Humanos , Lactante , Persona de Mediana Edad , Tipificación de Secuencias Multilocus , Reacción en Cadena de la Polimerasa , Serogrupo , Factores de Virulencia/genética , Secuenciación Completa del Genoma , Adulto Joven
7.
Georgian Med News ; (283): 123-129, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30516507

RESUMEN

Shiga toxin-producing Escherichia coli (STEC) causes illness ranging from mild diarrhea to bloody diarrhea, to the hemolytic uremic syndrome (HUS), which manifests with a triad of microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. Surveillance of HUS and bloody diarrhea is not performed in Georgia. The primary objective of our study was to determine the annual incidence of diarrheal diseases. The secondary objective was to assess epidemiological characteristics, etiology and risk factors of diarrhea and HUS in Georgia among children under 15. We collected a retrospective data on diarrheal diseases particularly bloody diarrhea and HUS among children in Georgia in 2009-2016 years. Laboratory, clinical and epidemiological data was entered into electronic database. Descriptive statistics, proportions, incidence rates, means and medians were calculated in R statistical language using statistical package R for windows v 3.4.3. A total of 316 cases of bloody diarrhea including 64 (20.2%) cases complicated with HUS under age 15 were identified from 2009 until 2016. From 316 patients 5 (1.6%) have died, all of them with diagnosis and severe complications of HUS. Average rate of HUS per 100,000 populations during 2009-2016 was 0.3 and for bloody diarrhea 2 per 100,000. High RR for food products consumed by children with bloody diarrhea either complicated with HUS or not were various ice-creams produced locally (RR 4.23 P<0.001), dairy products (RR 2.79 P = 0.01), ground beef products (RR 4.52 P<0.001). The another highest attack ratio was identified for fruits (RR 6.19 P<0.001) and vegetables (RR 3.45 P < 0.001). Different enteric pathogens including shiga toxin producing E. coli was detected as etiology of diarrheal diseases and HUS. Epidemiological data suggests that inadequately washed fruits, vegetables and eating undercooked food and ice-cream could be a possible risk factors of exposure with enteric pathogens and developing diarrhea and HUS among children. Further investigations of food products are required to determine epidemiology and source food products of bloody diarrhea and HUS among children in Georgia.


Asunto(s)
Diarrea/epidemiología , Infecciones por Escherichia coli/epidemiología , Síndrome Hemolítico-Urémico/epidemiología , Escherichia coli Shiga-Toxigénica/aislamiento & purificación , Adolescente , Niño , Preescolar , Diarrea/complicaciones , Diarrea/microbiología , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/microbiología , Femenino , Georgia (República)/epidemiología , Síndrome Hemolítico-Urémico/complicaciones , Síndrome Hemolítico-Urémico/microbiología , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Factores de Riesgo
8.
Int J Med Microbiol ; 308(8): 1121-1127, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30466555

RESUMEN

BACKGROUND: Multiple case definitions for post-diarrheal hemolytic uremic syndrome (D+ HUS) associated with Shiga toxin-producing Escherichia coli (STEC) are used across public health, research, and clinical practice. METHODS: To identify a single definition of D+ HUS for standardized use, we evaluated the comparability and validity of four common, heterogeneous definitions: the Council of State and Territorial Epidemiologists (CSTE) definition, hematology-focused and age-focused definitions from the literature, and hospital diagnosis. We reviewed medical records from 471 hospitalized E. coli O157:H7 cases reported in Washington State, 2005-2014. We assessed 1) reliability across definitions, 2) comparability of temporal trends, and 3) sensitivity and specificity using an omnibus reference standard, developed using a combination of definition agreement and clinical outcomes. With the standard, we classified cases as definite, borderline, or unlikely/not post-diarrheal D+ HUS. RESULTS: Reliability was highest between the age-focused definition and hospital diagnosis (κ = 0.84), and temporal trends were largely comparable across definitions. For definite D+ HUS cases, the age-focused definition had the highest overall validity [100% sensitivity, 95% confidence interval (CI): 94%, 100%; 96% specificity, 95% CI: 94%, 98%]. The CSTE definition had low specificity (75%, 95% CI: 70%, 79%). CONCLUSIONS: In this review, the CSTE definition overestimated the burden of D+ HUS, and the age-focused definition provided the best overall reliability and validity to define post-diarrheal D+ HUS. Disease monitoring and research activities should consider using the age-focused D+ HUS definition.


Asunto(s)
Diarrea/complicaciones , Infecciones por Escherichia coli/complicaciones , Escherichia coli O157/aislamiento & purificación , Síndrome Hemolítico-Urémico/diagnóstico , Síndrome Hemolítico-Urémico/etiología , Diagnóstico Diferencial , Diarrea/epidemiología , Femenino , Síndrome Hemolítico-Urémico/epidemiología , Humanos , Incidencia , Masculino , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , Sensibilidad y Especificidad , Escherichia coli Shiga-Toxigénica/aislamiento & purificación , Washingtón/epidemiología
9.
PLoS One ; 13(11): e0207492, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30419067

RESUMEN

To generate hypotheses on possible sources of Shiga toxin-producing Escherichia coli (STEC) serogroup O80 associated hemolytic-uremic syndrome (HUS), we explored differences in factors associated with STEC O80 associated HUS, compared with STEC O157 or STEC of other serogroups, in France during 2013-16. STEC was isolated from 153/521 (30%) reported HUS cases: 45 serogroup O80, 46 O157 and 62 other serogroups. Median ages were 1.1 years, 4.0 years and 1.8 years, respectively. O80 infected patients were less likely to report ground beef consumption (aOR [adjusted Odds Ratio] 0.14 95% CI [Confidence Interval] 0.02-0.80) or previous contact with a person with diarrhea or HUS (aOR 0.13 95%CI 0.02-0.78) than patients infected with STEC O157. They were also less likely to report previous contact with a person presenting with diarrhea/HUS than patients infected with other serogroups (aOR 0.13 95%CI 0.02-0.78). STEC O80 spread all over France among young children less exposed to known risk factors of O157 or other STEC infections, suggesting the existence of different reservoirs and transmission patterns.


Asunto(s)
Diarrea/epidemiología , Diarrea/microbiología , Síndrome Hemolítico-Urémico/epidemiología , Síndrome Hemolítico-Urémico/microbiología , Serogrupo , Escherichia coli Shiga-Toxigénica , Preescolar , Femenino , Francia/epidemiología , Humanos , Lactante , Masculino , Carne Roja/microbiología , Estudios Retrospectivos
10.
J Nephrol ; 31(6): 919-924, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30328581

RESUMEN

BACKGROUND: Intestinal infections caused by a shigatoxin-positive Escherichia coli (mostly of the serogroups O26, O45, O103, O111, O121, O145 and especially O157) are a common cause of hemolytic-uremic syndrome. Hemolytic-uremic syndrome was first linked with an E. coli urinary tract infection 40 years ago. METHODS: We conducted a systematic review of the literature addressing the association between E. coli urinary tract infection and hemolytic-uremic syndrome. RESULTS: For the final analysis, we retained 23 original reports published since 1979. Five unselected pediatric case series addressed the possible occurrence of hemolytic-uremic syndrome after an acute symptomatic E. coli urinary tract infection among 266 cases and found the mentioned association in 8 (3.0%) cases. We also found 28 individual cases (17 females and 11 males) of hemolytic-uremic syndrome preceded by an E. coli urinary tract infection: 16 children aged from 2 days to 6.0 years and 12 adults aged from 22 to 75 years. Testing for shigatoxin, performed in 19 cases, was positive in 15 cases. E. coli serotyping was performed in 18 cases: testing for serotype O157, O103 and O145 was positive in one, one and two cases, respectively, while testing for serotype O26, O45, O111 and O121 was always negative. CONCLUSIONS: Hemolytic-uremic syndrome rarely occurs after an acute E. coli urinary tract infection. It affects both children and adults and is mostly caused by germs that are shigatoxin-positive.


Asunto(s)
Infecciones por Escherichia coli/microbiología , Síndrome Hemolítico-Urémico/microbiología , Escherichia coli Shiga-Toxigénica/patogenicidad , Infecciones Urinarias/microbiología , Adulto , Anciano , Niño , Preescolar , Infecciones por Escherichia coli/diagnóstico , Infecciones por Escherichia coli/epidemiología , Femenino , Síndrome Hemolítico-Urémico/diagnóstico , Síndrome Hemolítico-Urémico/epidemiología , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pronóstico , Medición de Riesgo , Factores de Riesgo , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/epidemiología , Adulto Joven
11.
Cien Saude Colet ; 23(9): 3085-3094, 2018 Sep.
Artículo en Español | MEDLINE | ID: mdl-30281745

RESUMEN

The article deals with the construction of knowledge about diseases. The general objective is to analyze the process of constructing scientific knowledge of two diseases in comparative perspective: Hemolytic Uremic Syndrome and Fibromyalgia. The work reflects on the construction of biomedical knowledge and health policies, specifically how scientific knowledge impacts on the design of policies. Our research strategy was based on the analysis of scientific literature, health programs and bills of Argentina. The analysis was based on the axial model of diagnostic categories (semiological, morphological, explanatory and epidemiological) developed by Camargo Jr in order to detect how the distinctive features of biomedical sphere is translated into the political sphere. The investigation showed that the hierarchy given to each axis when a disease is defined at the moment of designing health policies is curcial. It also revealed that when biomedicine can not define the disease, based on their clinical and epidemiological reasoning, the roles are reversed. Then it is politics that recognizes the disease and gives the legitimacy that patients need.


Asunto(s)
Fibromialgia/diagnóstico , Conocimientos, Actitudes y Práctica en Salud , Política de Salud , Síndrome Hemolítico-Urémico/diagnóstico , Argentina , Fibromialgia/epidemiología , Síndrome Hemolítico-Urémico/epidemiología , Humanos , Política
12.
Int J Infect Dis ; 76: 82-87, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30223088

RESUMEN

Non-O157 strains of Shiga toxin-producing Escherichia coli (STEC) are more common causes of acute diarrhea than the better-known O157 strains and have the potential for large outbreaks. This systematic review of the literature identified 129 serogroups as well as 262 different O and H antigen combinations of STEC in cases of epidemic and sporadic disease worldwide. Excluding the results from a single large outbreak of STEC O104:H4 in Germany and France in 2011, the reported frequency of dysenteric illness in patients was 26% (119 of 464) for epidemic disease and 25% (646 of 2588) for sporadic cases. Hemolytic uremic syndrome was identified in 14% of epidemic disease cases and 9% of sporadic illness cases. With the increasing use of PCR-based diagnostics, STEC strain identification may not be possible. Rapid diagnostics are needed for STEC infections to aid the clinician while allowing epidemiologists the opportunity to identify outbreaks and to trace the source of infection.


Asunto(s)
Infecciones por Escherichia coli/diagnóstico , Escherichia coli Shiga-Toxigénica , Adulto , Diarrea/epidemiología , Brotes de Enfermedades , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/microbiología , Síndrome Hemolítico-Urémico/epidemiología , Humanos , Serogrupo , Escherichia coli Shiga-Toxigénica/clasificación
13.
Int J Med Microbiol ; 308(7): 921-926, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30257808

RESUMEN

BACKGROUND: The veracity of the association between antibiotic use and hemolytic uremic syndrome (HUS) caused by Escherichia coli O157:H7 has been a topic of debate. We postulated that criteria used to define HUS affect this association. METHODS: We reviewed 471 hospitalized E. coli O157:H7 cases reported in Washington State, 2005-2014, to determine HUS status by various case definitions and antibiotic treatment. We used age-adjusted logistic regression models to estimate the effect of treatment on HUS status according to four common, but heterogeneous, definitions: the Council of State and Territorial Epidemiologists (CSTE) definition, hematology-focused and age-focused definitions from the literature, and hospital diagnosis. RESULTS: Inter-annual variation in antibiotic use was high, but no meaningful change in antibiotic use was observed over this ten-year period. Thirteen percent of cases <18 years-old received antibiotics, compared to 54% of cases ≥18 years-old. The CSTE, hematology-focused, age-focused, and hospital diagnosis definitions identified 149, 57, 74, and 89 cases of HUS, respectively. The association between antibiotic treatment and HUS varied by definition: CSTE odds ratio (OR) 1.57 [95% confidence interval (CI) 0.98, 2.55]; hematology-focused OR 1.73 (95% CI 0.83, 3.54); age-focused OR 2.29 (95% CI 1.20, 4.39); and hospital diagnosis OR 1.94 (95% CI 1.01, 3.72). CONCLUSIONS: Each definition yielded an estimate of the association in the direction of increased risk of HUS with antibiotics. While the range of OR point estimates was relatively small, confidence intervals for two HUS definitions crossed the null and two did not, potentially altering the inference an investigator makes. Discrepant reports of the association between antibiotic use and HUS in the literature might be due in part to the choice of HUS definition, and a consistent definition of HUS should be adopted for research and public health purposes.


Asunto(s)
Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/tratamiento farmacológico , Escherichia coli O157/aislamiento & purificación , Síndrome Hemolítico-Urémico/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Diagnóstico Diferencial , Infecciones por Escherichia coli/epidemiología , Femenino , Síndrome Hemolítico-Urémico/inducido químicamente , Síndrome Hemolítico-Urémico/diagnóstico , Síndrome Hemolítico-Urémico/epidemiología , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , Washingtón/epidemiología , Adulto Joven
14.
Int J Med Microbiol ; 308(7): 927-932, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30257809

RESUMEN

Despite their general low incidence, Shiga toxin-producing Escherichia (E.) coli (STEC) infections are considered an important public health issue due to the severity of illness that can develop, particularly in young children. We report on two Austrian petting zoos, one in Tyrol (2015) and one in Vorarlberg (2016), which were identified as highly likely infection sources of STEC infections. The petting zoo related cases involved a case of hemolytic uremic syndrome (HUS) due to STEC O157:HNM in 2015 and an outbreak of STEC O157:H7 infections affecting five young children and two adults in 2016. The HUS case accounted for 2.8% of the 36 STEC O157:HNM/H7 infections notified in Austria in 2015 (5,9% of 17 HUS cases). The seven cases described for 2016 accounted for 4.0% of the 177 human STEC infections documented for Austria in 2016, and for 19.4% of the 36 STEC O157:HNM/H7 infections notified that year. The evaluation of the STEC infections described here clearly underlines the potential of sequence-based typing methods to offer suitable resolutions for public health applications. Furthermore, we give a state-of-the-art mini-review on the risks of petting zoos concerning exposure to the zoonotic hazard STEC and on proper measures of risk-prevention.


Asunto(s)
Animales de Zoológico/microbiología , Trazado de Contacto , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/transmisión , Escherichia coli Shiga-Toxigénica/aislamiento & purificación , Adulto , Animales , Austria/epidemiología , Preescolar , ADN Bacteriano/genética , Brotes de Enfermedades , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/microbiología , Escherichia coli O157/genética , Escherichia coli O157/aislamiento & purificación , Heces/microbiología , Femenino , Síndrome Hemolítico-Urémico/epidemiología , Síndrome Hemolítico-Urémico/etiología , Síndrome Hemolítico-Urémico/microbiología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Factores de Riesgo , Análisis de Secuencia de ADN , Toxinas Shiga/genética , Escherichia coli Shiga-Toxigénica/genética , Zoonosis/epidemiología
15.
Transfus Med Rev ; 32(4): 230-236, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-30177429

RESUMEN

Thrombotic microangiopathies (TMAs) are associated with microangiopathic hemolytic anemia and thrombocytopenia, resulting in microvascular thrombosis and end-organ damage. In pregnancy, this may be the result of pregnancy-related TMAs such as preeclampsia; hemolysis, elevated liver enzymes, and low platelets; or pregnancy-associated TMAs, specifically thrombotic thrombocytopenic purpura (TTP) or complement-mediated hemolytic uremic syndrome (CM HUS). TTP and CM HUS are rare disorders, and their diagnosis may be missed, no less because features at presentation may be misdiagnosed as a pregnancy-related TMA, such as hypertension, proteinuria, fetal growth restriction, or in utero fetal death. The mainstay of treatment for pregnancy-associated TMAs is plasma exchange. Presentation is likely in the third trimester for TTP and postpartum for CM HUS. However, both conditions can present in any trimester, unlike pregnancy-related TMAs which rarely present before the second trimester, commonly in the third trimester. Delivery is the mainstay of treatment for pregnancy-related TMAs. More recently, it has become clear that pregnancy may be a trigger for late-onset congenital TTP, as well as immune-mediated TTP, diagnosed by ADAMTS13 analysis. Complement inhibitor therapy is the treatment of choice for CM HUS cases. However, their diagnosis is by exclusion, but complement inhibitor therapy reduces the risk of end-stage renal failure. Subsequent pregnancies can be supported for TTP and CM HUS.


Asunto(s)
Proteína ADAMTS13/metabolismo , Síndrome Hemolítico-Urémico/diagnóstico , Púrpura Trombocitopénica Trombótica/diagnóstico , Adulto , Anemia Hemolítica/diagnóstico , Anemia Hemolítica/epidemiología , Inactivadores del Complemento/uso terapéutico , Femenino , Síndrome Hemolítico-Urémico/epidemiología , Humanos , Embarazo , Complicaciones Hematológicas del Embarazo/diagnóstico , Púrpura Trombocitopénica Trombótica/epidemiología , Microangiopatías Trombóticas/diagnóstico , Microangiopatías Trombóticas/epidemiología
16.
Pediatr Nephrol ; 33(12): 2371-2381, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30159625

RESUMEN

BACKGROUND: This study aims to identify epidemiological and clinical characteristics of patients and report our experience with eculizumab treatment during an outbreak of hemolytic uremic syndrome (HUS) caused by Shiga toxin-producing Escherichia coli (STEC) in Istanbul in 2015. METHODS: Thirty-two children (21 females, median age 3.25 years) were included in this study. Demographic, clinical and laboratory data, and treatment details were retrospectively collected. Renal outcomes were assessed at last follow-up visit. To assess the effect of eculizumab on prognosis of STEC-HUS, subgroup analysis was performed on patients who required dialysis. RESULTS: A high number of cases occurred within a certain region of Istanbul. Stool samples were cultured from 21 patients (65%), and enteroaggregative E. coli (EAEC; n = 7) and enterohemorrhagic E. coli (EHEC; n = 3) strains were detected. Rates of dialysis treatment, neurological manifestations, and death were 59%, 25%, and 3%, respectively. Mean follow-up duration was 8.6 ± 2.6 months (range 3-12 months). None of the patients (n = 25) was on dialysis at the final visit. The complete renal recovery rate was 54%. Nine patients were treated with eculizumab. At final follow-up visit, no differences in estimated glomerular filtration rate, proteinuria level, or hypertension incidence were observed between patients treated with eculizumab and those not treated with eculizumab. CONCLUSIONS: An outbreak of EAEC occurred in a specific region of Istanbul. Livestock markets were suspected as the source. Evidence for beneficial effects of eculizumab on renal outcome was not clear in this cohort.


Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Brotes de Enfermedades/estadística & datos numéricos , Infecciones por Escherichia coli/epidemiología , Síndrome Hemolítico-Urémico/epidemiología , Enfermedades del Sistema Nervioso/epidemiología , Escherichia coli Shiga-Toxigénica/aislamiento & purificación , Animales , Niño , Preescolar , Infecciones por Escherichia coli/microbiología , Infecciones por Escherichia coli/terapia , Infecciones por Escherichia coli/transmisión , Femenino , Estudios de Seguimiento , Síndrome Hemolítico-Urémico/complicaciones , Síndrome Hemolítico-Urémico/microbiología , Síndrome Hemolítico-Urémico/terapia , Humanos , Ganado/microbiología , Masculino , Enfermedades del Sistema Nervioso/microbiología , Diálisis Renal/estadística & datos numéricos , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del Tratamiento , Turquia
17.
Int J Med Microbiol ; 308(8): 1085-1095, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30115547

RESUMEN

Enterohemorrhagic Escherichia coli (EHEC) are a cause of bloody diarrhea, hemorrhagic colitis (HC) and the potentially fatal hemolytic uremic syndrome (HUS). While O157:H7 is the dominant EHEC serotype, non-O157 EHEC have emerged as serious causes of disease. In Germany, the most important non-O157 O-serogroups causing one third of EHEC infections, including diarrhea as well as HUS, are O26, O103, O111 and O145. Interestingly, we identified EHEC O-serogroups O26 and O111 in one single sequence type complex, STC29, that also harbours atypical enteropathogenic E. coli (aEPEC). aEPEC differ from typical EHEC merely in the absence of stx-genes. These findings inspired us to unravel a putative microevolutionary scenario of these non-O157 EHEC by whole genome analyses. Analysis of single nucleotide polymorphisms (SNPs) of the maximum common genome (MCG) of 20 aEPEC (11 human/ 9 bovine) and 79 EHEC (42 human/ 36 bovine/ 1 food source) of STC29 identified three distinct clusters: Cluster 1 harboured strains of O-serogroup O111, the central Cluster 2 harboured only O26 aEPEC strains, while the more heterogeneous Cluster 3 contained both EHEC and aEPEC strains of O-serogroup O26. Further combined analyses of accessory virulence associated genes (VAGs) and insertion sites for mobile genetic elements suggested a parallel evolution of the MCG and the acquisition of virulence genes. The resulting microevolutionary model suggests the development of two distinct EHEC lineages from one common aEPEC ancestor of ST29 by lysogenic conversion with stx-converting bacteriophages, independent of the host species the strains had been isolated from. In conclusion, our cumulative data indicate that EHEC of O-serogroups O26 and O111 of STC29 originate from a common aEPEC ancestor and are bona fide zoonotic agents. The role of aEPEC in the emergence of O26 and O111 EHEC should be considered for infection control measures to prevent possible lysogenic conversion with stx-converting bacteriophages as major vehicle driving the emergence of EHEC lineages with direct Public Health consequences.


Asunto(s)
Infecciones por Escherichia coli/microbiología , Escherichia coli O157/genética , Evolución Molecular , Síndrome Hemolítico-Urémico/microbiología , Serogrupo , Animales , Bovinos , Infecciones por Escherichia coli/epidemiología , Escherichia coli O157/patogenicidad , Genoma Bacteriano/genética , Alemania/epidemiología , Síndrome Hemolítico-Urémico/epidemiología , Humanos , Polimorfismo de Nucleótido Simple , Virulencia/genética , Secuenciación Completa del Genoma , Zoonosis/epidemiología , Zoonosis/microbiología
18.
Int J Med Microbiol ; 308(7): 962-968, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30055976

RESUMEN

The highly virulent Escherichia coli O104:H4 isolate that caused a large outbreak in 2011 carries three plasmids. Out of these, only one, the IncI plasmid pO104_90 that encodes two extended spectrum beta-lactamases, can transfer itself by conjugation. Considering its potential contribution to the emergence and virulence of the outbreak strain, we aimed to get a closer insight into pO104_90 transfer efficiency and control. We tested the host spectrum of the plasmid and observed transmission into Enterobactericeae including clinically relevant enterobacterial pathogens like Salmonella typhimurium and Shigella flexneri. However, we found that this plasmid did not transfer into E. coli strains that kill the donor strain due to bacteriocin production, e.g. the probiotic E. coli Nissle 1917. Under the same conditions, the highly transmittable control plasmid RP4 was efficiently transferred into all these recipients. Therefore we hypothesized that the failure of transfer of pO104_90 was simply due to the generally much lower transmission rates of this IncI plasmid and we decided to screen for factors that negatively affect the transfer of the plasmid by an in vivo deletion analysis. Our attempts to delete larger regions of the plasmid resulted in cells containing both a truncated plasmid (Δ50 kb and Δ75 kb) and a wild type copy of pO104_90. When used as donors in conjugation experiments, these cells transferred the wild type plasmid at dramatically increased rates. This indicated that the relatively limited region shared by both plasmids contained an activator of transfer. We therefore analyzed its transcriptional organization, dissected the candidate region by subcloning and showed that additional copies of repY/INC were sufficient to increase the transfer frequency of pO104_90 to the observed level. To our knowledge, this is the first evidence for a direct regulatory cross talk between core control elements of the vegetative replication and the transfer functions of an IncI1 plasmid.


Asunto(s)
Escherichia coli O104/genética , Transferencia de Gen Horizontal/genética , Especificidad del Huésped/genética , Plásmidos/genética , Salmonella typhimurium/genética , Shigella flexneri/genética , Bacteriocinas/metabolismo , Conjugación Genética/genética , Brotes de Enfermedades , Infecciones por Escherichia coli/epidemiología , Alemania/epidemiología , Síndrome Hemolítico-Urémico/epidemiología , Síndrome Hemolítico-Urémico/microbiología , Humanos , Análisis de Secuencia de ADN , beta-Lactamasas/genética
19.
Int J Med Microbiol ; 308(7): 933-939, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30042042

RESUMEN

Since 2015, the Swiss Federal Office of Public Health registered an increase of notifications of STEC, probably due to the adoption of culture independent stx screening tests in diagnostic laboratories. This study aimed to identify the serotypes and virulence genes of 120 STEC isolated from human clinical stx positive specimens during 2017 in order to estimate any changes in serotype distribution and toxin profiles of STEC compared to the time span 2010-2014. Culturing of STEC from stool samples was achieved using the streak plate technique on MacConkey agar. We performed O and H serotyping by PCR and by micro array. Virulence genes were identified and subtyped using molecular methods, including stx1 and stx2 subtypes, and the intimin encoding gene, eae. STEC were recovered from 27.5% of the stx positive samples. STEC O157:H7 accounted for 7.5% of all isolates, and STEC O80:H2, O91:H10/H14/H21, O103:H2/H11, and O26:H11 accounted for 36.9% of the non-O157 strains. Forty-five isolates with stx1 variants, 47 with stx2 variants and 28 isolates with both stx1 and stx2 variants were identified. Forty (33.3% of all isolates) carried the subtypes associated with high pathogenic potential, stx2a, stx2c, or stx2d. The eae gene for intimin was detected in 54 strains (45% of all strains). Compared to 2010-2014, our data show that the proportion of the so called "top five" serogroups, STEC O26, O111, O103, and O157 declined from 53.7% to 28.3% in 2017. The proportion of isolates with stx2a, stx2c, or stx2d decreased from 50.5% to 33.3%. We also observed an increase of STEC harbouring the low pathogenic subtypes stx2b and stx2e from 12.6% to 29.2%, and of eae negative STEC from 29.5% in 2010-2014 to 55% in 2017. Simultaneously, there was a sharp increase of the patients' median age from 24 years to 46.5 years. Clinical manifestations in the patients included abdominal pain without diarrhea (22.3%), diarrhea (77.7%), and the haemolytic-uremic syndrome (HUS) (7.4%). Our data show that a greater number and a wider range of STEC serotypes are detected by culture-independent testing, with implications for public health services.


Asunto(s)
Infecciones por Escherichia coli/epidemiología , Síndrome Hemolítico-Urémico/epidemiología , Toxina Shiga I/genética , Toxina Shiga II/genética , Escherichia coli Shiga-Toxigénica/genética , Escherichia coli Shiga-Toxigénica/patogenicidad , Adhesinas Bacterianas/genética , Adulto , Infecciones por Escherichia coli/microbiología , Proteínas de Escherichia coli/genética , Heces/microbiología , Síndrome Hemolítico-Urémico/microbiología , Humanos , Persona de Mediana Edad , Serogrupo , Serotipificación , Escherichia coli Shiga-Toxigénica/clasificación , Suiza/epidemiología , Factores de Virulencia/genética
20.
Int J Med Microbiol ; 308(7): 899-911, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-29937390

RESUMEN

In 2011, Germany was struck by the largest outbreak of hemolytic uremic syndrome. The highly virulent E. coli O104:H4 outbreak strain LB226692 possesses a blended virulence profile combining genetic patterns of human adapted enteroaggregative E. coli (EAEC), rarely detected in animal hosts before, and enterohemorrhagic E. coli (EHEC), a subpopulation of Shiga toxin (Stx)-producing E. coli (STEC) basically adapted to the ruminant host. This study aimed at appraising the relative level of adaptation of the EAEC/EHEC hybrid strain LB226692 to humans and cattle. Adherence and invasion of the hybrid strain to intestinal (jejunal and colonic) epithelial cells (IEC) of human and bovine origin was compared to that of E. coli strains representative of different pathovars and commensal E. coli by means of light and electron microscopy and culture. Strain-specific host gene transcription profiles of selected cytokines and chemokines as well as host-induced transcription of bacterial virulence genes were assessed. The release of Stx upon host cell contact was quantified. The outbreak strain's immunomodulation was assessed by cultivating primary bovine macrophages with conditioned supernatants from IEC infection studies with E. coli, serving as model for the innate immunity of the bovine gut. The outbreak strain adhered to IEC of both, human and bovine origin. Electron microscopy of infected cells revealed the strain's particular affinity to human small IEC, in contrast to few interactions with bovine small IEC. The outbreak strain possessed a high-level of adhesive power, similar to human-associated E. coli strains and in contrast to bovine-associated STEC strains. The outbreak strain displayed a non-invasive phenotype, in contrast to some bovine-associated E. coli strains, which were invasive. The outbreak strain provoked some pro-inflammatory activity in human cells, but to a lower extent as compared to other pathotypes. In contrasts to bovine-associated E. coli strains, the outbreak strain induced marked pro-inflammatory activity when interacting with bovine host cells directly (IEC) and indirectly (macrophages). Among stx2-positive strains, the human-pathogenic strains (LB226692 and EHEC strain 86-24) released higher amounts of Stx compared to bovine-associated STEC. The findings imply that the outbreak strain is rather adapted to humans than to cattle. However, the outbreak strain's potential to colonize IEC of both host species and the rather mixed reaction patterns observed for all strains under study indicate, that even STEC strains with an unusual genotype as the EHEC O104:H4 outbreak strain, i.e. with an EAEC genetic background, may be able to conquer other reservoir hosts.


Asunto(s)
Infecciones por Escherichia coli/epidemiología , Escherichia coli O104/patogenicidad , Síndrome Hemolítico-Urémico/epidemiología , Inflamación/inmunología , Mucosa Intestinal/microbiología , Animales , Bovinos , Línea Celular , Colon/citología , Colon/microbiología , Brotes de Enfermedades , Células Epiteliales/microbiología , Infecciones por Escherichia coli/microbiología , Escherichia coli O104/inmunología , Escherichia coli O104/aislamiento & purificación , Alemania/epidemiología , Síndrome Hemolítico-Urémico/microbiología , Interacciones Huésped-Patógeno/fisiología , Humanos , Mucosa Intestinal/citología , Yeyuno/citología , Yeyuno/microbiología , Macrófagos/microbiología , Toxina Shiga/biosíntesis , Células Vero , Virulencia
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA