MO1013RETROSPECTIVE ANALYSIS OF THROMBOTIC COMPLICATIONS IN SHIGA-TOXIN ASSOCIATED HEMOLYTIC UREMIC SYNDROME IN CHILDREN

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Khadizha Emirova ◽  
Evgeniya Tolstova ◽  
Olga Orlova ◽  
Alexandr Muzurov ◽  
Sofya Mstislavskaya ◽  
...  
Keyword(s):  
Hemolytic Uremic Syndrome ◽  
Shiga Toxin ◽  
Rare Complication ◽  
Femoral Vein ◽  
Vena Cava ◽  
Clinical Manifestations ◽  
Thrombin Time ◽  
Vena Cava Superior ◽  
Uremic Syndrome ◽  
Thrombotic Complications

Abstract Background and Aims Shiga-toxin associated hemolytic-uremic syndrome (STEC-HUS) is a thrombotic microangiopathy (TMA) followed by intestinal infection caused by shiga-toxin-producing E. coli. Endothelium damage of the microvasculature leads to the formation of platelet-fibrin thrombi and occlusion of small vessels. The aim of our study was a retrospective analysis of thrombotic complications in children with STEC-HUS. Method We retrospectively analyzed the case histories of patients in the dialysis department of St. Vladimir's Children's City Clinical Hospital from 2009 to 2019. The study included patients with STEC-HUS with the development of thrombotic complications. Results Among 410 patients with STEC-HUS, 16 patients with thrombotic complications were identified. Equally boys and girls, mean age 3.5 ± 2.4 g. Respiratory support was required in 6 cases. The duration of anuria was 9.9 +/- 6.2 days, in 2 cases only oliguria was noted. In all patients blood transfusion, fresh frozen plasma were needed, antibiotics were used. In all cases, continuous venovenous hemodiafiltration (CVVHDF) was performed with 2-way catheters, usually in the femoral vein. Thrombotic complications in all cases were associated with therapy. In 11 children, thrombosis was localized in the femoral, iliac veins and vena cava inferior. Clinical manifestations in the form of limb edema, cyanosis were noted in 4 patients, in other cases the diagnosis was made by ultrasound. 3 patients with thrombosis of the branches of the central retinal vein, vena cava superior, mesenteric thrombosis. 1 patient was diagnosed with dissecting femoral vein aneurysm. In 3 cases, CVVGDF had to be stopped due to catheter thrombosis. Before the current thrombosis, these children were not prescribed anicoagulants. Coagulation tests indices indicated hypercoagulability and were characterized by higher thrombin time, increased levels of D-dimer, and increased fibrinolysis time. Conclusion Large vessel thrombosis in children with STEC-HUS is a rare complication. The provoking factor for the implementation of thrombotic events in all cases was femoral vein catheterization. When managing patients with STEC-HUS monitoring of coagulation status is needed for the purpose of timely administration of anticoagulants.

The frequency of detection of markers of Сytomegalovirus infection in children with recurrent respiratory diseases in patients with Shiga-toxin-associated hemolytic-uremic syndrome (STEC-HUS)

2021 ◽  
Vol 20 (1) ◽  
pp. 12-18
Author(s):  
I. B. Repina ◽  
L. V. Feklisova ◽  
M. K. Khadisova ◽  
N. V. Karazhas ◽  
E. I. Likhanskaya
Keyword(s):  
Hemolytic Uremic Syndrome ◽  
Shiga Toxin ◽  
Acute Infection ◽  
Clinical Manifestations ◽  
Culture Method ◽  
Herpesvirus Type ◽  
Diagnostic Values ◽  
Respiratory Pathology ◽  
Uremic Syndrome ◽  
Type V

The paper presents data on the detection and role of cytomegalovirus infection (CMVI) in 146 children of certain groups aged from 3 months to 15 years who were hospitalized — frequently ill children with respiratory pathology, patients with shiga-toxin-associated hemolytic uremic syndrome (STEC-HUS) and schoolchildren with somatic diseases during rehabilitation in a sanatorium.The aim of the study was to determine the frequency of detection of CMVI in the presented groups, the originality of the main clinical manifestations in correlation with the markers of activity of herpesvirus type V infection. Clinical monitoring was carried out, oropharyngeal swabs, saliva,blood samples (serum and blood cells) were studied using a set of laboratory diagnostic methods:RCM (rapid culture method) on Vero- and M-19 cells, IIR (reaction of indirect immunofluorescence), ELISA to detect specific antigens and antibodies (IgM, IgG).The detection rate of CMV IgG in diagnostic values ranged from 6.4% in the group of frequently ill children with respiratory pathology to 31.7% in schoolchildren of the sanatorium, the acute course of infection was detected in3.2% and 6.4%, respectively, based on markers of acute infection (CMV IgM and cytomegalovirus antigen). In patients with STEC-HUS CMV IgG in diagnostic titers were recorded with the highest frequency — in 74.4% of patients. 

Tissue-resident macrophages mediate neutrophil recruitment and kidney injury in shiga toxin-induced hemolytic uremic syndrome.

2021 ◽  
Author(s):  
Julia K. Lill ◽  
Stephanie Thiebes ◽  
Judith-Mira Pohl ◽  
Jenny Bottek ◽  
Nirojah Subramaniam ◽  
...  
Keyword(s):  
Hemolytic Uremic Syndrome ◽  
Shiga Toxin ◽  
Kidney Injury ◽  
Neutrophil Recruitment ◽  
Uremic Syndrome

scholarly journals Hemoconcentration and predictors in Shiga toxin-producing E. coli-hemolytic uremic syndrome (STEC-HUS)

2021 ◽  
Author(s):  
Sebastian Loos ◽  
Jun Oh ◽  
Laura van de Loo ◽  
Markus J. Kemper ◽  
Martin Blohm ◽  
...  
Keyword(s):  
Risk Factor ◽  
Serum Creatinine ◽  
Hemolytic Uremic Syndrome ◽  
Shiga Toxin ◽  
Neurological Symptoms ◽  
Fluid Loss ◽  
Good Prediction ◽  
E Coli ◽  
Complicated Course ◽  
Uremic Syndrome

Abstract Background Hemoconcentration has been identified as a risk factor for a complicated course in Shiga toxin-producing E. coli-hemolytic uremic syndrome (STEC-HUS). This single-center study assesses hemoconcentration and predictors at presentation in STEC-HUS treated from 2009–2017. Methods Data of 107 pediatric patients with STEC-HUS were analyzed retrospectively. Patients with mild HUS (mHUS, definition: max. serum creatinine < 1.5 mg/dL and no major neurological symptoms) were compared to patients with severe HUS (sHUS, definition: max. serum creatinine ≥ 1.5 mg/dL ± major neurological symptoms). Additionally, predictors of complicated HUS (dialysis ± major neurological symptoms) were analyzed. Results Sixteen of one hundred seven (15%) patients had mHUS. Admission of patients with sHUS occurred median 2 days earlier after the onset of symptoms than in patients with mHUS. On admission, patients with subsequent sHUS had significantly higher median hemoglobin (9.5 g/dL (3.6–15.7) vs. 8.5 g/dL (4.2–11.5), p = 0.016) than patients with mHUS. The product of hemoglobin (g/dL) and LDH (U/L) (cutoff value 13,302, sensitivity 78.0%, specificity of 87.5%) was a predictor of severe vs. mild HUS. Creatinine (AUC 0.86, 95% CI 0.79–0.93) and the previously published score hemoglobin (g/dL) + 2 × creatinine (mg/dL) showed a good prediction for development of complicated HUS (AUC 0.87, 95% CI 0.80–0.93). Conclusions At presentation, patients with subsequent severe STEC-HUS had a higher degree of hemoconcentration. This underlines that fluid loss or reduced fluid intake/administration may be a risk factor for severe HUS. The good predictive value of the score hemoglobin (g/dL) + 2 × creatinine (mg/dL) for complicated HUS could be validated in our cohort. Graphical abstract

scholarly journals Whole-genome characterization of hemolytic uremic syndrome-causing Shiga toxin-producing Escherichia coli in Sweden

Virulence ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 1296-1305
Author(s):  
Ying Hua ◽  
Milan Chromek ◽  
Anne Frykman ◽  
Cecilia Jernberg ◽  
Valya Georgieva ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Hemolytic Uremic Syndrome ◽  
Shiga Toxin ◽  
Whole Genome ◽  
Genome Characterization ◽  
Uremic Syndrome

scholarly journals Hemolytic Uremic Syndrome Associated withEscherichia coliO8:H19 and Shiga Toxin 2f Gene

2015 ◽  
Vol 21 (1) ◽  
pp. 168-169 ◽  
Author(s):  
Ingrid H.M. Friesema ◽  
Mandy G. Keijzer-Veen ◽  
Marja Koppejan ◽  
Henk S. Schipper ◽  
Arjanne J. van Griethuysen ◽  
...  
Keyword(s):  
Hemolytic Uremic Syndrome ◽  
Shiga Toxin ◽  
Uremic Syndrome

scholarly journals Therapeutic use of a receptor mimic probiotic reduces intestinal Shiga toxin levels in a piglet model of hemolytic uremic syndrome

2014 ◽  
Vol 7 (1) ◽  
Author(s):  
Shannon J Hostetter ◽  
Amy F Helgerson ◽  
James C Paton ◽  
Adrienne W Paton ◽  
Nancy A Cornick
Keyword(s):  
Hemolytic Uremic Syndrome ◽  
Shiga Toxin ◽  
Therapeutic Use ◽  
Uremic Syndrome

scholarly journals First Shiga Toxin-ProducingEscherichia coliIsolate from a Patient with Hemolytic Uremic Syndrome, Brazil

2002 ◽  
Vol 8 (5) ◽  
pp. 535-536 ◽  
Author(s):  
Beatriz Ernestina C. Guth ◽  
Renato Lopes de Souza ◽  
Tânia Mara I. Vaz ◽  
Kinue Irino
Keyword(s):  
Hemolytic Uremic Syndrome ◽  
Shiga Toxin ◽  
Uremic Syndrome

Outbreak of Shiga Toxin–Producing Escherichia coli (STEC) O104:H4 Infection in Germany Causes a Paradigm Shift with Regard to Human Pathogenicity of STEC Strains

2012 ◽  
Vol 75 (2) ◽  
pp. 408-418 ◽  
Author(s):  
LOTHAR BEUTIN ◽  
ANNETT MARTIN
Keyword(s):  
Escherichia Coli ◽  
Hemolytic Uremic Syndrome ◽  
Shiga Toxin ◽  
Outbreak Strain ◽  
Fenugreek Seeds ◽  
E Coli ◽  
Aggregative Adherence ◽  
Uremic Syndrome ◽  
Enterocyte Effacement ◽  
The Way

An outbreak that comprised 3,842 cases of human infections with enteroaggregative hemorrhagic Escherichia coli (EAHEC) O104:H4 occurred in Germany in May 2011. The high proportion of adults affected in this outbreak and the unusually high number of patients that developed hemolytic uremic syndrome makes this outbreak the most dramatic since enterohemorrhagic E. coli (EHEC) strains were first identified as agents of human disease. The characteristics of the outbreak strain, the way it spread among humans, and the clinical signs resulting from EAHEC infections have changed the way Shiga toxin–producing E. coli strains are regarded as human pathogens in general. EAHEC O104:H4 is an emerging E. coli pathotype that is endemic in Central Africa and has spread to Europe and Asia. EAHEC strains have evolved from enteroaggregative E. coli by uptake of a Shiga toxin 2a (Stx2a)–encoding bacteriophage. Except for Stx2a, no other EHEC-specific virulence markers including the locus of enterocyte effacement are present in EAHEC strains. EAHEC O104:H4 colonizes humans through aggregative adherence fimbrial pili encoded by the enteroaggregative E. coli plasmid. The aggregative adherence fimbrial colonization mechanism substitutes for the locus of enterocyte effacement functions for bacterial adherence and delivery of Stx2a into the human intestine, resulting clinically in hemolytic uremic syndrome. Humans are the only known natural reservoir known for EAHEC. In contrast, Shiga toxin–producing E. coli and EHEC are associated with animals as natural hosts. Contaminated sprouted fenugreek seeds were suspected as the primary vehicle of transmission of the EAHEC O104:H4 outbreak strain in Germany. During the outbreak, secondary transmission (human to human and human to food) was important. Epidemiological investigations revealed fenugreek seeds as the source of entry of EAHEC O104:H4 into the food chain; however, microbiological analysis of seeds for this pathogen produced negative results. The survival of EAHEC in seeds and the frequency of human carriers of EAHEC should be investigated for a better understanding of EAHEC transmission routes.

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