[Epidemiology of hemolytic uremic syndrome in two regions of Buenos Aires Province]. / Epidemiología del síndrome urémico hemolítico en dos regiones de la Provincia de Buenos Aires.

The objectives of this study were (a) to describe and estimate the frequency of hemolytic uremic syndrome (HUS) in rural and urban populations in two regions of Buenos Aires Province, and (b) to compare the presentation and distribution of factors hypothetically associated with HUS. A total of 82 HUS cases, recorded during the years 2005-2010 in rural and urban areas of the south-central region of Buenos Aires Province, were clinically and epidemiologically characterized. Statistical data analysis included Chi square or Fisher test and median test. The incidence rate of HUS was significantly higher in the rural population, being 12.7 cases per 100 000 (CI 0-23.5) in rural inhabitants vs. 7.1 cases per 100 000 (CI 0-9.5) in urban inhabitants. The median age of the patients was 27 months (5-139 months), significantly lower in children from the rural area. This could be explained by a more frequent contact with bovine feces, the consumption of raw milk and a higher proportion of relatives who work in risk labors found in the rural population. Although HUS is often associated with the consumption of undercooked minced meat, most of the children cases here included did not present this antecedent. Clinical manifestations were similar in both subpopulations. One-third of urban patients had received antibiotics prior to HUS development.

A proof of concept infant-microbiota associated rat model for studying the role of gut microbiota and alleviation potential of Cutibacterium avidum in infant colic.

Establishing the relationship between gut microbiota and host health has become a main target of research in the last decade. Human gut microbiota-associated animal models represent one alternative to human research, allowing for intervention studies to investigate causality. Recent cohort and in vitro studies proposed an altered gut microbiota and lactate metabolism with excessive H2 production as the main causes of infant colic. To evaluate H2 production by infant gut microbiota and to test modulation of gut colonizer lactose- and lactate-utilizer non-H2-producer, Cutibacterium avidum P279, we established and validated a gnotobiotic model using young germ-free rats inoculated with fecal slurries from infants younger than 3 months. Here, we show that infant microbiota-associated (IMA) rats inoculated with fresh feces from healthy (n = 2) and colic infants (n = 2) and fed infant formula acquired and maintained similar quantitative and qualitative fecal microbiota composition compared to the individual donor's profile. We observed that IMA rats excreted high levels of H2, which were linked to a high abundance of lactate-utilizer H2-producer Veillonella. Supplementation of C. avidum P279 to colic IMA rats reduced H2 levels compared to animals receiving a placebo. Taken together, we report high H2 production by infant gut microbiota, which might be a contributing factor for infant colic, and suggest the potential of C. avidum P279 in reducing the abdominal H2 production, bloating, and pain associated with excessive crying in colic infants.

Colonization of Cutibacterium avidum during infant gut microbiota establishment.

Establishment of the infant gut microbiota affects gut maturation and influences long-term health. Cutibacterium (formerly Propionibacterium) have been identified as early colonizers, but little is known about their function. Using a cultivation-dependent and -independent approach, we determined Cutibacterium prevalence, diversity and functional potential. In feces from a Swiss infant cohort (n = 38), prevalence of Propionibacterium/Cutibacterium decreased from 84% at 2 weeks, to 65% at 4 weeks, 47% at 8 weeks and 41% at 12 weeks of age. Abundance varied among individuals, and persistence depended on the colonization levels at 2 weeks. Cutibacterium isolates (n = 87) were obtained from 10 infants from a smaller cohort (n = 12); restriction fragment length polymorphism clustered isolates in four groups, and all identified as Cutibacterium avidum. Colonization potential and metabolic effects of C. avidum addition were tested in an in vitro continuous intestinal fermentation model mimicking infant proximal colon conditions. Cutibacterium avidum spiked daily at 108 or 109 cells mL-1 colonized, decreased formate and persisted during the washout period. Significant correlations were observed between Propionibacterium/Cutibacterium and lactate-producers and protein-degraders in both reactors and infant feces. Our findings highlight the natural presence of C. avidum and its role as a lactate-consumer and propionate-producer in infants younger than 3 months.

Cutibacterium avidum is phylogenetically diverse with a subpopulation being adapted to the infant gut.

The infant gut harbors a diverse microbial community consisting of several taxa whose persistence depends on adaptation to the ecosystem. In healthy breast-fed infants, the gut microbiota is dominated by Bifidobacterium spp.. Cutibacterium avidum is among the initial colonizers, however, the phylogenetic relationship of infant fecal isolates to isolates from other body sites, and C. avidum carbon utilization related to the infant gut ecosystem have been little investigated. In this study, we investigated the phylogenetic and phenotypic diversity of 28 C. avidum strains, including 16 strains isolated from feces of healthy infants. We investigated the in vitro capacity of C. avidum infant isolates to degrade and consume carbon sources present in the infant gut, and metabolic interactions of C. avidum with infant associated Bifidobacterium longum subsp. infantis and Bifidobacterium bifidum. Isolates of C. avidum showed genetic heterogeneity. C. avidum consumed d- and l-lactate, glycerol, glucose, galactose, N-acetyl-d-glucosamine and maltodextrins. Alpha-galactosidase- and ß-glucuronidase activity were a trait of a group of non-hemolytic strains, which were mostly isolated from infant feces. Beta-glucuronidase activity correlated with the ability to ferment glucuronic acid. Co-cultivation with B. infantis and B. bifidum enhanced C. avidum growth and production of propionate, confirming metabolic cross-feeding. This study highlights the phylogenetic and functional diversity of C. avidum, their role as secondary glycan degraders and propionate producers, and suggests adaptation of a subpopulation to the infant gut.

Lactate Metabolism Is Strongly Modulated by Fecal Inoculum, pH, and Retention Time in PolyFermS Continuous Colonic Fermentation Models Mimicking Young Infant Proximal Colon.

The metabolism of lactate impacts infant gut health and may lead to acute accumulation of lactate and/or H2 associated with pain and crying of colicky infants. Because gut microbiota studies are limited due to ethical and safety concerns, in vitro fermentation models were developed as powerful tools to assess effects of environmental conditions on the gut microbiota. In this study, we established a continuous colonic fermentation model (PolyFermS), inoculated with immobilized fecal microbiota and mimicking the proximal colon of 2-month-old infants. We investigated the effects of pH and retention time (RT) on lactate metabolism and of lactate-utilizing bacteria (LUB) exhibiting little or no H2 production. We observed that a drop in pH from 6.0 to 5.0 increased the number of lactate-producing bacteria (LPB) and decreased LUB concomitantly with lactate accumulation. Increasing RT from 5 to 10 h at pH 5.0 resulted in complete lactate consumption associated with increased LUB. Supplementation with dl-lactate (60 mM) to mimic lactate accumulation promoted propionate and butyrate production with no effect on acetate production. We further demonstrated that lactate-utilizing Propionibacterium avidum was able to colonize the reactors 4 days after spiking, suggesting its ability to compete with other lactate-utilizing bacteria producing H2 In conclusion, we showed that PolyFermS is a suitable model for mimicking young infant colonic microbiota. We report for the first time pH and RT as strong drivers for composition and metabolic activity of infant gut microbiota, especially for the metabolism of lactate, which is a key intermediate product for ecology and infant health.IMPORTANCE The metabolism of lactate is important for infant gut health and may lead to acute lactate and/or H2 accumulation, pain, and crying as observed in colicky infants. Functional human studies often faced ethical challenges due to invasive medical procedures; thus, in this study, we implemented PolyFermS fermentation models to mimic the infant proximal colon, which were inoculated with immobilized fecal microbiota of two 2-month-old infants. We investigated the impact of pH, retention time, and accumulation of dl-lactate on microbiota composition and metabolic activity. We found that a drop in pH from 6.0 to 5.0 led to increased LPB and decreased LUB concomitantly with lactate accumulation. Increasing the RT resulted in complete lactate consumption associated with increased LUB. Our data highlight for the first time the impact of key abiotic factors on the metabolism of lactate, which is an important intermediate product for ecology and infant health.

Epidemiología del síndrome urémico hemolítico en dos regiones de la Provincia de Buenos Aires / Epidemiology of hemolytic uremic syndrome in two regions of Buenos Aires Province

Los objetivos de este estudio fueron describir y comparar la frecuencia del síndrome urémico hemolítico (SUH), registrada durante el periodo 2005-2010 en pobladores rurales y urbanos de la región centro-sur de la provincia de Buenos Aires y caracterizar la distribución de factores hipotéticos asociados al SUH en ambas poblaciones. Se caracterizaron 82 casos de SUH clínica y epidemiológicamente. Para el análisis estadístico de los datos se utilizó el test de Chi² o test exacto de Fisher cuando fue necesario, y el test de la mediana. La incidencia específica fue 12.7 casos cada 100 000 habitantes rurales (IC 0-23.5) y 7.1 casos cada 100 000 habitantes urbanos (IC 0-9.5). La mediana de la edad en el total de los pacientes estudiados fue de 27 meses (5-139 meses), siendo significativamente más baja en los niños del área rural. Estos resultados podrían explicarse por el contacto más frecuente con materia fecal de bovinos, el mayor consumo de leche sin pasteurizar y la mayor proporción de familiares que realizan actividades de riesgo, encontrados en la subpoblación rural. Aunque el SUH es una enfermedad que se asocia frecuentemente con el consumo de carne picada, la mayor parte de los niños que enfermaron no presentaron este antecedente. Las manifestaciones clínicas fueron semejantes en ambas subpoblaciones. Un tercio de los pacientes urbanos había recibido tratamiento con antibióticos previo al desarrollo del SUH.

The objectives of this study were (a) to describe and estimate the frequency of hemolytic uremic syndrome (HUS) in rural and urban populations in two regions of Buenos Aires Province, and (b) to compare the presentation and distribution of factors hypothetically associated with HUS. A total of 82 HUS cases, recorded during the years 2005-2010 in rural and urban areas of the south-central region of Buenos Aires Province, were clinically and epidemiologically characterized. Statistical data analysis included Chi square or Fisher test and median test. The incidence rate of HUS was significantly higher in the rural population, being 12.7 cases per 100 000 (CI 0-23.5) in rural inhabitants vs. 7.1 cases per 100 000 (CI 0-9.5) in urban inhabitants. The median age of the patients was 27 months (5-139 months), significantly lower in children from the rural area. This could be explained by a more frequent contact with bovine feces, the consumption of raw milk and a higher proportion of relatives who work in risk labors found in the rural population. Although HUS is often associated with the consumption of undercooked minced meat, most of the children cases here included did not present this antecedent. Clinical manifestations were similar in both subpopulations. One-third of urban patients had received antibiotics prior to HUS development.

Epidemiología del síndrome urémico hemolítico en dos regiones de la Provincia de Buenos Aires / Epidemiology of hemolytic uremic syndrome in two regions of Buenos Aires Province

Los objetivos de este estudio fueron describir y comparar la frecuencia del síndrome urémico hemolítico (SUH), registrada durante el periodo 2005-2010 en pobladores rurales y urbanos de la región centro-sur de la provincia de Buenos Aires y caracterizar la distribución de factores hipotéticos asociados al SUH en ambas poblaciones. Se caracterizaron 82 casos de SUH clínica y epidemiológicamente. Para el análisis estadístico de los datos se utilizó el test de Chi² o test exacto de Fisher cuando fue necesario, y el test de la mediana. La incidencia específica fue 12.7 casos cada 100 000 habitantes rurales (IC 0-23.5) y 7.1 casos cada 100 000 habitantes urbanos (IC 0-9.5). La mediana de la edad en el total de los pacientes estudiados fue de 27 meses (5-139 meses), siendo significativamente más baja en los niños del área rural. Estos resultados podrían explicarse por el contacto más frecuente con materia fecal de bovinos, el mayor consumo de leche sin pasteurizar y la mayor proporción de familiares que realizan actividades de riesgo, encontrados en la subpoblación rural. Aunque el SUH es una enfermedad que se asocia frecuentemente con el consumo de carne picada, la mayor parte de los niños que enfermaron no presentaron este antecedente. Las manifestaciones clínicas fueron semejantes en ambas subpoblaciones. Un tercio de los pacientes urbanos había recibido tratamiento con antibióticos previo al desarrollo del SUH.(AU)

The objectives of this study were (a) to describe and estimate the frequency of hemolytic uremic syndrome (HUS) in rural and urban populations in two regions of Buenos Aires Province, and (b) to compare the presentation and distribution of factors hypothetically associated with HUS. A total of 82 HUS cases, recorded during the years 2005-2010 in rural and urban areas of the south-central region of Buenos Aires Province, were clinically and epidemiologically characterized. Statistical data analysis included Chi square or Fisher test and median test. The incidence rate of HUS was significantly higher in the rural population, being 12.7 cases per 100 000 (CI 0-23.5) in rural inhabitants vs. 7.1 cases per 100 000 (CI 0-9.5) in urban inhabitants. The median age of the patients was 27 months (5-139 months), significantly lower in children from the rural area. This could be explained by a more frequent contact with bovine feces, the consumption of raw milk and a higher proportion of relatives who work in risk labors found in the rural population. Although HUS is often associated with the consumption of undercooked minced meat, most of the children cases here included did not present this antecedent. Clinical manifestations were similar in both subpopulations. One-third of urban patients had received antibiotics prior to HUS development.(AU)

Epidemiología del síndrome urémico hemolítico en dos regiones de la Provincia de Buenos Aires. / [Epidemiology of hemolytic uremic syndrome in two regions of Buenos Aires Province].

The objectives of this study were (a) to describe and estimate the frequency of hemolytic uremic syndrome (HUS) in rural and urban populations in two regions of Buenos Aires Province, and (b) to compare the presentation and distribution of factors hypothetically associated with HUS. A total of 82 HUS cases, recorded during the years 2005-2010 in rural and urban areas of the south-central region of Buenos Aires Province, were clinically and epidemiologically characterized. Statistical data analysis included Chi square or Fisher test and median test. The incidence rate of HUS was significantly higher in the rural population, being 12.7 cases per 100 000 (CI 0-23.5) in rural inhabitants vs. 7.1 cases per 100 000 (CI 0-9.5) in urban inhabitants. The median age of the patients was 27 months (5-139 months), significantly lower in children from the rural area. This could be explained by a more frequent contact with bovine feces, the consumption of raw milk and a higher proportion of relatives who work in risk labors found in the rural population. Although HUS is often associated with the consumption of undercooked minced meat, most of the children cases here included did not present this antecedent. Clinical manifestations were similar in both subpopulations. One-third of urban patients had received antibiotics prior to HUS development.

Caracterización epidemiológica de casos de síndrome urémico hemolítico en la región sur de la provincia de Buenos Aires / Epidemiological characterization of hemolytic-uremic syndrome cases in the south region of Buenos Aires province

INTRODUCCION: El síndrome urémico hemolítico (SUH) es la causa más frecuente de insuficiencia renal aguda en niños menores de 5 años en Argentina y se asocia principalmente a la infección por Escherichia coli shigatoxigénica (STEC). El bovino es el principal reservorio de STEC, las infecciones al hombre pueden producirse directa o indirectamente a partir de él. Es probable que las personas que presentan un mayor contacto con estos animales tengan una mayor exposición a la bacteria.OBJETIVO: Caracterizar epidemiológicamente la presentación de casos de SUH registrados durante 2005-2010 en poblaciones rurales y urbanas de la región centro-sur de la provincia de Buenos Aires.METODOS: El análisis de los datos incluyó estadísticas descriptivas y de comparación.RESULTADOS: La mediana de las edades del total de los pacientes estudiados fue de 27 meses (5-139 meses). El 54,3% de los casos respondió al género femenino y el 17,5%, al medio rural. Aunque la mayoría de los casos de SUH fueron pobladores urbanos, la tasa de incidencia específica fue significativamente mayor en poblaciones rurales y, en este grupo, las edades de los niños fueron más bajas.CONCLUSIONES: Los resultados obtenidos en el presente estudio concuerdan con otros realizados en la Argentina en lo que respecta a edad y género. No obstante, se encontró una mayor incidencia de SUH en pobladores rurales y a edades más bajas, lo que constituye una novedad. Esto podría deberse al contacto más frecuente con bovinos, ya sea directa o indirectamente, lo que aumentaría el riesgo de enfermar, sobre todo a edades más tempranas.

INTRODUCTION: In Argentina, the hemolytic-uremic syndomre (HUS) is the most frequent cause of acute renal failure in children under 5 years old and is associated with shigatoxigenic Escherichia coli (STEC) infection. Cattle are the major reservior for STEC, and the infection in human may be acquired directly or indirectly from cattle. People with increased contact with cattle are more likely to acquire STEC infections.OBJECTIVE: To characterize epidemiologically the HUS cases recorded during 2005-2010 in rural and urban populations in the central-southern region of Buenos Aires province.METHODS: Data analysis included descriptive and comparative statistics.RESULTS: The median age of the patients was 27 months (5-139 months). 54.3% of the cases were female and 17.5% belonged to rural areas. Although most cases of HUS were urban, the specific incidence rate was significantly higher in rural populations and the children were younger.CONCLUSIONS: The results obtaines in ths study are consistent with other studies conducted in Argentina in terms of age and gender. However, it detected a higher HUS incidence in rural populations and at younger ages, which is new in Argentina. This may be due to more frequent contact with cattle, directly or indirectly increasing the risk of developing the disease especially in younger children.

Caracterización epidemiológica de casos de síndrome urémico hemolítico en la región sur de la provincia de Buenos Aires / Epidemiological characterization of hemolytic-uremic syndrome cases in the south region of Buenos Aires province

INTRODUCCION: El síndrome urémico hemolítico (SUH) es la causa más frecuente de insuficiencia renal aguda en niños menores de 5 años en Argentina y se asocia principalmente a la infección por Escherichia coli shigatoxigénica (STEC). El bovino es el principal reservorio de STEC, las infecciones al hombre pueden producirse directa o indirectamente a partir de él. Es probable que las personas que presentan un mayor contacto con estos animales tengan una mayor exposición a la bacteria.OBJETIVO: Caracterizar epidemiológicamente la presentación de casos de SUH registrados durante 2005-2010 en poblaciones rurales y urbanas de la región centro-sur de la provincia de Buenos Aires.METODOS: El análisis de los datos incluyó estadísticas descriptivas y de comparación.RESULTADOS: La mediana de las edades del total de los pacientes estudiados fue de 27 meses (5-139 meses). El 54,3% de los casos respondió al género femenino y el 17,5%, al medio rural. Aunque la mayoría de los casos de SUH fueron pobladores urbanos, la tasa de incidencia específica fue significativamente mayor en poblaciones rurales y, en este grupo, las edades de los niños fueron más bajas.CONCLUSIONES: Los resultados obtenidos en el presente estudio concuerdan con otros realizados en la Argentina en lo que respecta a edad y género. No obstante, se encontró una mayor incidencia de SUH en pobladores rurales y a edades más bajas, lo que constituye una novedad. Esto podría deberse al contacto más frecuente con bovinos, ya sea directa o indirectamente, lo que aumentaría el riesgo de enfermar, sobre todo a edades más tempranas.

INTRODUCTION: In Argentina, the hemolytic-uremic syndomre (HUS) is the most frequent cause of acute renal failure in children under 5 years old and is associated with shigatoxigenic Escherichia coli (STEC) infection. Cattle are the major reservior for STEC, and the infection in human may be acquired directly or indirectly from cattle. People with increased contact with cattle are more likely to acquire STEC infections.OBJECTIVE: To characterize epidemiologically the HUS cases recorded during 2005-2010 in rural and urban populations in the central-southern region of Buenos Aires province.METHODS: Data analysis included descriptive and comparative statistics.RESULTS: The median age of the patients was 27 months (5-139 months). 54.3% of the cases were female and 17.5% belonged to rural areas. Although most cases of HUS were urban, the specific incidence rate was significantly higher in rural populations and the children were younger.CONCLUSIONS: The results obtaines in ths study are consistent with other studies conducted in Argentina in terms of age and gender. However, it detected a higher HUS incidence in rural populations and at younger ages, which is new in Argentina. This may be due to more frequent contact with cattle, directly or indirectly increasing the risk of developing the disease especially in younger children.