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Kidney Week

Abstract: PO2333

Targeting Bloody Diarrhea to Fight Shiga Toxin-Producing Escherichia coli-Hemolytic Uremic Syndrome in Children: The Experience of the ItalKid HUS Network

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Ardissino, Gianluigi, Pediatric Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
  • Colombo, Rosaria, Microbiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
  • Daprai, Laura, Microbiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
  • Capone, Valentina, Pediatric Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
  • Dodaro, Antonella, Microbiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
  • Testa, Sara, Pediatric Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
  • Paglialonga, Fabio, Pediatric Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
  • Vignati, Chiara, Microbiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
  • Masia, Carla, Microbiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
  • Tel, Francesca, Pediatric Department, Vittore Buzzi Children's Hospital, Univeristà degli Studi di Milano, Milano, Italy
  • Possenti, Ilaria, Pediatric Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
  • Montini, Giovanni, Pediatric Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
Background

Bloody diarrhea (BD) is often the first distinctive sign of hemolytic uremic syndrome (eHUS), the leading cause of acute kidney injury in infants, caused by shiga toxin (Stx)-producing Escherichia Coli (STEC) infection. The few days prior the development of the renal complication, when bloody diarrhea is the only symptom, represent a window for better understanding, preventing or mitigating HUS. The present study aims at identifying patients at risk for HUS early and at evaluating the rate of BDs associated with STEC infection.

Methods

This multicenter case series study was performed between 2010 and 2019 in Pediatric emergency departments and clinics belonging to a network of 63 pediatric hospitals in Northern Italy (referral population: 12 million general population; 2.3 million children). 4767 children (<20 yo) presenting with BD were enrolled. Stool samples were centrally screened for the presence of Stx genes (1 and 2) using a Reverse Dot blot assays (Genotype EHEC - Arnika) until 2018 and Real Time PCR (RIDA Gene-Relab) thereafter. Stx-positive cases were further investigated for E.coli serogroups. Children positive for Stx genes were monitored for hemoglobinuria, blood tests to rule in or out the diagnosis of STEC-HUS were done if urine dipstick turned positive for hemoglobinuria.

Results

Out of the 4767 screened samples, 214 (4.5%) turned out to be positive for either Stx1 (n: 62; 29.0%) or Stx2 (n: 97; 45.3%) or both (n: 55; 25.7%). 34 patients out of the 214 positive for Stx (15.9%) developed eHUS (0.71% of BDs). Patients infected with STEC producing Stx2 alone were at higher risk for eHUS compared with Stx1+2 (23.7 vs. 12.7%) while Stx1 alone was only exceptionally associated with eHUS (1.1%). The most frequent serogroup found in patients with Stx+BD was the O157 while in patients with eHUS the O26 was the most (36.5% of cases), followed by O157 (20%).

Conclusion

STEC is all but a rare cause of BD in children thus the screening for Stx of BD is recommended. We also suggest to monitor patients carrying Stx2 closely with urine dipstick for hemoglobinuria every 12 hours for the early detection of eHUS together with providing them with generous fluid infusion.