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Kidney Week

Abstract: SA-PO685

Bloody Diarrhea and Shiga Toxin-Producing Escherichia coli Infection in Children: Data from the ItalKid-HUS Network

Session Information

  • Pediatric Glomerular Disease
    November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Ardissino, Gianluigi, Center for HUS Prevention Control and Management, Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy
  • Colombo, Rosaria, Center for HUS Prevention Control and Management, Laboratory of Microbiology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Not applicable, Italy
  • Daprai, Laura, Center for HUS Prevention Control and Management, Laboratory of Microbiology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Not applicable, Italy
  • Capone, Valentina, Center for HUS Prevention Control and Management, Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy
  • Dodaro, Antonella, Center for HUS Prevention Control and Management, Laboratory of Microbiology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Not applicable, Italy
  • Tel, Francesca, Department of Pediatrics, Vittore Buzzi Children’s Hospital, Milano, Italy
  • Possenti, Ilaria, Center for HUS Prevention Control and Management, Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy
  • Testa, Sara, Center for HUS Prevention Control and Management, Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy
  • Paglialonga, Fabio, Center for HUS Prevention Control and Management, Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy
  • Luini, Mario Vittorio, Lombardia and Emilia Romagna Experimental Zootechnic Institute (IZSLER), Lodi, Italy
  • Brigotti, Maurizio, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
  • Vignati, Chiara, Center for HUS Prevention Control and Management, Laboratory of Microbiology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Not applicable, Italy
  • Masia, Carla, Center for HUS Prevention Control and Management, Laboratory of Microbiology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Not applicable, Italy
Background

Shiga toxin-producing Escherichia coli (STEC) are responsible for STEC-HUS. The few days before the development of the renal complication, when bloody diahrrea (BD) is the only symptom, represent a window of therapeutic opportunities for preventing or mitigating HUS.

Methods

In order to identify patients at risk for HUS early in the course of the disease, a network connecting >60 pediatric hospitals in Northern Italy (12 millions gp; 2.3 million children) has been developed since May 2010, aimed at identifying patients with STEC infections with the aim of an early management of the severe renal complication.
Children (<18 yrs old) with BD were centrally screened for the presence of Stx genes in stools using a Reverse Dot blot assays (Genotype EHEC-Arnika) until 2018 and Real-Time PCR (RIDA Gene-Relab) thereafter.

Results

Out of 4239 analyzed samples, 216 (5.1%) were positive for Stx (1: 63 (29.2%), 2: 92 (42.6%) and 1&2: 61 (28.2%)). Forty patients (0.9% of BD) developed HUS (Stx1 alone was found in 1 eHUS only). The most frequent serogroup identified was the O26 (29%), followed by the O157 (19%) and the other top5 (18%), while a significant proportion were “non top5" (19.7%).
In late Summer, the probability that BD is associated with Stx, increases from the year average of 5.1% to around 15%.
BD was more common in younger children (85% of cases < 10 yo) but the likelihood that BD was caused by STEC infection was not different in different age groups. Finally, the probability of developing HUS in case of STEC infection decreases with age.

Conclusion

The present analysis provides important information about the epidemiology of BD and gives the evidence that STEC is everything but a rare cause of BD that should therefore always be screened for Stx given the severity of its complication.

Funding

  • Private Foundation Support