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Chen Y, Li L, Wei X, Hu M, Zhao X, Zhang Q, Luo Y, Zhao M, Liu Z, Cai Y, Liu Y. Phage Tail Fiber Protein as a Specific Probe for Recognition of Shiga Toxin-Producing Escherichia coli O91, O103, and O111. Anal Chem 2023; 95:18407-18414. [PMID: 38053255 DOI: 10.1021/acs.analchem.3c03370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
The ability to quickly identify specific serotypes of Shiga toxin-producing Escherichia coli (STEC) could facilitate the monitoring and control of STEC pathogens. In this study, we identified the receptors and receptor-binding proteins (RBPs) of three novel phages (pO91, pO103, and pO111) isolated from hospital wastewater. Recombinant versions of these RBPs (pO91-ORF43, pO103-ORF42, and pO111-ORF8) fused to a fluorescent reporter protein were then constructed. Both fluorescence microscopy and transmission electron microscopy showed that all three recombinant RBPs were bound to the bacterial surface. Indirect enzyme-linked immunosorbent assay was used to verify that each recombinant RBP bound specifically to E. coli O91, O103, or O111, but not to any of the 83 strains of E. coli with different O-antigens, nor to 10 other bacterial species that were tested. The recombinant RBPs adsorbed to their respective host bacteria within 10 min of incubation. The minimum concentration of bacteria required for detection by the recombinant RBPs was 33 colony-forming units (CFU)/mL (range: 3.3 × 10 to 3.3 × 108 CFU/mL). Furthermore, each recombinant RBP was also able to detect bacteria in lettuce, chicken breast meat, and infected mice, indicating that their usage will facilitate the detection of STEC and may help to reduce the spread of STEC-related infections and diseases.
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Affiliation(s)
- Yibao Chen
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Jinan 250100, China
| | - Lulu Li
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Jinan 250100, China
| | - Xiaotian Wei
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Jinan 250100, China
| | - Ming Hu
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Jinan 250100, China
| | - Xiaonan Zhao
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Jinan 250100, China
| | - Qing Zhang
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Jinan 250100, China
| | - Yanbo Luo
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Jinan 250100, China
| | - Min Zhao
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Jinan 250100, China
| | - Zhengjie Liu
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Jinan 250100, China
| | - Yumei Cai
- College of Veterinary Medicine, Shandong Agricultural University, Taian 271018, China
| | - Yuqing Liu
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Jinan 250100, China
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Byrne L, Douglas A, Launders N, Godbole G, Lynn R, Inward C, Jenkins C. Haemolytic uraemic syndrome in children England, Wales, Northern Ireland, and Ireland: A prospective cohort study. Epidemiol Infect 2023; 151:e160. [PMID: 37655611 PMCID: PMC10600734 DOI: 10.1017/s0950268823001413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023] Open
Abstract
Haemolytic uraemic syndrome (HUS) caused by infection with Shiga toxin-producing Escherichia coli (STEC) is a relatively rare but potentially fatal multisystem syndrome clinically characterised by acute kidney injury. This study aimed to provide robust estimates of paediatric HUS incidence in England, Wales, Northern Ireland, and the Republic of Ireland by using data linkage and case reconciliation with existing surveillance systems, and to describe the characteristics of the condition. Between 2011 and 2014, 288 HUS patients were included in the study, of which 256 (89.5%) were diagnosed as typical HUS. The crude incidence of paediatric typical HUS was 0.78 per 100,000 person-years, although this varied by country, age, gender, and ethnicity. The majority of typical HUS cases were 1 to 4 years old (53.7%) and female (54.0%). Clinical symptoms included diarrhoea (96.5%) and/or bloody diarrhoea (71.9%), abdominal pain (68.4%), and fever (41.4%). Where STEC was isolated (59.3%), 92.8% of strains were STEC O157 and 7.2% were STEC O26. Comparison of the HUS case ascertainment to existing STEC surveillance data indicated an additional 166 HUS cases were captured during this study, highlighting the limitations of the current surveillance system for STEC for monitoring the clinical burden of STEC and capturing HUS cases.
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Affiliation(s)
- Lisa Byrne
- Gastro and Food Safety (One Health) Division, United Kingdom Health Security Agency, London, UK
| | - Amy Douglas
- Gastro and Food Safety (One Health) Division, United Kingdom Health Security Agency, London, UK
| | - Naomi Launders
- Gastro and Food Safety (One Health) Division, United Kingdom Health Security Agency, London, UK
| | - Gauri Godbole
- Gastro and Food Safety (One Health) Division, United Kingdom Health Security Agency, London, UK
| | - Richard Lynn
- British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, London, UK
| | - Carol Inward
- British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, London, UK
- University Hospitals Bristol and Weston, NHS Foundation Trust, Bristol, UK
| | - Claire Jenkins
- Gastro and Food Safety (One Health) Division, United Kingdom Health Security Agency, London, UK
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Abstract
The last 2 decades have witnessed considerable advances in our understanding of thrombotic thrombocytopenic purpura (TTP). However, there is still some ambiguity regarding the precise nature of this disease, especially with respect to nervous system involvement and the correct nomenclature. This article seeks to summarize the clinical manifestations of TTP and the associated diseases. We describe TTP complicated with cerebrovascular disease, spinal cord injury, posterior reversible encephalopathy syndrome (PRES), anxious-depressive symptoms, and cognitive decline. TTP with spinal cord injury is rarely reported. For better clarity, we discuss the case of a 57-year-old woman who was diagnosed with neuromyelitis optica spectrum disease (NMOSD) with atypical TTP. The concurrent occurrence of NMOSD and TTP in this patient is consistent with the characteristics of acquired autoimmunity. We highlight the importance of early recognition of TTP in patients with atypical presentation who may not have the expected clinical or laboratory findings. This is particularly important in TTP patients with other concomitant autoimmune diseases or age-related comorbid conditions.
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Affiliation(s)
- Hui Zhu
- Department of Neurology, The First Hospital, Jilin University, Changchun, China
| | - Jing-Yao Liu
- Department of Neurology, The First Hospital, Jilin University, Changchun, China
- * Correspondence: Jing-Yao Liu, Department of Neurology, The First Hospital, Jilin University, Jilin Road, No. 3302, Changchun 130031, China (e-mail: , )
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Yu HT, Zhang JQ, Sun MC, Chen H, Shi XM, You FP, Qiao SY. Polymeric Nanohybrids Engineered by Chitosan Nanoparticles and Antimicrobial Peptides as Novel Antimicrobials in Food Biopreservatives: Risk Assessment and Anti-Foodborne Pathogen Escherichia coli O157:H7 Infection by Immune Regulation. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2022; 70:12535-12549. [PMID: 36153996 DOI: 10.1021/acs.jafc.2c05308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Polymeric nanomaterials (APs) are gaining attention as promising clinical antimicrobials with rapidly increasing antibiotic resistance. Infections by zoonotic enterohemorrhagic Escherichia coli are a severe global threat to public health. Chitosan nanoparticles-microcin J25 (CNM), a class of APs engineered by bioactive peptides and chitosan nanoparticles, can be used as a novel antimicrobial agent against bacterial infections. However, the risk assessment of CNM on animal health or its potential immune modulation to treat serotype E. coli O157:H7 infection impacts in vivo are not well understood. Herein, our findings in mouse models uncovered that oral administration of low levels of CNM significantly increased the body weight and made beneficial effects on the lifespan or clinical signs, accompanied by a significant improvement in gut health, including enhancing the intestinal barrier, immune modulation, and changes in gut microbiota compositions or metabolites. However, high concentrations of CNM induced serious adverse effects, negatively improving intestinal health targets. Anti-infective results proved that oral 0.1% CNM enhances host defense against E. coli O157:H7 infection by improving immune functions and modulating the Th1/Th2 balance. In summary, these findings uncover an instrumental link between the dosage and toxicity risk, suggesting that APs need to be comprehensively assessed for risk before application as safe and reliable food preservatives or therapeutic agents. In addition, CNM as a promising AP may markedly enhance host immunity and therapeutic effects by oral administration.
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Affiliation(s)
- Hai-Tao Yu
- Institute of Systems Biomedicine, Department of Immunology, School of Basic Medical Sciences, Beijing Key Laboratory of Tumor Systems Biology, Peking University Health Science Center, Beijing 100191, P. R. China
| | - Jia-Qi Zhang
- State Key Laboratory of Animal Nutrition, Institute of Animal Sciences of Chinese Academy of Agricultural Sciences, Beijing 100193, P. R. China
| | - Ming-Chao Sun
- State Key Laboratory of Animal Nutrition, Institute of Animal Sciences of Chinese Academy of Agricultural Sciences, Beijing 100193, P. R. China
| | - Han Chen
- State Key Laboratory of Animal Nutrition, Institute of Animal Sciences of Chinese Academy of Agricultural Sciences, Beijing 100193, P. R. China
| | - Xiu-Mei Shi
- State Key Laboratory of Animal Nutrition, Institute of Animal Sciences of Chinese Academy of Agricultural Sciences, Beijing 100193, P. R. China
| | - Fu-Ping You
- Institute of Systems Biomedicine, Department of Immunology, School of Basic Medical Sciences, Beijing Key Laboratory of Tumor Systems Biology, Peking University Health Science Center, Beijing 100191, P. R. China
| | - Shi-Yan Qiao
- State Key Laboratory of Animal Nutrition, Ministry of Agriculture and Rural Affairs Feed Industry Center, College of Animal Science and Technology, China Agricultural University, Beijing 100193, P. R. China
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Lazem M, Hooman N, Sheikhtaheri A. Development and pilot implementation of Iranian Hemolytic Uremic Syndrome Registry. Orphanet J Rare Dis 2022; 17:228. [PMID: 35710568 PMCID: PMC9205084 DOI: 10.1186/s13023-022-02376-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 06/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Patients with Hemolytic Uremic Syndrome (HUS) face late diagnosis and lack of appropriate treatment because of a lack of knowledge and experience in this field. A prerequisite for such knowledge is the development of research infrastructures such as a registry system. Therefore, this study aimed to develop and describe the HUS registry in accordance with the Iranian health system and implement its software system. Methods We first interviewed 10 pediatric nephrologists and after analyzing the interviews, we identified the features and requirements and the data related to HUS. Then, during two rounds of the Delphi technique (the first round with 23 participants and the second round with 18 participants), the model of this registry was finalized based on the agreement of at least 75% of specialists. At the next step, based on the agreed requirements, IRI.HUS.Reg (Iranian Hemolytic Uremic Syndrome Registry) software was developed and implemented in a pediatric hospital. Results We classified 369 meaning units of interviews in 41 codes and 7 final themes including purposes of the registry (10 codes), inclusion criteria (7 codes), data collection method (4 codes), data quality control (6 codes), data sources (4 codes), data analysis (3 codes) and software features (7 codes). These 7 feature groups (67 subgroups) and 12 data classes (138 data elements) include demographic data, referrals, examinations, clinical signs, causes, laboratory tests, medical histories, paraclinical measures, treatments, outcomes, patient’s status at discharge, and follow-up data were reviewed by the Delphi panelists, and finally, 64 features and 131 data elements were accepted by at least 78% agreement. Then, we developed and implemented a registry software system in a hospital. Conclusion We implemented IRI.HUS.Reg based on related features, 12 data classes agreed by specialists, literature review, and comparison with other existing registries. Therefore, the data collected in this registry can be compared with other data from existing registries in other countries. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02376-9.
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Affiliation(s)
- Mina Lazem
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Nakysa Hooman
- Aliasghar Clinical Research Development Center (AACRDC), Aliasghar Children Hospital, Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
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Vilardouro AS, Cachão J, Rodrigues M, Durão F, Costa-Reis P, Sandes AR, Silva JED, Boto L, Stone R. Hemolytic-uremic syndrome: 24 years' experience of a pediatric nephrology unit. J Bras Nefrol 2022; 45:51-59. [PMID: 35385571 PMCID: PMC10139713 DOI: 10.1590/2175-8239-jbn-2021-0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/01/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION A better understanding of hemolytic-uremic syndrome (HUS) pathophysiology significantly changed its treatment and prognosis. The aim of this study is to characterize the clinical features, severity, management, and outcomes of HUS patients. MATERIALS AND METHODS Retrospective study of HUS patients admitted to a Pediatric Nephrology Unit between 1996 and 2020. Demographic and clinical data regarding etiology, severity, treatment strategies, and patient outcome were collected. RESULTS Twenty-nine patients with HUS were admitted to our unit, but four were excluded. Median age at diagnosis was two years (2 months - 17 years). Clinical manifestations included diarrhea, vomiting, oliguria, hypertension, and fever. During the acute phase, 14 patients (56%) required renal replacement therapy. Infectious etiology was identified in seven patients (five Escherichia coli and two Streptococcus pneumoniae). Since 2015, 2/7 patients were diagnosed with complement pathway dysregulation HUS and there were no cases of infectious etiology detected. Six of these patients received eculizumab. The global median follow-up was 6.5 years [3 months-19.8 years]. One patient died, seven had chronic kidney disease, four of whom underwent kidney transplantation, one relapsed, and seven had no sequelae. CONCLUSION These results reflect the lack of infectious outbreaks in Portugal and the improvement on etiological identification since genetic testing was introduced. The majority of patients developed sequels and mortality was similar to that of other countries. HUS patients should be managed in centers with intensive care and pediatric nephrology with capacity for diagnosis, etiological investigation, and adequate treatment. Long-term follow-up is essential.
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Affiliation(s)
- Ana Sofia Vilardouro
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Unidade de Nefrologia Pediátrica e Transplante Renal, Departamento de Pediatria, Lisboa, Portugal
| | - Joana Cachão
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Unidade de Nefrologia Pediátrica e Transplante Renal, Departamento de Pediatria, Lisboa, Portugal.,Hospital de São Bernardo, Centro Hospitalar de Setúbal, Serviço de Pediatria, Setúbal, Portugal
| | - Márcia Rodrigues
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Serviço de Genética, Departamento de Pediatria, Lisboa, Portugal
| | - Filipa Durão
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Unidade de Nefrologia Pediátrica e Transplante Renal, Departamento de Pediatria, Lisboa, Portugal.,Universidade de Lisboa, Faculdade de Medicina, Lisboa, Portugal
| | - Patrícia Costa-Reis
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Unidade de Nefrologia Pediátrica e Transplante Renal, Departamento de Pediatria, Lisboa, Portugal.,Universidade de Lisboa, Faculdade de Medicina, Lisboa, Portugal
| | - Ana Rita Sandes
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Unidade de Nefrologia Pediátrica e Transplante Renal, Departamento de Pediatria, Lisboa, Portugal.,Universidade de Lisboa, Faculdade de Medicina, Lisboa, Portugal
| | - José Esteves da Silva
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Unidade de Nefrologia Pediátrica e Transplante Renal, Departamento de Pediatria, Lisboa, Portugal.,Universidade de Lisboa, Faculdade de Medicina, Lisboa, Portugal
| | - Leonor Boto
- Universidade de Lisboa, Faculdade de Medicina, Lisboa, Portugal.,Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Unidade de Cuidados Intensivos Pediátricos, Departamento de Pediatria, Lisboa, Portugal
| | - Rosário Stone
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Unidade de Nefrologia Pediátrica e Transplante Renal, Departamento de Pediatria, Lisboa, Portugal.,Universidade de Lisboa, Faculdade de Medicina, Lisboa, Portugal
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Weber B, Chan D, Hammer S. Eculizumab Use in a Temporarily Dialysis-Dependent Patient With Shiga Toxin-Producing Escherichia Coli Hemolytic Uremic Syndrome With Neurological Complications. J Pediatr Pharmacol Ther 2022; 27:90-95. [PMID: 35002565 DOI: 10.5863/1551-6776-27.1.90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 01/25/2021] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Bo Weber
- Department of Pharmacy (BW), Legacy Health, Portland, OR.,Department of Pharmacy (BW), DCH Regional Medical Center, Tuscaloosa, AL
| | - Dominic Chan
- Department of Pharmacy (DC), Legacy Health, Portland, OR
| | - Sandy Hammer
- Department of Pharmacy (SH), Legacy Emanuel Medical Center, Portland, OR
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Cabarcas-Barbosa O, Aroca-Martínez G, Musso CG, Ramos-Bolaños E, González-Tórres H, Espitaleta-Vergara Z, Domínguez-Vargas A, Ararat-Rodriguez E, Orozco J, Castillo-Parodi L, Conde-Manotas J, Daza-Arnedo R, Rodríguez-SanJuan V, Gómez-Navarro L, Acosta-Madiedo R, Barros-Camargo L, Aduen-Carrillo A, Ayola-Anaya F, Pulgar-Emiliani M, Cadena-Bonfanti A. Atypical hemolytic uremic syndrome in the Colombian Caribbean: its particular characteristics. Int Urol Nephrol 2021; 54:1323-1330. [PMID: 34643860 PMCID: PMC8513378 DOI: 10.1007/s11255-021-03011-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 10/04/2021] [Indexed: 11/26/2022]
Abstract
Introduction Atypical hemolytic uremic syndrome (aHUS) is a rare and genetically mediated systemic disease most often caused by uncontrolled and chronic complement activation that leads to systemic thrombotic microangiopathy, renal and extra-renal damage. Materials and methods This is descriptive, retrospective and multicenter study, which reports demographic, clinical, laboratory, and genetic characteristics, as well as their treatment response and outcome of 20 aHUS patients diagnosed between 2014 and 2018. Results Most patients were female adults (75%) and 30% were associated to pregnancy/postpartum, 15% to autoimmune disease, and 65% to infections. Gastrointestinal involvement (75%) was the most frequent extra-renal organ damage. Antenatal mortality and mortality rate were 5% and 10%, respectively. 25% of the patients progressed to end-stage renal disease. In 4/8 of patients treated within 1 week of presentation, eculizumab treatment restored multi-organ function after 4 weeks of treatment. CFH (37%) and CFI (25%) mutations were the most frequent. Conclusion This is the first series of aHUS cases of Colombian Caribbean region which reports the clinical and epidemiological characteristics of this condition in this region.
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Affiliation(s)
- Omar Cabarcas-Barbosa
- Facultad de Ciencias de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla, Colombia
- Clínica de la Costa, Barranquilla, Colombia
| | - Gustavo Aroca-Martínez
- Facultad de Ciencias de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla, Colombia
- Clínica de la Costa, Barranquilla, Colombia
| | - Carlos G Musso
- Facultad de Ciencias de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla, Colombia.
- Unidad de Biología Del Envejecimiento, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | | | - Henry González-Tórres
- Facultad de Ciencias de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla, Colombia
- Clínica de la Costa, Barranquilla, Colombia
| | - Zilac Espitaleta-Vergara
- Facultad de Ciencias de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla, Colombia
- Clínica de la Costa, Barranquilla, Colombia
| | - Alex Domínguez-Vargas
- Facultad de Ciencias de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla, Colombia
| | | | - José Orozco
- Facultad de Ciencias de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla, Colombia
| | - Luis Castillo-Parodi
- Facultad de Ciencias de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla, Colombia
- Clínica de la Costa, Barranquilla, Colombia
| | - Juan Conde-Manotas
- Facultad de Ciencias de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla, Colombia
- Clínica San Rafael, Sabanalarga, Colombia
| | - Rodrigo Daza-Arnedo
- Facultad de Ciencias de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla, Colombia
- Servicio de Cuidados Intensivos Obstétricos, Hospital Niño Jesús, Barranquilla, Colombia
| | | | | | | | | | | | | | - María Pulgar-Emiliani
- Facultad de Ciencias de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla, Colombia
| | - Andrés Cadena-Bonfanti
- Facultad de Ciencias de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla, Colombia
- Clínica de la Costa, Barranquilla, Colombia
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9
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Luna M, Kamariski M, Principi I, Bocanegra V, Vallés PG. Severely ill pediatric patients with Shiga toxin-associated hemolytic uremic syndrome (STEC-HUS) who suffered from multiple organ involvement in the early stage. Pediatr Nephrol 2021; 36:1499-1509. [PMID: 33205220 DOI: 10.1007/s00467-020-04829-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/24/2020] [Accepted: 10/15/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC-HUS) is the main cause of pediatric acute kidney injury (AKI) in Argentina. Endothelial injury is the trigger event in the microangiopathic process. The host inflammatory response to toxin and E. coli lipopolysaccharide (LPS) is involved in disease pathophysiology. METHODS This retrospective study describes pediatric STEC-HUS patients with multiorgan involvement at the initial phase of disease. A retrospective study of critically ill HUS patients with evidence of E. coli infection was conducted through a period of 15 years. RESULTS Forty-four patients 35.4 ± 4.1 months were admitted to the intensive care unit for 21 ± 2 days. Mechanical ventilation was required in 41 patients, early inotropic support in 37, and 28 developed septic shock. Forty-one patients required kidney replacement therapy for 12 ± 1 days. Forty-one patients showed neurological dysfunction. Dilated cardiomyopathy was demonstrated in 3 patients, left ventricular systolic dysfunction in 4, and hypertension in 17. Four patients had pulmonary hemorrhage, and acute respiratory distress syndrome in 2. Colectomy for transmural colonic necrosis was performed in 3 patients. Thirty-seven patients were treated with therapeutic plasma exchange, and 28 patients received methylprednisolone (10 mg/kg for 3 days). Of the surviving 32 patients, neurological sequelae were seen in 11 and chronic kidney failure in 5. CONCLUSIONS Severe clinical outcome at onset suggests an amplified inflammatory response after exposure to Shiga toxin and/or E. coli LPS. STEC-HUS associated with severe neurological involvement, hemodynamic instability, and AKI requires intensive care and focused therapy.
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Affiliation(s)
- Mariana Luna
- Servicio de Nefrología, Departamento de Pediatría, Hospital Humberto Notti, Mendoza, Argentina
| | - Mariana Kamariski
- Servicio de Nefrología, Departamento de Pediatría, Hospital Humberto Notti, Mendoza, Argentina
| | - Iliana Principi
- Servicio de Nefrología, Departamento de Pediatría, Hospital Humberto Notti, Mendoza, Argentina
| | - Victoria Bocanegra
- Instituto de Medicina y Biología Experimental de Cuyo (IMBECU), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Mendoza, Argentina
| | - Patricia G Vallés
- Servicio de Nefrología, Departamento de Pediatría, Hospital Humberto Notti, Mendoza, Argentina. .,Área de Fisiopatología, Departamento de Patología, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, Mendoza, Argentina.
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10
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Hua Y, Chromek M, Frykman A, Jernberg C, Georgieva V, Hansson S, Zhang J, Marits AK, Wan C, Matussek A, Bai X. Whole-genome characterization of hemolytic uremic syndrome-causing Shiga toxin-producing Escherichia coli in Sweden. Virulence 2021; 12:1296-1305. [PMID: 33939581 PMCID: PMC8096335 DOI: 10.1080/21505594.2021.1922010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Shiga toxin-producing Escherichia coli, a foodborne bacterial pathogen, has been linked to a broad spectrum of clinical outcomes ranging from asymptomatic carriage to fatal hemolytic uremic syndrome (HUS). Here, we collected clinical data and STEC strains from HUS patients from 1994 through 2018, whole-genome sequencing was performed to molecularly characterize HUS-associated STEC strains, statistical analysis was conducted to identify bacterial genetic factors associated with severe outcomes in HUS patients. O157:H7 was the most predominant serotype (57%) among 54 HUS-associated STEC strains, followed by O121:H19 (19%) and O26:H11 (7%). Notably, some non-predominant serotypes such as O59:H17 (2%) and O109:H21 (2%) also caused HUS. All O157:H7 strains with one exception belonged to clade 8. During follow-up at a median of 4 years, 41% of the patients had renal sequelae. Fifty-nine virulence genes were found to be statistically associated with severe renal sequelae, these genes encoded type II and type III secretion system effectors, chaperones, and other factors. Notably, virulence genes associated with severe clinical outcomes were significantly more prevalent in O157:H7 strains. In contrast, genes related to mild symptoms were evenly distributed across all serotypes. The whole-genome phylogeny indicated high genomic diversity among HUS-STEC strains. No distinct cluster was found between HUS and non-HUS STEC strains. The current study showed that O157:H7 remains the main cause of STEC-associated HUS, despite the rising importance of other non-O157 serotypes. Besides, O157:H7 is associated with severe renal sequelae in the follow-up, which could be a risk factor for long-term prognosis in HUS patients.
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Affiliation(s)
- Ying Hua
- Department of Microbiology, School of Public Health, Southern Medical University, Guangzhou, China.,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Milan Chromek
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Anne Frykman
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Valya Georgieva
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Sverker Hansson
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ji Zhang
- Molecular Epidemiology and Public Health Laboratory, School of Veterinary Sciences, Massey University, Palmerston North, New Zealand
| | - Ann Katrine Marits
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Chengsong Wan
- Department of Microbiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Andreas Matussek
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Sweden.,Laboratory Medicine, Jönköping Region County, Department of Clinical and Experimental Medicine, Linköping University, Jönköping, Sweden.,Oslo University Hospital, Oslo, Norway.,Division of Laboratory Medicine, Institute of Clinical Medicine, University of Oslo, Norway
| | - Xiangning Bai
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Sweden.,Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Huddinge, Sweden.,State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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11
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Pugh D, O'Sullivan ED, Duthie FA, Masson P, Kavanagh D. Interventions for atypical haemolytic uraemic syndrome. Cochrane Database Syst Rev 2021; 3:CD012862. [PMID: 33783815 PMCID: PMC8078160 DOI: 10.1002/14651858.cd012862.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Atypical haemolytic uraemic syndrome (aHUS) is a rare disorder characterised by thrombocytopenia, microangiopathic haemolytic anaemia, and acute kidney injury. The condition is primarily caused by inherited or acquired dysregulation of complement regulatory proteins with ~40% of those affected aged < 18 years. Historically, kidney failure and death were common outcomes, however, improved understanding of the condition has led to discovery of novel therapies. OBJECTIVES To evaluate the benefits and harms of interventions for aHUS. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies for randomised controlled studies (RCTs) up to 3 September 2020 using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. MEDLINE(OVID) 1946 to 27 July 2020 and EMBASE (OVID) 1974 to 27 July 2020 were searched for non-RCTs. SELECTION CRITERIA All randomised and non-randomised clinical trials comparing an intervention with placebo, an intervention with supportive therapy, or two or more interventions for aHUS were included. Given the rare nature of the condition in question, prospective single-arm studies of any intervention for aHUS were also included. DATA COLLECTION AND ANALYSIS Two authors independently extracted pre-specified data from eligible studies and evaluated risk of bias using a newly developed tool based on existing Cochrane criteria. As statistical meta-analysis was not appropriate, qualitative analysis of data was then performed. MAIN RESULTS We included five single-arm studies, all of which evaluated terminal complement inhibition for the treatment of aHUS. Four studies evaluated the short-acting C5 inhibitor eculizumab and one study evaluated the longer-acting C5 inhibitor ravulizumab. All included studies within the review were of non-randomised, single-arm design. Thus, risk of bias is high, and it is challenging to draw firm conclusions from this low-quality evidence. One hundred patients were included within three primary studies evaluating eculizumab, with further data reported from 37 patients in a secondary study. Fifty-eight patients were included in the ravulizumab study. After 26 weeks of eculizumab therapy there were no deaths and a 70% reduction in the number of patients requiring dialysis. Complete thrombotic microangiopathic (TMA) response was observed in 60% of patients at 26 weeks and 65% at two years. After 26 weeks of ravulizumab therapy four patients had died (7%) and complete TMA response was observed in 54% of patients. Substantial improvements were seen in estimated glomerular filtration rate and health-related quality of life in both eculizumab and ravulizumab studies. Serious adverse events occurred in 42% of patients, and meningococcal infection occurred in two patients, both treated with eculizumab. AUTHORS' CONCLUSIONS When compared with historical data, terminal complement inhibition appears to offer favourable outcomes in patients with aHUS, based upon very low-quality evidence drawn from five single-arm studies. It is unlikely that an RCT will be conducted in aHUS and therefore careful consideration of future single-arm data as well as longer term follow-up data will be required to better understand treatment duration, adverse outcomes and risk of disease recurrence associated with terminal complement inhibition.
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Affiliation(s)
- Dan Pugh
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Eoin D O'Sullivan
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Inflammation Research, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Fiona Ai Duthie
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Philip Masson
- Department of Renal Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - David Kavanagh
- Renal Department, Newcastle University/Freeman Hospital, Newcastle Upon Tyne, UK
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12
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Goldstein J, Nuñez-Goluboay K, Pinto A. Therapeutic Strategies to Protect the Central Nervous System against Shiga Toxin from Enterohemorrhagic Escherichia coli. Curr Neuropharmacol 2021; 19:24-44. [PMID: 32077828 PMCID: PMC7903495 DOI: 10.2174/1570159x18666200220143001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 01/20/2020] [Accepted: 02/19/2020] [Indexed: 11/23/2022] Open
Abstract
Infection with Shiga toxin-producing Escherichia coli (STEC) may cause hemorrhagic colitis, hemolytic uremic syndrome (HUS) and encephalopathy. The mortality rate derived from HUS adds up to 5% of the cases, and up to 40% when the central nervous system (CNS) is involved. In addition to the well-known deleterious effect of Stx, the gram-negative STEC releases lipopolysaccharides (LPS) and may induce a variety of inflammatory responses when released in the gut. Common clinical signs of severe CNS injury include sensorimotor, cognitive, emotional and/or autonomic alterations. In the last few years, a number of drugs have been experimentally employed to establish the pathogenesis of, prevent or treat CNS injury by STEC. The strategies in these approaches focus on: 1) inhibition of Stx production and release by STEC, 2) inhibition of Stx bloodstream transport, 3) inhibition of Stx entry into the CNS parenchyma, 4) blockade of deleterious Stx action in neural cells, and 5) inhibition of immune system activation and CNS inflammation. Fast diagnosis of STEC infection, as well as the establishment of early CNS biomarkers of damage, may be determinants of adequate neuropharmacological treatment in time.
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Affiliation(s)
- Jorge Goldstein
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Instituto de Fisiología y Biofísica “Houssay” (IFIBIO), Laboratorio de Neurofisiopatología, Facultad de Medicina, Argentina
| | - Krista Nuñez-Goluboay
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Instituto de Fisiología y Biofísica “Houssay” (IFIBIO), Laboratorio de Neurofisiopatología, Facultad de Medicina, Argentina
| | - Alipio Pinto
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Instituto de Fisiología y Biofísica “Houssay” (IFIBIO), Laboratorio de Neurofisiopatología, Facultad de Medicina, Argentina
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13
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Abstract
Sepsis morbidity and mortality exacts a toll on patients and contributes significantly to healthcare costs. Preclinical models of sepsis have been used to study disease pathogenesis and test new therapies, but divergent outcomes have been observed with the same treatment even when using the same sepsis model. Other disorders such as diabetes, cancer, malaria, obesity, and cardiovascular diseases have used standardized, preclinical models that allow laboratories to compare results. Standardized models accelerate the pace of research and such models have been used to test new therapies or changes in treatment guidelines. The National Institutes of Health mandated that investigators increase data reproducibility and the rigor of scientific experiments and has also issued research funding announcements about the development and refinement of standardized models. Our premise is that refinement and standardization of preclinical sepsis models may accelerate the development and testing of potential therapeutics for human sepsis, as has been the case with preclinical models for other disorders. As a first step toward creating standardized models, we suggest standardizing the technical standards of the widely used cecal ligation and puncture model and creating a list of appropriate organ injury and immune dysfunction parameters. Standardized sepsis models could enhance reproducibility and allow comparison of results between laboratories and may accelerate our understanding of the pathogenesis of sepsis.
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14
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García-Martín E, Manrique-Rodríguez S, Martínez Fernández-Llamazares C, Goicoechea-Diezhondino M, Álvarez-Blanco O, García-Morín M, Sanjurjo-Sáez M. Variability in management and outcomes of therapy with eculizumab in atypical hemolytic uremic syndrome. Expert Opin Orphan Drugs 2019. [DOI: 10.1080/21678707.2019.1703108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Estela García-Martín
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Silvia Manrique-Rodríguez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | | | - Marian Goicoechea-Diezhondino
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Olalla Álvarez-Blanco
- Pediatric Nephrology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Marina García-Morín
- Pediatric Oncohematology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Sanjurjo-Sáez
- Director of Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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15
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Haiwen Z, Rui H, Bingxi Z, Qingfeng G, Beibei W, Jifeng Z, Xuemei W, Kebang W. Cathelicidin- derived PR39 protects enterohemorrhagic Escherichia coli O157:H7 challenged mice by improving epithelial function and balancing the microbiota in the intestine. Sci Rep 2019; 9:9456. [PMID: 31263234 PMCID: PMC6603261 DOI: 10.1038/s41598-019-45913-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 06/20/2019] [Indexed: 12/21/2022] Open
Abstract
The zoonotic enterohaemorrhagic Escherichia coli (EHEC) O157:H7 can disrupt intestinal epithelial barrier function and in turn leading to serious intestinal and systemic disease. PR39 could effectively inhibit the growth of Gram-negative bacteria, but there is little knowledge of its effects on intestinal barrier function and the microbiota in E. coli-challenged mice. In this study, an intestinal disease caused by EHEC O157:H7 was established, to analyze the effect of PR39 on EHEC O157:H7 induced intestinal epithelial barrier injury and disorder. Interestingly, PR39 attenuated EHEC O157:H7-induced systemic symptoms and significantly decreased mortality and the degree of E. coli shedding in faeces. Furthermore, the infiltration index of macrophages and neutrophils in intestine of the PR39 treatment group were obviously attenuated, along with the level of apoptosis. PR39 treatment group had distinctly improved tight junction associated proteins’ expression after EHEC O157:H7 caused injury. Additionally, the sequencing analysis of cecum microbiota showed that PR39 altered the abnormal increase in Bacteroides caused by EHEC O157:H7 and promoted the growth of probiotics such as Lactobacillus. In conclusion, cathelicidin-derived PR39 could effectively improve EHEC O157:H7-induced epithelial barrier injury, and dysfunction of immune and microbiota homeostasis in the intestinal tract, indicating that PR39 could be an excellent potential drug for zoonotic EHEC O157:H7-related intestinal disease.
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Affiliation(s)
- Zhang Haiwen
- Tropical animal breeding and nutrition laboratory, Hainan University, Haikou, Hainan, 570228, People's Republic of China.,Key Laboratory of Tropical Biological Resources of Ministry of Education, Haikou, Hainan, 570228, People's Republic of China
| | - Hua Rui
- Tropical animal breeding and nutrition laboratory, Hainan University, Haikou, Hainan, 570228, People's Republic of China
| | - Zhang Bingxi
- Tropical animal breeding and nutrition laboratory, Hainan University, Haikou, Hainan, 570228, People's Republic of China
| | - Guan Qingfeng
- Tropical animal breeding and nutrition laboratory, Hainan University, Haikou, Hainan, 570228, People's Republic of China.,Key Laboratory of Tropical Biological Resources of Ministry of Education, Haikou, Hainan, 570228, People's Republic of China
| | - Wang Beibei
- Key Laboratory of Tropical Biological Resources of Ministry of Education, Haikou, Hainan, 570228, People's Republic of China.
| | - Zeng Jifeng
- Tropical animal breeding and nutrition laboratory, Hainan University, Haikou, Hainan, 570228, People's Republic of China.,Key Laboratory of Tropical Biological Resources of Ministry of Education, Haikou, Hainan, 570228, People's Republic of China
| | - Wang Xuemei
- Tropical animal breeding and nutrition laboratory, Hainan University, Haikou, Hainan, 570228, People's Republic of China.,Key Laboratory of Tropical Biological Resources of Ministry of Education, Haikou, Hainan, 570228, People's Republic of China
| | - Wu Kebang
- Tropical animal breeding and nutrition laboratory, Hainan University, Haikou, Hainan, 570228, People's Republic of China. .,Key Laboratory of Tropical Biological Resources of Ministry of Education, Haikou, Hainan, 570228, People's Republic of China.
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16
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Haiwen Z, Rui H, Bingxi Z, Qingfeng G, Jifeng Z, Xuemei W, Beibei W. Oral Administration of Bovine Lactoferrin-Derived Lactoferricin (Lfcin) B Could Attenuate Enterohemorrhagic Escherichia coli O157:H7 Induced Intestinal Disease through Improving Intestinal Barrier Function and Microbiota. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2019; 67:3932-3945. [PMID: 30892034 DOI: 10.1021/acs.jafc.9b00861] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Lactoferricin (Lfcin) B, derived from lactoferrin in whey, has attracted considerable attention because of its multiple biological functions. Zoonotic enterohemorrhagic Escherichia coli (EHEC) O157:H7 has adverse effects on intestinal epithelial barrier function, leading to serious intestinal disease. In this study, the EHEC O157:H7-induced intestinal dysfunction model was developed to investigate the effects of Lfcin B on EHEC O157:H7-induced epithelial barrier disruption and microbiota dysbiosis. Results showed that the inflammatory infiltration indexes in the jejunum of Lfcin B-treated animals were significantly decreased. Lfcin B administration also significantly improved ZO-1 and occludin expression following O157:H7-induced injury. Finally, microbiota analysis of the cecal samples revealed that Lfcin B inhibited the O157:H7-induced abnormal increase in Bacteroides. Therefore, Lfcin B efficiently attenuated O157:H7-induced epithelial barrier damage and dysregulation of inflammation status, while maintaining microbiota homeostasis in the intestine, indicating that it may be an excellent food source for prevention and therapy of EHEC O157:H7-related intestinal dysfunction.
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Affiliation(s)
- Zhang Haiwen
- Key Laboratory of Tropical Animal Breeding and Epidemic Disease Research of Hainan Province , Hainan University , Haikou , Hainan 570228 , People's Republic of China
- Key Laboratory of Tropical Biological Resources of Ministry of Education , Haikou , Hainan 570228 , People's Republic of China
| | - Hua Rui
- Key Laboratory of Tropical Animal Breeding and Epidemic Disease Research of Hainan Province , Hainan University , Haikou , Hainan 570228 , People's Republic of China
| | - Zhang Bingxi
- Key Laboratory of Tropical Animal Breeding and Epidemic Disease Research of Hainan Province , Hainan University , Haikou , Hainan 570228 , People's Republic of China
| | - Guan Qingfeng
- Key Laboratory of Tropical Animal Breeding and Epidemic Disease Research of Hainan Province , Hainan University , Haikou , Hainan 570228 , People's Republic of China
- Key Laboratory of Tropical Biological Resources of Ministry of Education , Haikou , Hainan 570228 , People's Republic of China
| | - Zeng Jifeng
- Key Laboratory of Tropical Animal Breeding and Epidemic Disease Research of Hainan Province , Hainan University , Haikou , Hainan 570228 , People's Republic of China
- Key Laboratory of Tropical Biological Resources of Ministry of Education , Haikou , Hainan 570228 , People's Republic of China
| | - Wang Xuemei
- Key Laboratory of Tropical Animal Breeding and Epidemic Disease Research of Hainan Province , Hainan University , Haikou , Hainan 570228 , People's Republic of China
- Key Laboratory of Tropical Biological Resources of Ministry of Education , Haikou , Hainan 570228 , People's Republic of China
| | - Wang Beibei
- Key Laboratory of Tropical Biological Resources of Ministry of Education , Haikou , Hainan 570228 , People's Republic of China
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17
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Das A, Dean A, Clay T. Gemcitabine-induced haemolytic uraemic syndrome in pancreatic adenocarcinoma. BMJ Case Rep 2019; 12:12/4/e228363. [PMID: 30962211 DOI: 10.1136/bcr-2018-228363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A woman in her mid-70s with metastatic pancreatic adenocarcinoma presented with fatigue, nausea and bilateral leg swelling, 4 days after an intravenous gemcitabine infusion. Additional examination and laboratory tests showed mild hypertension, low haemoglobin, high lactate dehydrogenase, low platelet count and high serum creatinine. The patient was subsequently diagnosed with haemolytic uraemic syndrome (HUS), and gemcitabine administration was immediately ceased. The patient received a 5-day course of methylprednisolone, with a full recovery being made 10 days after diagnosis. Clinicians should be aware of the rare but serious complication of gemcitabine-induced HUS (GiHUS), as early diagnosis and management, which includes prompt discontinuation of gemcitabine, are crucial in promptly resolving this condition. This case report describes one treatment that can be used for the treatment of GiHUS, while briefly covering some other novel treatments that have been described in other studies.
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Affiliation(s)
- Adarsh Das
- Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Andrew Dean
- Department of Medical Oncology, Saint John of God Hospital Subiaco, Subiaco, Western Australia, Australia
| | - Tim Clay
- Department of Medical Oncology, Saint John of God Hospital Subiaco, Subiaco, Western Australia, Australia
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18
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Mass spectrometry-based Shiga toxin identification: A clinical validation. J Proteomics 2019; 198:145-150. [PMID: 30716422 DOI: 10.1016/j.jprot.2019.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 11/20/2022]
Abstract
After we published our preliminary study on the use of liquid chromatography-tandem mass spectrometry (LC-MS/MS) and curated E. coli toxin databases on the identification of E. coli Shiga toxins (Stxs) in the Journal of Proteomics in year 2018, we were encouraged to further refine the method and test clinical isolates. In this study, different concentrations of mitomycin C (MMC) and ciprofloxacin (CF), two common antibiotic/chemotherapy agents capable of stimulating Stx production, were first tested and compared on three reference strains and eight clinical isolates to observe the toxin induction and subsequent identification. Notably, no differences were observed between the two agents other than the concentrations applied. Seventeen more clinical isolates were then tested using fixed MMC and CF concentrations and sample amount. This study confirms that the majority of stx2-positive E. coli strains can be stimulated to produce sufficient toxin for confident identification. This does not occur with stx1-positive E. coli isolates, however, despite the fact that both Stxs can be identified for several isolates without MMC or CF stimulation. BIOLOGICAL SIGNIFICANCE: Stxs, especially Stx2, are very important causes of severe food-borne disease, even death. This study confirms that receptor analogue-based affinity enrichment of Stxs, after MMC or CF treatment of E. coli, is useful for fast and accurate Stx2 identification through LC-MS/MS.
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19
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Kara MA, Demircioğlu Kılıç B. Çocukluk Çağında Atipik Hemolitik Üremik Sendrom. DICLE MEDICAL JOURNAL 2018. [DOI: 10.5798/dicletip.497936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Bucaretchi F, Pimenta MMB, Borrasca-Fernandes CF, Prado CC, Capitani EMD, Hyslop S. Thrombotic microangiopathy following Bothrops jararaca snakebite: case report. Clin Toxicol (Phila) 2018; 57:294-299. [PMID: 30444155 DOI: 10.1080/15563650.2018.1514621] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
CONTEXT Thrombotic microangiopathy (TMA) is an uncommon and severe complication of snakebites, and is similar, in general, to hemolytic-uremic syndrome (HUS). We describe a case of TMA following envenomation by Bothrops jararaca. CASE DETAILS A 56-y-old-woman with controlled hypertension was transferred from a primary hospital to our ER ∼7 h after being bitten by B. jararaca in the distal left leg. She developed edema extending from the bite site to the proximal thigh, associated with intense radiating local pain, local paresthesia and ecchymosis at the bite site. Laboratory features upon admission revealed coagulopathy (20 min whole blood clotting time - WBCT20 > 20 min), thrombocytopenia (76,000 platelets/mm3) and slight increase in serum creatinine (1.58 mg/dL; RV < 1.2 mg/dL). Upon admission, the patient was treated with bothropic antivenom and fluids replacement. During evolution, her thrombocytopenia and anemia worsened, with blood films showing fragmented red cells, haptoglobin consumption, increase in serum lactate dehydrogenase, and progressive increase of serum creatinine (KDIGO stage = 3). No RBC transfusion, renal replacement therapy or plasmapheresis was done. The patient showed progressive improvement from day nine (D9) onwards and was discharged on D20; there was complete recovery of hemoglobin levels at follow-up (D50). ADAMTS-13 activity, assayed 10 months post-bite, was within reference values. DISCUSSION TMA following snakebite has been reported mainly in India, Sri Lanka and Australia, with several patients needing renal replacement therapy. Although controversial, plasmapheresis has also been used in some cases. Our patient developed microangiopathic hemolytic anemia, thrombocytopenia and acute kidney injury, a triad of features compatible with TMA similar to HUS. Despite the severity, the outcome following conservative treatment was good, with complete recovery.
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Affiliation(s)
- Fábio Bucaretchi
- a Department of Pediatrics, School of Medical Sciences , State University of Campinas (UNICAMP) , Campinas , Brazil.,d Campinas Poison Control Center, School of Medical Sciences , State University of Campinas (UNICAMP) , Campinas , Brazil
| | - Maíra M Branco Pimenta
- d Campinas Poison Control Center, School of Medical Sciences , State University of Campinas (UNICAMP) , Campinas , Brazil
| | - Carla F Borrasca-Fernandes
- a Department of Pediatrics, School of Medical Sciences , State University of Campinas (UNICAMP) , Campinas , Brazil.,d Campinas Poison Control Center, School of Medical Sciences , State University of Campinas (UNICAMP) , Campinas , Brazil
| | - Camila Carbone Prado
- d Campinas Poison Control Center, School of Medical Sciences , State University of Campinas (UNICAMP) , Campinas , Brazil
| | - Eduardo Mello De Capitani
- b Department of Clinical Medicine, School of Medical Sciences , State University of Campinas (UNICAMP) , Campinas , Brazil.,d Campinas Poison Control Center, School of Medical Sciences , State University of Campinas (UNICAMP) , Campinas , Brazil
| | - Stephen Hyslop
- c Department of Pharmacology, School of Medical Sciences , State University of Campinas (UNICAMP) , Campinas , Brazil.,d Campinas Poison Control Center, School of Medical Sciences , State University of Campinas (UNICAMP) , Campinas , Brazil
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21
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Yesilbas O, Sevketoglu E, Petmezci MT, Kihtir HS, Benzer M, Arikan C, Berdeli A, Baloglu H, Baskan O. Infant onset severe complement-mediated hemolytic uremic syndrome complicated by secondary sclerosing cholangitis. J Clin Apher 2018; 33:619-623. [PMID: 30168181 DOI: 10.1002/jca.21651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/06/2018] [Accepted: 07/08/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Osman Yesilbas
- Pediatric Intensive Care Unit, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Esra Sevketoglu
- Pediatric Intensive Care Unit, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Mey Talip Petmezci
- Pediatric Intensive Care Unit, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Hasan Serdar Kihtir
- Pediatric Intensive Care Unit, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Meryem Benzer
- Department of Pediatric Nephrology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Cigdem Arikan
- Departments of Pediatric Gastroenterology, Hepatology and Nutrition, Memorial Health Group, Istanbul, Turkey
| | - Afig Berdeli
- Department of Pediatrics, Molecular Medicine Laboratory and Stem Cell Department of Health Science Institute, Ege University Medical Faculty, Izmir, Turkey
| | - Huseyin Baloglu
- Department of Pathology, Anadolu Medical Center, Kocaeli, Turkey
| | - Ozdil Baskan
- Department of Radiology, Memorial Health Group, Istanbul, Turkey
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Atypical hemolytic uremic syndrome: An unusual postoperative complication. ACTA ACUST UNITED AC 2018; 65:351-355. [PMID: 29426622 DOI: 10.1016/j.redar.2017.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/16/2017] [Accepted: 12/19/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Thrombotic thrombocytopenic purpura and atypical haemolytic uremic syndrome (aHUS) are acute, rare, life-threatening thrombotic microangiopathies that require swift management. We report a case of acute microangiopathic haemolytic anaemia (MAHA) presenting in perioperative setting. CLINICAL CASE After hepatic pericystectomy for hydatid cyst, a 46-year-old female developed MAHA, thrombocytopenia and acute renal failure in the immediate postoperative period. "aHUS" was considered and immediate plasma exchange was initiated. Plasma exchange was performed for 2 weeks with remission of renal dysfunction. Further evaluation of genetic mutations and immunological causes for MAHA were sought. Mutations in complement factor H associated with factor H deficiency were identified, which are associated with increased risk of aHUS. CONCLUSION MAHA is a rare postoperative condition, requiring rapid differential diagnosis and treatment. Anaesthetists should bear in mind aHUS as a possible cause of MAHA, especially concerning immediate care for these patients.
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Rasa M, Musgrave J, Abe K, Tanaka L, Xoinis K, Shiramizu B, Foskett G, Lau R. A Case of Escherichia coli Hemolytic Uremic Syndrome in a 10-Year-Old Male With Severe Neurologic Involvement Successfully Treated With Eculizumab. J Investig Med High Impact Case Rep 2017; 5:2324709617741144. [PMID: 29152520 PMCID: PMC5680941 DOI: 10.1177/2324709617741144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 10/10/2017] [Indexed: 01/25/2023] Open
Abstract
Hemolytic uremic syndrome (HUS) can be classified as typical and atypical, and the treatment recommendations currently differ between the 2 types. Eculizumab is recommended as first-line treatment for atypical HUS; however, its use in typical HUS has been controversial. We report a case of a 10-year-old male with severe neurologic impairment who was successfully treated with eculizumab, which was started 4 days after onset of neurologic symptoms. Our case supports the use of eculizumab in typical HUS with neurologic involvement, even when given later in the course, as the pathophysiology of typical HUS has been shown to involve activation of the complement pathway, similar to atypical HUS. Further studies are required to establish the efficacy and duration of eculizumab use in this patient population.
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Affiliation(s)
- Malia Rasa
- Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - James Musgrave
- Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Keith Abe
- Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Len Tanaka
- Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | | | - Bruce Shiramizu
- Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Gretchen Foskett
- Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Rhiana Lau
- Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
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Hämolytisch-urämisches Syndrom im Kindes- und Jugendalter. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-017-0331-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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25
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Okhovat AA, Ansari B, Rezaali S, Altintas A, Naser Moghadasi A. Catastrophic presentation of a patient with combined NMOSD and thrombotic thrombocytopenic purpura/hemolytic uremic syndrome: a case report. Acta Neurol Belg 2017; 117:757-759. [PMID: 27757811 DOI: 10.1007/s13760-016-0710-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/09/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Ali Asghar Okhovat
- Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnaz Ansari
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Rezaali
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ayse Altintas
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Abdorreza Naser Moghadasi
- Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
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26
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Atypical hemolytic uremic syndrome triggered by varicella infection. IDCases 2017; 9:89-90. [PMID: 28725563 PMCID: PMC5506859 DOI: 10.1016/j.idcr.2017.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 04/13/2017] [Accepted: 04/13/2017] [Indexed: 11/21/2022] Open
Abstract
Varicella Zoster Virus (VZV) is a well-known virus that belongs to the Herpesviridae family which induces a self-limited disease except in specific cases in particular among stem cell transplant patients. This virus is not known however to trigger atypical Hemolytic Uremic Syndrome (aHUS). Here we report the case of a six-year-old boy who was hospitalized with fever and abdominal pains associated to pruritic and vesicular rash, thrombocytopenia and acute renal failure. He was diagnosed with aHUS precipitated by varicella virus. He was treated by an association of antimicrobials against potential superinfections, plasmapheresis and eculizumab for curative aHUS treatment. This was effective but after 6 months the kidney function remained poor. The current case describes an aHUS associated to varicella infection as demonstrated by the simultaneous occurrence of the viral infection and aHUS manifestations. Apart from typical Hemolytic Uremic Syndrome which is triggered by bacteria mostly Shiga toxin producing Echerichia coli and Streptococcus pneumoniae or Shigella, aHUS may be linked to viral infections such as HIV, EBV and enteroviruses, but very rarely by varicella. This case highlights a possible even rare complication of varicella infection a very common childhood disease. This complication could be avoided by to anti-VZV vaccination.
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27
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Cheng K, Sloan A, Li X, Armstrong GD, Wang G. Mass spectrometry-based Shiga toxin identification: An optimized approach. J Proteomics 2017; 180:36-40. [PMID: 28602982 DOI: 10.1016/j.jprot.2017.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 05/25/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
Abstract
Toxin expression is a key factor in Shiga toxin (Stx)-producing E. coli, a common pathogen involved in foodborne disease outbreaks. A liquid chromatography-tandem mass spectrometry (LC-MS/MS) based approach has been used in this study to identify commonly reported E. coli toxins, with a focus on Shiga toxins (Stxs). Different sample preparation methods using variable culture conditions and concentrations of mitomycin C (MMC), a common antibiotic/chemotherapy agent capable of stimulating Stx production, were first tested on reference strains EDL933 and 90-2380 by LC-MS/MS detection of tryptic digests of receptor-analogue affinity binding enriched Stx preparations from culture supernatants and lysates. A curated E. coli protein toxin database was also used for faster and more straightforward toxin identification. With eight more genetically confirmed E. coli strains examined to verify the method, this preliminary study indicates that receptor-analogue based affinity enrichment on cell lysate or supernatant is a sensitive and accurate method for Stx identification. BIOLOGICAL SIGNIFICANCE The existence of Stx is very important for identifying Stx-producing E. coli and implementing a clinical treatment regime. This study demonstrates for the first time that using a curated E. coli toxin database, together with receptor-analogue-based affinity enrichment of Stxs after MMC treatment of E. coli, is an easy and appropriate approach for fast and accurate Stx identification through LC-MS/MS.
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Affiliation(s)
- Keding Cheng
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada; Department of Human Anatomy and Cell Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Angela Sloan
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Xingle Li
- Henan Center for Disease Control, Henan, PR China
| | - Glen D Armstrong
- Department of Microbiology, Immunology & Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Gehua Wang
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
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28
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Azoulay E, Knoebl P, Garnacho-Montero J, Rusinova K, Galstian G, Eggimann P, Abroug F, Benoit D, von Bergwelt-Baildon M, Wendon J, Scully M. Expert Statements on the Standard of Care in Critically Ill Adult Patients With Atypical Hemolytic Uremic Syndrome. Chest 2017; 152:424-434. [PMID: 28442312 DOI: 10.1016/j.chest.2017.03.055] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/01/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022] Open
Abstract
A typical hemolytic uremic syndrome (aHUS) presents similarly to thrombotic thrombocytopenic purpura (TTP) and other causes or conditions with thrombotic microangiopathy (TMA), such as disseminated intravascular coagulation or sepsis. Similarity in clinical presentation may hinder diagnosis and optimal treatment selection in the urgent setting in the ICU. However, there is currently no consensus on the diagnosis or treatment of aHUS for ICU specialists. This review aims to summarize available data on the diagnosis and treatment strategies of aHUS in the ICU to enhance the understanding of aHUS diagnosis and outcomes in patients managed in the ICU. To this end, a review of the recent literature (January 2009-March 2016) was performed to select the most relevant articles for ICU physicians. Based on the paucity of adult aHUS cases overall and within the ICU, no specific recommendations could be formally graded for the critical care setting. However, we recognize a core set of skills required by intensivists for diagnosing and managing patients with aHUS: recognizing thrombotic microangiopathies, differentiating aHUS from related conditions, recognizing involvement of other organ systems, understanding the pathophysiology of aHUS, knowing the diagnostic workup and relevant outcomes in critically ill patients with aHUS, and knowing the standard of care for patients with aHUS based on available data and guidelines. In conclusion, managing critically ill patients with aHUS requires basic skills that, in the absence of sufficient data from patients treated within the ICU, can be gleaned from an increasingly relevant literature outside the ICU. More data on critically ill patients with aHUS are needed to validate these conclusions within the ICU setting.
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Affiliation(s)
- Elie Azoulay
- Medical Intensive Care Unit, Hôpital Saint-Louis, Paris, France.
| | - Paul Knoebl
- Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | | | - Katerina Rusinova
- University Hospital, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | | | - Fekri Abroug
- Fattouma Bourguiba Teaching Hospital Monastir, Tunisia
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LIPIEC K, ADAMCZYK P, ŚWIĘTOCHOWSKA E, ZIORA K, SZCZEPAŃSKA M. Angiotensinogen and Interleukin-18 as Markers of Chronic Kidney Damage in Children With a History of Hemolytic Uremic Syndrome. Physiol Res 2017; 66:251-261. [DOI: 10.33549/physiolres.933340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Hemolytic uremic syndrome (HUS) is a type of thrombotic microangiopathy, in the course of which some patients may develop chronic kidney disease (CKD). It is clinically important to investigate the markers of a poor prognosis. The levels of angiotensinogen (AGT) and interleukin-18 (IL-18) in serum and urine were evaluated. Study was conducted in 29 children with a history of HUS. Serum and urine AGT concentration was significantly higher in children after HUS as compared to the control group. No differences depending on the type of HUS and gender were noted. The serum concentration of IL-18 in children after HUS was significantly lower, whereas in urine did not differ significantly between the sick and healthy children. A negative correlation between the concentration of AGT in serum and albuminuria in patients after HUS was detected. The results indicate that the concentration of AGT in serum and urine in children after HUS increases, which may indicate the activation of the intrarenal renin-angiotensin-aldosterone system. The statement, that AGT may be a good biomarker of CKD after acute kidney injury due to HUS requires prospective studies with follow-up from the acute phase of the disease on a larger group of patients. Reduced IL-18 serum concentration in children after HUS with no difference in its urine concentration may indicate a loss of the protective effects of this cytokine on renal function due to previously occurred HUS.
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Affiliation(s)
| | | | | | | | - M. SZCZEPAŃSKA
- Department and Clinic of Pediatrics, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
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31
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Rigamonti D, Simonetti GD. Direct cardiac involvement in childhood hemolytic-uremic syndrome: case report and review of the literature. Eur J Pediatr 2016; 175:1927-1931. [PMID: 27659663 DOI: 10.1007/s00431-016-2790-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 09/12/2016] [Accepted: 09/14/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED Overhydration, hypertension, anemia, or dyselectrolytemias sometimes cause cardiovascular impairment in childhood hemolytic-uremic syndrome. Here, we report the case of a 4.5-year-old boy with hemolytic-uremic syndrome and sudden onset, 6 h later, of hemodynamic compromise secondary to a cardiac thrombotic micro-angiopathy. The child died. In the literature, we found 18 further cases with cardiac compromise ≤25 days after diagnosis. The following causes were found: micro-angiopathy, pericardial blood causing tamponade, and myocarditis. CONCLUSION We were able to document only 19 cases of childhood hemolytic-uremic syndrome complicated by a direct cardiac compromise. Nonetheless, we speculate that a direct cardiac compromise accounts for many cases of childhood hemolytic-uremic syndrome complicated by sudden death during the initial hospitalization. Hence, we propose to always measure troponin in children with hemolytic-uremic syndrome to detect a latent myocardial damage. What is Known: • Overhydration, hypertension, anemia, or dyselectrolytemias sometimes cause cardiovascular impairment in childhood hemolytic-uremic syndrome. What is New: • This study documents 19 cases of childhood hemolytic-uremic syndrome complicated by a direct cardiac compromise ≤ 25 days after diagnosis. • The Following causes were found: micro-angiopathy, pericardial blood causing tamponade, and myocarditis.
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Affiliation(s)
- Davide Rigamonti
- Pediatric Department of Southern Switzerland, Via Ospedale, CH-6500, Bellinzona, Switzerland
| | - Giacomo D Simonetti
- Pediatric Department of Southern Switzerland, Via Ospedale, CH-6500, Bellinzona, Switzerland. .,Division of Pediatric Nephrology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, CH-3010, Bern, Switzerland.
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32
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Jenssen GR, Vold L, Hovland E, Bangstad HJ, Nygård K, Bjerre A. Clinical features, therapeutic interventions and long-term aspects of hemolytic-uremic syndrome in Norwegian children: a nationwide retrospective study from 1999-2008. BMC Infect Dis 2016; 16:285. [PMID: 27297224 PMCID: PMC4906913 DOI: 10.1186/s12879-016-1627-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 06/07/2016] [Indexed: 12/25/2022] Open
Abstract
Background Hemolytic-uremic syndrome (HUS) is a clinical triad of microangiopathic hemolytic anemia, impaired renal function and thrombocytopenia, primarily affecting pre-school-aged children. HUS can be classified into diarrhea-associated HUS (D+HUS), usually caused by Shiga toxin-producing Escherichia coli (STEC), and non-diarrhea-associated HUS (D−HUS), both with potentially serious acute and long-term complications. Few data exists on the clinical features and long-term outcome of HUS in Norway. The aim of this paper was to describe these aspects of HUS in children over a 10-year period. Methods We retrospectively collected data on clinical features, therapeutic interventions and long-term aspects directly from medical records of all identified HUS cases <16 years of age admitted to Norwegian pediatric departments from 1999 to 2008. Cases of D+HUS and D−HUS are described separately, but no comparative analyses were possible due to small numbers. Descriptive statistics are presented in proportions and median values with ranges, and/or summarized in text. Results Forty seven HUS cases were identified; 38 D+HUS and nine D−HUS. Renal complications were common; in the D+HUS and D−HUS group, 29/38 and 5/9 developed oligoanuria, 22/38 and 3/9 needed dialysis, with hemodialysis used most often in both groups, and plasma infusion(s) were utilized in 6/38 and 4/9 patients, respectively. Of extra-renal complications, neurological complications occurred in 9/38 and 2/9, serious gastrointestinal complications in 6/38 and 1/9, respiratory complications in 10/38 and 2/9, and sepsis in 11/38 and 3/9 cases, respectively. Cardiac complications were seen in two D+HUS cases. In patients where data on follow up ≥1 year after admittance were available, 8/21 and 4/7 had persistent proteinuria and 5/19 and 4/5 had persistent hypertension in the D+HUS and D−HUS group, respectively. Two D+HUS and one D−HUS patient were diagnosed with chronic kidney disease and one D+HUS patient required a renal transplantation. Two D+HUS patients died in the acute phase (death rate; 5 %). Conclusions The HUS cases had a high rate of complications and sequelae, including renal, CNS-related, cardiac, respiratory, serious gastrointestinal complications and sepsis, consistent with other studies. This underlines the importance of attention to extra-renal manifestations in the acute phase and in renal long-term follow-up of HUS patients.
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Affiliation(s)
- Gaute Reier Jenssen
- Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health (Nasjonalt Folkehelseinstitutt), Postboks 4404, Nydalen, NO 0403, Oslo, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Line Vold
- Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health (Nasjonalt Folkehelseinstitutt), Postboks 4404, Nydalen, NO 0403, Oslo, Norway
| | - Eirik Hovland
- Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health (Nasjonalt Folkehelseinstitutt), Postboks 4404, Nydalen, NO 0403, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Karin Nygård
- Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health (Nasjonalt Folkehelseinstitutt), Postboks 4404, Nydalen, NO 0403, Oslo, Norway
| | - Anna Bjerre
- Department of Pediatrics, Oslo University Hospital, Oslo, Norway
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