Is Shigatoxin 1 protective for the development of Shigatoxin 2-related hemolytic uremic syndrome in children? Data from
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BRIEF REPORT
Is Shigatoxin 1 protective for the development of Shigatoxin 2-related hemolytic uremic syndrome in children? Data from the ItalKid-HUS Network Gianluigi Ardissino 1 & Ilaria Possenti 2 & Chiara Vignati 3 & Laura Daprai 3 & Valentina Capone 1 & Maurizio Brigotti 4 & Mario Vittorio Luini 5 & Dario Consonni 6 & Giovanni Montini 1,7 Received: 28 February 2020 / Revised: 16 June 2020 / Accepted: 25 June 2020 # IPNA 2020
Abstract Background Shigatoxin (Stx)-producing Escherichia coli (STEC) are the most common causes of hemolytic uremic syndrome (STEC-HUS). The aim of our study is to compare the risk of developing STEC-HUS in relation to the type of Stx genes (Stx1, Stx2, or both). Methods This is a prospective, observational, multicenter study involving 63 pediatric units in Northern Italy (ItalKid-HUS Network). STEC-infected children were identified within a screening program for bloody diarrhea during a 10-year period (2010–2019). Stx genes were detected by reverse dot blot or real-time PCR. After the identification of STEC infection, children were followed until diarrhea complete recovery for the possible development of STEC-HUS. Results Of the 214 Stx-positive patients, 34 (15.9%) developed STEC-HUS. The risk of HUS in STEC-infected children with Stx1 (n: 62; 29.0%) and Stx2 (n: 97; 45.3%) was respectively 0% and 23.7%, while in patients carrying both Stx1 and Stx2 (n: 55; 25.7%), the risk was 12.7% (p: 0.001). Conclusions Our data confirm that Stx1 is a very rare cause of STEC-HUS and demonstrate that the risk of STEC-HUS halves in the case of Stx1+2-producing Escherichia coli infection compared with infections where Stx2 is present alone. This observation is helpful in assessing the risk of individual STEC-infected patients for the development of HUS and suggests that Stx1, in the presence of Stx2, might exert a protective role possibly by receptor competition. Keywords Shiga toxin . Hemolytic uremic syndrome . Diarrhea . Children
Abbreviation HUS Hemolytic uremic syndrome STEC Shigatoxin (Stx)-producing Escherichia coli KRT Kidney replacement therapy
Introduction
* Gianluigi Ardissino [email protected]
4
Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40126 Bologna, Italy
5
Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia-Romagna, 26900 Lodi, Italy
6
Epidemiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via San Barnaba 8, 20122 Milan, Italy
7
Giuliana and Bernardo Caprotti Chair of Pediatrics, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
1
Center for HUS Prevention, Control and Management, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, via Commenda 9, 20122 Milan, Italy
2
Pediatric Unit, Ospedale Infantile C.Arrigo, Spalto Marengo 46, 15121 Alessandria, Italy
3
Unit of Microbiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, via Commenda 9, 20122 Milan, Italy
Hemolytic uremic syndrome (HUS) is a life-threatening disease defi
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