RESUMO
BACKGROUND: Shiga toxin-producing Escherichia coli (STEC) infection is the most common cause of hemolytic uremic syndrome (HUS). Only few studies correlated serotypes and stx genotypes with disease severity. This study aimed to update STEC serotypes, stx genotypes, and virulence factors (eae and ehxA) in a cohort of patients with STEC-HUS and investigate whether they influence the severity of disease. METHODS: In this multicentric study, children hospitalized between 2005 and 2016 with STEC-HUS confirmed by the National Reference Laboratory were included. Serotypes (O157, O145, O121, and others), stx genotypes (stx1a, stx2a, stx2c, stx2d, and others), and virulence factors were analyzed, and their association with dialysis requirement (>10 days); severe neurological, cardiovascular, and/or bowel involvement; and death was assessed. RESULTS: The records of 280 patients were reviewed; 160 females, median age 21 months (IQR18m). STEC O157 was isolated in 206 (73.6%) patients, O145 in 47 (16.8%), O121 in 15 (5.4%), and other serotypes in 12 (4.2%). The stx2a/2c genotype was carried by 179 (63.9%) strains, stx2a by 94 (33.6%), stx1a/stx2a by five (1.8%), and stx1a only by two (0.7%). All strains except six harbored eae and ehxA genes. Fifty-nine (21.1%) patients had severe neurological involvement, 29 (10.4%) severe bowel injury, 14 (5%) cardiovascular involvement, 53 (18.9%) required > 10 days of dialysis, and 12 (4.3%) died. Neither serotypes nor stx genotypes detected were significantly linked to severity. CONCLUSIONS: Serotype O157 and virulence stx2a/2c, eae, ehxA genotype are prevalent in Argentina, and no relationship was found between severity and serotypes and genotypes of STEC detected.
Assuntos
Infecções por Escherichia coli , Síndrome Hemolítico-Urêmica , Escherichia coli Shiga Toxigênica , Argentina/epidemiologia , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/epidemiologia , Proteínas de Escherichia coli/genética , Feminino , Genótipo , Síndrome Hemolítico-Urêmica/epidemiologia , Síndrome Hemolítico-Urêmica/etiologia , Humanos , Lactente , Masculino , Diálise Renal , Sorogrupo , Escherichia coli Shiga Toxigênica/genética , Fatores de Virulência/genéticaRESUMO
OBJECTIVES: (1) Evaluate mortality rate in patients with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome, (2) determine the leading causes of death, and (3) identify predictors of mortality at hospital admission. METHODS: We conducted a multicentric, observational, retrospective, cross-sectional study. It included patients under 18 years old with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome hospitalized between January 2005 and June 2016. Clinical and laboratory data were obtained from the Argentine National Epidemiological Surveillance System of Hemolytic Uremic Syndrome. Clinical and laboratory variables were compared between deceased and non-deceased patients. Univariate and multivariate analyses were performed. ROC curves and area under the curve were obtained. RESULTS: Seventeen (3.65%) out of the 466 patients died, being central nervous system involvement the main cause of death. Predictors of death were central nervous system involvement, the number of days since the beginning of diarrhea to hospitalization, hyponatremia, high hemoglobin, high leukocyte counts, and low bicarbonate concentration on admission. In the multivariate analysis, central nervous system involvement, sodium concentration, and hemoglobin were independent predictors. The best cut off for sodium was ≤ 128 meq/l and for hemoglobin ≥ 10.8 g/dl. CONCLUSIONS: Mortality was low in children with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome, being central nervous system involvement the main cause of death. The best mortality predictors found were central nervous system involvement, hemoglobin, and sodium concentration. Hyponatremia may be a new Shiga toxin-producing Escherichia coli hemolytic uremic syndrome mortality predictor.
Assuntos
Infecções por Escherichia coli/mortalidade , Síndrome Hemolítico-Urêmica/mortalidade , Hiponatremia/mortalidade , Doenças do Sistema Nervoso/mortalidade , Escherichia coli Shiga Toxigênica/isolamento & purificação , Pré-Escolar , Estudos Transversais , Infecções por Escherichia coli/sangue , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/microbiologia , Feminino , Hemoglobinas/análise , Síndrome Hemolítico-Urêmica/sangue , Síndrome Hemolítico-Urêmica/complicações , Síndrome Hemolítico-Urêmica/microbiologia , Humanos , Hiponatremia/sangue , Hiponatremia/diagnóstico , Hiponatremia/etiologia , Lactente , Masculino , Doenças do Sistema Nervoso/sangue , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/etiologia , Prognóstico , Curva ROC , Estudos Retrospectivos , Medição de Risco , Sódio/sangueRESUMO
Se estudiaron nueve pacientes de edades comprendidas entre los cinco y veinte años; siete de sexo femenino y dos de sexo masculino portadores de insuficiencia renal crónica terminal con un tiempo de hemodiálisis de cuatro meses a seis años. Se valoraron las respuestas de LH y FSH a la administración de LHRH intravenoso, post diálisis obteniéndose muestras a los 60,90,120 min., también maduración ósea, RX de silla turca y niveles de creatinina sérica. Se observaron tres tipos de respuestas a LH; exagerada, normal, bloqueada. Hubo correlación entre niveles de creatinina sérica y LH en el grupo de hiperrespuesta. También obtuvimos tres tipos de respuestas de FSH: hiperrespuesta, normal, bloqueada. No hubo correlación entre creatinina y FSH. El retraso del desarrollo puberal se correlacionó con la edad ósea y no con la edad cronológica. Las alteraciones encontradas en las respuestas de LH y FSH podrían deberse a disturbios en el el eje hipotálamo hipofiso gonadal
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Adolescente , Adulto , Puberdade , Insuficiência Renal Crônica , Estradiol , Hormônio Liberador de Gonadotropina , TestosteronaRESUMO
Se estudiaron nueve pacientes de edades comprendidas entre los cinco y veinte años; siete de sexo femenino y dos de sexo masculino portadores de insuficiencia renal crónica terminal con un tiempo de hemodiálisis de cuatro meses a seis años. Se valoraron las respuestas de LH y FSH a la administración de LHRH intravenoso, post diálisis obteniéndose muestras a los 60,90,120 min., también maduración ósea, RX de silla turca y niveles de creatinina sérica. Se observaron tres tipos de respuestas a LH; exagerada, normal, bloqueada. Hubo correlación entre niveles de creatinina sérica y LH en el grupo de hiperrespuesta. También obtuvimos tres tipos de respuestas de FSH: hiperrespuesta, normal, bloqueada. No hubo correlación entre creatinina y FSH. El retraso del desarrollo puberal se correlacionó con la edad ósea y no con la edad cronológica. Las alteraciones encontradas en las respuestas de LH y FSH podrían deberse a disturbios en el el eje hipotálamo hipofiso gonadal