scholarly journals Case-management protocol for bloody diarrhea as a model to reduce the clinical impact of Shiga toxin-producing Escherichia coli infections. Experience from Southern Italy

2019 ◽  
Vol 39 (3) ◽  
pp. 539-547 ◽  
Author(s):  
Daniela Loconsole ◽  
◽  
Mario Giordano ◽  
Nicola Laforgia ◽  
Diletta Torres ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Shiga Toxin ◽  
Clinical Management ◽  
Southern Italy ◽  
Laboratory Diagnosis ◽  
Bloody Diarrhea ◽  
Neurological Involvement ◽  
Progression Rate ◽  
Strict Adherence ◽  
Management Protocol

AbstractTo describe an operating protocol for bloody diarrhea (BD) in a pediatric population as a rapid response to a public health threat represented by an excess of pediatric HUS cases in the Apulia region (Southern Italy) starting from 2013. The protocol was set up with the goal of correct clinical management of Shiga toxin-producing Escherichia coli (STEC) infections, reductions in subsequent cases of hemolytic uremic syndrome (HUS), and improved short- and long-term disease outcomes. The protocol consisted of rapid hospitalization of children with bloody diarrhea (BD), hematochemical laboratory tests every 12–24 hours, and prompt laboratory diagnosis of STEC. No antibiotics were recommended until diagnosis. Children positive for STEC infections underwent early vigorous volume expansion. In June–December 2018, 438 children with BD were hospitalized, of which 53 (12.1%) had a STEC infection. The most common serogroups were O26 (36.1%), O111 (23.0%), and O157 (14.8%). Thirty-one samples carried the stx2 gene. Four cases evolved into HUS (7.5%), all with favorable outcome despite neurological involvement in two cases. Prompt and accurate laboratory diagnosis of STEC infections is of the utmost importance in patients with BD for correct clinical management. The strict adherence to the protocol could reduce the progression rate of STEC infections to HUS and prevents complications. Enhanced BD surveillance may help reduce cases of pediatric HUS in Southern Italy.

scholarly journals Shiga Toxin-producing Escherichia coli in Peruvian Children With Bloody Diarrhea

2012 ◽  
Vol 31 (3) ◽  
pp. 314-316 ◽  
Author(s):  
Alejandro Llanos ◽  
Jorge Lee ◽  
Francisco López ◽  
Carmen Contreras ◽  
Francesca Barletta ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Shiga Toxin ◽  
Bloody Diarrhea

scholarly journals Clinical and Laboratory Predictors of Shiga Toxin–Producing Escherichia coli Infection in Children With Bloody Diarrhea

2018 ◽  
Vol 7 (3) ◽  
pp. e116-e122 ◽  
Author(s):  
Ryan S McKee ◽  
Phillip I Tarr ◽  
Dennis J Dietzen ◽  
Rachit Chawla ◽  
David Schnadower
Keyword(s):  
Escherichia Coli ◽  
Shiga Toxin ◽  
Bloody Diarrhea ◽  
Escherichia Coli Infection

SHIGELLA AND SHIGA TOXIN-PRODUCING ESCHERICHIA COLI CAUSING BLOODY DIARRHEA IN LATIN AMERICA

2000 ◽  
Vol 14 (1) ◽  
pp. 41-65 ◽  
Author(s):  
Eduardo L. López ◽  
Valeria Prado-Jiménez ◽  
Miguel O'Ryan-Gallardo ◽  
María M. Contrini
Keyword(s):  
Escherichia Coli ◽  
Latin America ◽  
Shiga Toxin ◽  
Bloody Diarrhea

scholarly journals Epidemiology of Shiga Toxin-Producing Escherichia coli Infections in Southern Italy after Implementation of Symptom-Based Surveillance of Bloody Diarrhea in the Pediatric Population

2020 ◽  
Vol 17 (14) ◽  
pp. 5137
Author(s):  
Daniela Loconsole ◽  
Mario Giordano ◽  
Francesca Centrone ◽  
Marisa Accogli ◽  
Daniele Casulli ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Shiga Toxin ◽  
Pediatric Population ◽  
Health Impact ◽  
Reporting Rate ◽  
Bloody Diarrhea ◽  
Significant Public Health ◽  
Uremic Syndrome ◽  
Stool Samples ◽  
Severity Of The Disease

Shiga toxin-producing Escherichia coli (STEC) infections result in a significant public health impact because of the severity of the disease that, in young children especially, can lead to hemolytic–uremic syndrome (HUS). A rise in the number of HUS cases was observed in the Apulia region of Italy from 2013 to 2017, and so, in 2018, a symptom-based surveillance system for children with bloody diarrhea (BD) was initiated in order to detect and manage STEC infections. The objective of the study was to describe the epidemiology of STEC infections in children from June 2018 to August 2019. Children <15 years old with BD were hospitalized and tested for STEC. Real-time PCR for virulence genes (stx1, stx2, eae) and serogroup identification tests were performed on stool samples/rectal swabs of cases. STEC infection was detected in 87 (10.6%) BD cases. The median age of STEC cases was 2.7 years, and 60 (68.9%) were <4. Of these 87 cases, 12 (13.8%) came from households with diarrhea. The reporting rate was 14.2/100,000, with the highest incidence in cases from the province of Bari (24.2/100,000). Serogroups O26 and O111 were both detected in 22/87 (25.3%) cases. Co-infections occurred in 12.6% of cases (11/87). Twenty-nine STEC were positive for stx1, stx2, and eae. Five cases (5.7%) caused by O26 (n = 2), O111 (n = 2), and O45 (n = 1) developed into HUS. A risk-oriented approach based on the testing of children with BD during the summer may represent a potentially beneficial option to improve the sensitivity of STEC surveillance, not only in Italy but also in the context of Europe as a whole.

scholarly journals Extra-corporeal membrane oxygenation and Eculizumab: Atypical treatments for typical haemolytic uraemic syndrome

2019 ◽  
Vol 21 (2) ◽  
pp. 191-193
Author(s):  
Matthew D Kelham ◽  
Liam Gleeson ◽  
Inma Alcalde ◽  
Rosalba Spiritoso ◽  
Alastair G Proudfoot ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Cardiogenic Shock ◽  
Shiga Toxin ◽  
Haemolytic Uraemic Syndrome ◽  
Intensive Therapy ◽  
Supportive Therapy ◽  
Neurological Involvement ◽  
Extra Corporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Atypical Haemolytic Uraemic Syndrome

A 19-year-old female with no medical history presented with bloody diarrhoea. Investigations revealed an acute kidney injury, thrombocytopenia and microangiopathic haemolysis. A diagnosis of haemolytic uraemic syndrome secondary to Shiga toxin-producing Escherichia coli 055 was confirmed and supportive therapy commenced in the intensive therapy unit. On day 11 of her admission, she rapidly deteriorated with evidence of refractory cardiogenic shock and neurological involvement, both features associated with a poor prognosis. Cross-specialty collaboration prompted a trial of veno-arterial extra-corporeal membrane oxygenation and Eculizumab, a complement inhibitor normally reserved for atypical haemolytic uraemic syndrome, as a bridge to organ recovery. To our knowledge, herein we present the first adult patient with haemolytic uraemic syndrome induced cardiogenic shock successfully supported to cardiac recovery with extra-corporeal membrane oxygenation. The potential role for Eculizumab in Shiga toxin-producing Escherichia coli/typical haemolytic uraemic syndrome is also discussed.

scholarly journals Eculizumab Use in a Temporarily Dialysis-Dependent Patient With Shiga Toxin–Producing Escherichia Coli Hemolytic Uremic Syndrome With Neurological Complications

2021 ◽  
Vol 27 (1) ◽  
pp. 90-95
Author(s):  
Bo Weber ◽  
Dominic Chan ◽  
Sandy Hammer
Keyword(s):  
Escherichia Coli ◽  
Renal Failure ◽  
Hemolytic Uremic Syndrome ◽  
Shiga Toxin ◽  
Dose Adjustment ◽  
Inpatient Rehabilitation ◽  
Cellular Damage ◽  
Neurological Involvement ◽  
Organ Systems ◽  
Uremic Syndrome

Shiga toxin–producing Escherichia coli hemolytic uremic syndrome (STEC-HUS) is the most common cause of acute renal failure in children, and it is associated with thrombocytopenia and hemolytic anemia. Although this disease primarily affects the kidney, it can also contribute to cellular damage in other organ systems, such as the CNS. Eculizumab is a monoclonal antibody that binds to complement proteins to prevent complement-mediated intravascular hemolysis in atypical HUS. In STEC-HUS, complement activation also occurs by Shiga toxin, and previous cases of eculizumab use in the setting of neurological involvement have been shown to be successful. We report the successful use of eculizumab in the setting of typical STEC-HUS–induced neurological symptoms including seizure, altered mental status, and left arm weakness. The patient also experienced concomitant renal failure requiring dose adjustment for hemodialysis. Following 2 doses of eculizumab, our patient was discharged to an inpatient rehabilitation facility with resolution of her renal injury, seizures, and altered mentation without adverse effects from eculizumab throughout the admission. Based on our case study, it appears that eculizumab may be given during or between hemodialysis without dose adjustment.

scholarly journals Peripheral neurological involvement in Shiga toxin-producing Escherichia coli-hemolytic uremic syndrome (STEC-HUS) as a rare complication with a positive outcome in two consecutive children – Case Report

2021 ◽  
Author(s):  
Luisa Santangelo ◽  
Giuseppe Stefano Netti ◽  
Diletta Domenica Torres ◽  
Giovanni Piscopo ◽  
Vincenza Carbone ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Hemolytic Uremic Syndrome ◽  
Functional Recovery ◽  
Shiga Toxin ◽  
Rehabilitation Program ◽  
Lower Limbs ◽  
Motor Deficit ◽  
Neurological Involvement ◽  
Renal Complication ◽  
Uremic Syndrome

Abstract Background. The Neurological involvement is the most common extra-renal complication of Shiga toxin-producing Escherichia coli-hemolytic uremic syndrome (STEC-HUS). On brain magnetic resonance examination, main neurological signs encompass acute lesions of the basal ganglia and the white matter, which could usually regress after Eculizumab infusion. In contrast, STEC-HUS-related peripheral nervous system (PNS) involvement is very rare and, when occurring, it requires a careful management of neurological sequelae and an intensive multidisciplinary neuro-rehabilitation program.Case presentation. Here, we present two cases of severe and complicated STEC-HUS patients with PNS-involvement who successfully required therapeutic treatment and an intensive multidisciplinary neuro-rehabilitation program.In both cases, PNS-involvement followed the recovery from STEC-HUS-related severe central neurological damage and manifested mainly with marked bilateral motor deficit and hyporeflexia/areflexia in the lower limbs. The peripheral polyneuropathy was treated with immune-suppressive therapy (methylprednisolone pulses, i.v. immunoglobulins, therapeutic plasma exchange), followed by a prolonged intensive neuro-rehabilitation program. After 8 months of neuro-rehabilitation, both patients gained complete functional recovery.Conclusions. PNS involvement during STEC-HUS is a rare event and potentially leading to severe disability. A timely clinical assessment is mandatory to set up a prompt therapeutic and neuro-rehabilitation program and to obtain a complete clinical and functional recovery.

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