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de Zwart PL, Mueller TF, Spartà G, Luyckx VA. Eculizumab in Shiga toxin-producing Escherichia coli hemolytic uremic syndrome: a systematic review. Pediatr Nephrol 2024; 39:1369-1385. [PMID: 38057431 PMCID: PMC10943142 DOI: 10.1007/s00467-023-06216-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Infection-associated hemolytic uremic syndrome (IA-HUS), most often due to infection with Shiga toxin-producing bacteria, mainly affects young children. It can be acutely life-threatening, as well as cause long-term kidney and neurological morbidity. Specific treatment with proven efficacy is lacking. Since activation of the alternative complement pathway occurs in HUS, the monoclonal C5 antibody eculizumab is often used off-label once complications, e.g., seizures, occur. Eculizumab is prohibitively expensive and carries risk of infection. Its utility in IA-HUS has not been systematically studied. This systematic review aims to present, summarize, and evaluate all currently available data regarding the effect of eculizumab administration on medium- to long-term outcomes (i.e., outcomes after the acute phase, with a permanent character) in IA-HUS. METHODS PubMed, Embase, and Web of Science were systematically searched for studies reporting the impact of eculizumab on medium- to long-term outcomes in IA-HUS. The final search occurred on March 2, 2022. Studies providing original data regarding medium- to long-term outcomes in at least 5 patients with IA-HUS, treated with at least one dose of eculizumab during the acute illness, were included. No other restrictions were imposed regarding patient population. Studies were excluded if data overlapped substantially with other studies, or if outcomes of IA-HUS patients were not reported separately. Study quality was assessed using the ROBINS-I tool for risk of bias in non-randomized studies of interventions. Data were analyzed descriptively. RESULTS A total of 2944 studies were identified. Of these, 14 studies including 386 eculizumab-treated patients met inclusion criteria. All studies were observational. Shiga toxin-producing E. coli (STEC) was identified as the infectious agent in 381 of 386 patients (98.7%), effectively limiting the interpretation of the data to STEC-HUS patients. Pooling of data across studies was not possible. No study reported a statistically significant positive effect of eculizumab on any medium- to long-term outcome. Most studies were, however, subject to critical risk of bias due to confounding, as more severely ill patients received eculizumab. Three studies attempted to control for confounding through patient matching, although residual bias persisted due to matching limitations. DISCUSSION Current observational evidence does not permit any conclusion regarding the impact of eculizumab in IA-HUS given critical risk of bias. Results of randomized clinical trials are eagerly awaited, as new therapeutic strategies are urgently needed to prevent long-term morbidity in these severely ill patients. SYSTEMATIC REVIEW REGISTRATION NUMBER OSF Registries, MSZY4, Registration DOI https://doi.org/10.17605/OSF.IO/MSZY4 .
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Affiliation(s)
- Paul L de Zwart
- Department of Nephrology, University Children's Hospital Zurich, Zurich, Switzerland.
| | - Thomas F Mueller
- Clinic of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Giuseppina Spartà
- Department of Nephrology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Valerie A Luyckx
- Department of Nephrology, University Children's Hospital Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, Department of Public and Global Health, University of Zurich, Zurich, Switzerland
- Brigham and Women's Hospital, Renal Division, Harvard Medical School, Boston, MA, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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Duman D, Sürmeli Döven S, Karpuz D, Danacı Vatansever E, Taşdelen B, Delibaş A. Autonomic activity and cardiovascular system risk assessment in pediatric patients with hemolytic uremic syndrome. Eur J Pediatr 2024; 183:1447-1454. [PMID: 38240764 PMCID: PMC10951013 DOI: 10.1007/s00431-024-05420-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/23/2023] [Accepted: 01/02/2024] [Indexed: 03/20/2024]
Abstract
In pediatric patients with hemolytic uremic syndrome (HUS), cardiac involvement and autonomic nervous system function can be evaluated by a non-invasive method called heart rate variability (HRV). This study aims to evaluate heart rate variability and electrocardiography findings in patients with HUS by comparing a healthy group. Patients who are diagnosed with HUS at a university hospital from December 2020 to June 2022 are screened by electrocardiography (ECG), echocardiography, and 24-h Holter ECG. A healthy control group, compatible in age and gender with the patient group, was selected from healthy subjects. HRV parameters, laboratory values, and ECG findings were analyzed and compared with the healthy group and each other. There were 25 patients with HUS and 51 participants in the healthy control group. Statistically significant differences were found in some HRV parameters: standard deviation of normal to normal intervals, the mean of the 5-min RR interval standard deviations, the standard deviation of 5-min RR interval means, the triangular interpolation of normal to normal interval, and very-low-frequency power. HUS patients had impaired and declined HRV values compared to the healthy group. There was a significant decrease in the PR distance, while a significant increase in the corrected QT and QT dispersion values was detected in the electrocardiographic findings of the patient group. HRV values impaired as renal failure parameters increased. Conclusion: Patients with HUS may have autonomic nervous system dysfunction. HRV measurement is a non-invasive method that can evaluate this. It can be thought that there may be an increased risk of cardiovascular events and arrhythmias in some patients with HUS. ECG should be also considered to detect arrhythmia. What is Known: • Hemolytic uremic syndrome (HUS) primarily effects the hematologic parameters and kidney. • Secondary cardiomyopathy with hypertension and renal failure could be observed in these patients. • Rhythm problems are not expected primarily in these patients. • There is very limited data in evaluating autonomic function and arrhythmia risk for these patients. What is New: • Patients with HUS may have autonomic nervous system dysfunction. • HRV measurement is a non-invasive method that can evaluate this. • Cardiovascular events and arrhythmias due to the deterioration of the balance between the sympathetic and parasympathetic systems could manifest in patients with HUS. • An ECG and screening patients for cardiac events, and monitoring them closely should be considered.
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Affiliation(s)
- Derya Duman
- Faculty of Medicine, Department of Pediatric Cardiology, Mersin University, 34. Cadde, Ciftlikkoy Kampusu, 33343, Mersin, Turkey.
| | - Serra Sürmeli Döven
- Faculty of Medicine, Department of Pediatric Nephrology, Mersin University, 34 Cadde, Ciftlikkoy Kampusu 33343, Mersin, Turkey
| | - Derya Karpuz
- Faculty of Medicine, Department of Pediatric Cardiology, Mersin University, 34. Cadde, Ciftlikkoy Kampusu, 33343, Mersin, Turkey
| | - Esra Danacı Vatansever
- Faculty of Medicine, Department of Pediatric Nephrology, Mersin University, 34 Cadde, Ciftlikkoy Kampusu 33343, Mersin, Turkey
| | - Bahar Taşdelen
- Faculty of Medicine, Department of Biostatistics and Medical Informatics, Mersin University, 33343, Mersin, Turkey
| | - Ali Delibaş
- Faculty of Medicine, Department of Pediatric Nephrology, Mersin University, 34 Cadde, Ciftlikkoy Kampusu 33343, Mersin, Turkey
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Whelan R, Lih D, Xue J, Himmelfarb J, Zheng Y. Modeling Shiga toxin-induced human renal-specific microvascular injury. Integr Biol (Camb) 2024; 16:zyae001. [PMID: 38266067 DOI: 10.1093/intbio/zyae001] [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: 09/11/2023] [Revised: 12/14/2023] [Accepted: 12/27/2023] [Indexed: 01/26/2024]
Abstract
Shiga toxin (Stx) causes significant renal microvascular injury and kidney failure in the pediatric population, and an effective targeted therapy has yet to be demonstrated. Here we established a human kidney microvascular endothelial cell line for the study of Stx mediated injuries with respect to their morphologic, phenotypic, and transcriptional changes, and modeled Stx induced thrombotic microangiopathy (TMA) in flow-mediated 3D microvessels. Distinct from other endothelial cell lines, both isolated primary and immortalized human kidney microvascular endothelial cells demonstrate robust cell-surface expression of the Stx receptor Gb3, and concomitant dose-dependent toxicity to Stx, with significant contributions from caspase-dependent cell death. Use of a glucosylceramide synthase inhibitor (GCSi) to target disruption of the synthetic pathway of Gb3 resulted in remarkable protection of kidney microvascular cells from Stx injury, shown in both cellular morphologies, caspase activation and transcriptional analysis from RNA sequencing. Importantly, these findings are recapitulated in 3D engineered kidney microvessels under flow. Moreover, whole blood perfusion through Stx-treated microvessels led to marked platelet binding on the vessel wall, which was significantly reduced with the treatment of GCSi. These results validate the feasibility and utility of a bioengineered ex vivo human microvascular model under flow to recapitulate relevant blood-endothelial interactions in STEC-HUS. The profound protection afforded by GCSi demonstrates a preclinical opportunity for investigation in human tissue approximating physiologic conditions. Moreover, this work provides a broad foundation for novel investigation into TMA injury pathogenesis and treatment. Insight Box: Shiga toxin (Stx) causes endothelial injury that results in significant morbidity and mortality in the pediatric population, with no effective targeted therapy. This paper utilizes human kidney microvascular cells to examine Stx mediated cell death in both 2D culture and flow-mediated 3D microvessels, with injured microvessels also developing marked platelet binding and thrombi formation when perfused with blood, consistent with the clinical picture of HUS. This injury is abrogated with a small molecule inhibitor targeting the synthetic pathway of the Shiga toxin receptor. Our findings shed light onto Stx-induced vascular injuries and pave a way for broad investigation into thrombotic microangiopathies.
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Affiliation(s)
- Russell Whelan
- Department of Bioengineering, University of Washington, Seattle, WA, USA
- Kidney Research Institute, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Daniel Lih
- Department of Bioengineering, University of Washington, Seattle, WA, USA
- Kidney Research Institute, University of Washington, Seattle, WA, USA
- Institute of Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA
| | - Jun Xue
- Department of Bioengineering, University of Washington, Seattle, WA, USA
- Kidney Research Institute, University of Washington, Seattle, WA, USA
- Institute of Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA
| | - Jonathan Himmelfarb
- Department of Bioengineering, University of Washington, Seattle, WA, USA
- Kidney Research Institute, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ying Zheng
- Department of Bioengineering, University of Washington, Seattle, WA, USA
- Kidney Research Institute, University of Washington, Seattle, WA, USA
- Institute of Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA
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Lu M, Zhu Y, Li D, Zhou Z, Lin H, Hong H, Shi J, Wu Z. Gb3-Coated Bovine Milk Exosomes as a Practical Neutralizer for Shiga Toxin. ACS APPLIED BIO MATERIALS 2023; 6:5798-5808. [PMID: 37988327 DOI: 10.1021/acsabm.3c00919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
Shiga toxin (Stx) is associated with foodborne infections of some Shigella spp. and Shiga toxin-producing Escherichia coli (STEC), leading to life-threatening hemolytic uremic syndrome (HUS). Target-specific therapeutics against HUS are currently unavailable in clinical practice. Herein, we reported the construction and in vitro characterization of Gb3-coated bovine milk exosomes (Gb3-mExo) as a multivalent Shiga toxin neutralizer, utilizing the natural advantages of milk exosomes (mExo) in drug delivery and multivalent interactions between Stx and its receptor Gb3. Gb3-mExo constructs were achieved by conjugating mExo with the Gb3 derivatives containing stearic acid-derived lipid tail, which was prepared through an efficient chemoenzymatic approach. The constructs were able to potently neutralize the binding of the B subunit of Stx2 (Stx2B) to receptor Gb3 immobilized on the plate or expressed on model cells. General safety of the constructs was evidenced by the cytotoxicity analysis and hemolysis assay. In addition to the excellent stability under conventional storage and handling conditions, the construct can also retain most of its neutralization potency under gastrointestinal pH extremes, showing the potential for oral administration. Considering the natural availability and excellent biocompatibility of mExo, Gb3-mExo conjugates should prove to be a practical prophylactic and therapeutic for the Shiga toxin-related infections.
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Affiliation(s)
- Mingming Lu
- Key Laboratory of Carbohydrate Chemistry & Biotechnology, Ministry of Education, School of Biotechnology, Jiangnan University, 214122 Wuxi, China
| | - Yating Zhu
- Key Laboratory of Carbohydrate Chemistry & Biotechnology, Ministry of Education, School of Biotechnology, Jiangnan University, 214122 Wuxi, China
| | - Dan Li
- Key Laboratory of Carbohydrate Chemistry & Biotechnology, Ministry of Education, School of Biotechnology, Jiangnan University, 214122 Wuxi, China
| | - Zhifang Zhou
- Key Laboratory of Carbohydrate Chemistry & Biotechnology, Ministry of Education, School of Biotechnology, Jiangnan University, 214122 Wuxi, China
| | - Han Lin
- Key Laboratory of Carbohydrate Chemistry & Biotechnology, Ministry of Education, School of Biotechnology, Jiangnan University, 214122 Wuxi, China
| | - Haofei Hong
- Key Laboratory of Carbohydrate Chemistry & Biotechnology, Ministry of Education, School of Biotechnology, Jiangnan University, 214122 Wuxi, China
| | - Jie Shi
- Key Laboratory of Carbohydrate Chemistry & Biotechnology, Ministry of Education, School of Biotechnology, Jiangnan University, 214122 Wuxi, China
| | - Zhimeng Wu
- Key Laboratory of Carbohydrate Chemistry & Biotechnology, Ministry of Education, School of Biotechnology, Jiangnan University, 214122 Wuxi, China
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Adachi T, Inoue Y, Okada S, Eguchi S. Haemolytic uraemic syndrome managed with subtotal colectomy. BMJ Case Rep 2023; 16:e256585. [PMID: 37751977 PMCID: PMC10533651 DOI: 10.1136/bcr-2023-256585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
A man in his early 70s was transferred to our hospital due to rapid decline in renal function and inflammation throughout the colon, indicating severe ischaemic enteritis. On the day following the start of intensive care, a stool specimen tested positive for verotoxin, and haemolytic uraemic syndrome (HUS) was diagnosed. On the same day, his vital signs deteriorated suddenly, and emergency surgery was performed due to the possibility of intestinal necrosis and perforation. Severe inflammation extending to the serosal surface of the whole colon was observed, but there was no obvious intestinal necrosis or perforation. Advanced mucosal necrosis of the entire colon suggested sepsis due to bacterial translocation, and subtotal colectomy was performed to remove the infection source. Postoperative management was successful. This case demonstrates the importance of considering HUS in patients with severe renal dysfunction and bloody stools, as well as the significance of colectomy in such patients.
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Affiliation(s)
- Toshiyuki Adachi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yusuke Inoue
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Satomi Okada
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Cao Y, Liu P, Song Q, Wang J. Case report: A case of sepsis caused by rickettsial infection-induced hemophagocytic syndrome. Front Med (Lausanne) 2023; 10:1209174. [PMID: 37608831 PMCID: PMC10440429 DOI: 10.3389/fmed.2023.1209174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/17/2023] [Indexed: 08/24/2023] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare histiocytic disorder characterized by reactive hyperplasia of the mononuclear phagocytic system, which is primarily caused by dysfunction of cytotoxic killer cells and natural killer cells, leading to antigen clearance barriers and the overactivation of the mononuclear phagocytic system due to continuous antigen stimulation. HLH encompasses a group of clinical syndromes marked by the overproduction of inflammatory cytokines. A 68-year-old Chinese man presented with persistent fever, chills, nausea, and vomiting; the patient had no history of any underlying conditions. Laboratory investigations revealed decreased levels of red blood cells, white blood cells, and platelets, along with reduced natural killer cell activity, increased CD25, hyperferritinemia, and the detection of Rickettsia DNA in his blood, meeting the diagnostic criteria of the Histiocyte Society HLH-2004 guidelines. The patient was treated with antibiotics, improving anemia, glucocorticoid therapy, and continuous renal replacement therapy (CRRT), temporarily improving his condition. However, the patient died after 2 years from chronic renal failure caused by septic shock.
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Affiliation(s)
| | | | | | - Jing Wang
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, China
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7
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Khalid M, Miller C, Gebregziabher N, Guckien Z, Goswami S, Perkins A, Andreoli SP. Factors affecting dialysis duration in children with Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome. Pediatr Nephrol 2023; 38:2753-2761. [PMID: 36705754 DOI: 10.1007/s00467-022-05839-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/23/2022] [Accepted: 11/23/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Predicting disease severity can be informative for management of HUS. Dialysis requirement, volume depletion, elevated white blood cell counts, very young age, and use of antimotility agents are known factors associated with severe HUS. METHODS A retrospective cohort analysis was performed to identify factors associated with dialysis duration using electronic medical record and chart review of 76 children ≤ 18 years of age at presentation with STEC-HUS identified through billing data from July 2008 to April 2020 at James Whitcomb Riley Hospital for Children, Indiana University, Indiana. RESULTS Novel findings associated with prolonged dialysis duration were age ≥ 6 years old at presentation (p = 0.041) and lack of drop in platelets below 60,000/mm3 anytime during the illness (p = 0.015). In addition, children with NSAID exposure trended longer on dialysis: 15 days with vs. 10 days without (p = 0.117). Known risk factors for severe disease including elevated peak white blood cell (WBC) count and higher hematocrit at presentation were also associated with longer dialysis duration: children with peak WBC > 20,000/mm3 were on dialysis for 15 vs. 9.5 days (p = 0.002) and in children on dialysis ≥ 14 days hematocrit at presentation was 29.6% vs. 24.2% (p = 0.03). Children requiring dialysis for 20 days or longer were more likely to be on anti-hypertensive medications (p = 0.025) and have chronic kidney disease at 12-month follow up (p = 0.044). CONCLUSIONS Age ≥ 6, elevated WBC count > 20,000/mm3, higher hematocrit at presentation, lack of drop in platelets to < 60,000/mm3, and possibly NSAID exposure during illness are associated with longer dialysis duration in STEC-HUS. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Myda Khalid
- James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Chloe Miller
- James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Netsanet Gebregziabher
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Zoe Guckien
- James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shrea Goswami
- James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Anthony Perkins
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sharon Phillips Andreoli
- James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
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Mansour MA, Khalil DF, Hasham MA, Youssef A, Rashad M, Awadallah M, Ali H. Hemolytic uremic syndrome with central nervous system manifestations, a case report and literature review. Radiol Case Rep 2023; 18:2268-2273. [PMID: 37128253 PMCID: PMC10147953 DOI: 10.1016/j.radcr.2023.02.035] [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: 12/21/2022] [Revised: 01/19/2023] [Accepted: 02/16/2023] [Indexed: 05/03/2023] Open
Abstract
Hemolytic uremic syndrome (HUS) is a multisystem disorder generally seen in children and young adults, manifesting with the symptomatic triad of thrombocytopenia, hemolytic anemia, and acute kidney injury. These symptoms are often preceded by a prodrome of bloody diarrhea, vomiting, fever, and weakness. HUS is an exceedingly rare entity, with less than 1.5 per 100,000 people affected annually. HUS with central nervous system (CNS) manifestations constitutes approximately 20%-50% of cases and often presents with seizures, altered level of consciousness, and brainstem symptoms. CNS involvement in HUS is a major cause of acute morbidity and mortality; therefore, timely diagnosis and treatment are crucial in the management of these cases. Neuroimaging plays a critical role in the diagnosis; however, it might be very challenging in a large number of cases because studies that report the typical neuroradiologic features of brain injury in cases with HUS are not commonly available. Herein, we demonstrate in a case-based approach, the importance of combining clinical suspicion with different radiologic modalities to better characterize HUS cases with CNS involvement, as well as demonstrate how the early start of meticulous supportive therapy can lead to a favorable outcome even when severe brain involvement is evident on acute imaging studies. Furthermore, we provide an illustrated overview of the current theories that explain the neurologic involvement in HUS, as well as the commonly affected brain areas and how this entity can be radiologically differentiated from other potential diagnoses.
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Affiliation(s)
- Moustafa A. Mansour
- Department of Neurology and Neurologic Surgery, Faculty of Medicine, Al-Azhar University, 1 Al-Mokhyam Al-Daem St., Nasr City, Cairo 11884, Egypt
- Department of Neurology and Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Division of Neuro-Intensive Care, Dar Al-Fouad Medical Corporation, Cairo, Egypt
- Department of Emergency Medicine and Critical Care, Faculty of Medicine, Al-Azhar University, 1 Al-Mokhyam Al-Daem St., Nasr City, Cairo 11884, Egypt
- Corresponding author.
| | - Dyana F. Khalil
- Department of Emergency Medicine and Critical Care, Dubai Healthcare City, Dubai, UAE
| | - Mohab A. Hasham
- Department of Emergency Medicine and Critical Care, Faculty of Medicine, Al-Azhar University, 1 Al-Mokhyam Al-Daem St., Nasr City, Cairo 11884, Egypt
| | - Ahmed Youssef
- Department of Emergency Medicine and Critical Care, Faculty of Medicine, Al-Azhar University, 1 Al-Mokhyam Al-Daem St., Nasr City, Cairo 11884, Egypt
| | - Mohamed Rashad
- Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Muhammad Awadallah
- Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hassan Ali
- Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Division of Neurology and Neurodevelopmental Disorders, Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Hosseinzadeh Siboni F, Behboudi F, Mohebbi K, Majidi S, Yaghobi Y, Carroll K. Virginia Henderson's Writings on the Nature of Nursing: An Exemplar of Nursing Practice. Nurs Sci Q 2023; 36:134-138. [PMID: 36994952 DOI: 10.1177/08943184221150255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Virginia Henderson's views on the nature of nursing continues to serve patients. Henderson emphasized that with the increasing complexity and technology in healthcare, nursing has never had a more important opportunity to contribute to the placement of the patient in the best conditions to achieve health. The aim of this article is to highlight a case study that employed Henderson's principles and plan of care to assist a child with a diagnosis of hemolytic uremic syndrome (HUS) through the performance of activities centering on achieving health and recovery.
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Affiliation(s)
- Fatemeh Hosseinzadeh Siboni
- Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, IR Iran
| | - Faezeh Behboudi
- Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, IR Iran
| | - Kasra Mohebbi
- Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, IR Iran
| | - Soheila Majidi
- Department of Midwifery, Zeynab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Yasaman Yaghobi
- Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, IR Iran
| | - Karen Carroll
- Ann & Robert H. Lurie Children's Hospital of Chicago, USA
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Thrombotic microangiopathies in critically ill children: The MATUCIP registry in Spain. An Pediatr (Barc) 2023; 98:194-203. [PMID: 36842880 DOI: 10.1016/j.anpede.2023.02.006] [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: 09/06/2022] [Accepted: 11/23/2022] [Indexed: 02/28/2023] Open
Abstract
INTRODUCTION Thrombotic microangiopathies (TMA) are rare diseases usually presenting with renal, haematological, neurologic and cardiovascular involvement and nonspecific but severe symptoms. A registry of TMA cases managed in Spanish paediatric intensive care units (the MATUCIP Registry) was established with the aim of gaining knowledge on their clinical characteristics, diagnosis and acute-phase treatment. METHODS We conducted a prospective multicentre observational study in 20 paediatric intensive care units (PICUs) in Spain from January 2017 to December 2021 in children aged more than 1 month with TMAs, who were followed up through the discharge from the PICU. RESULTS The sample included 97 patients (51.5% female) with a median age of 2.6 years (interquartile range [IQR], 1.6-5.7). The initial manifestations were gastrointestinal (74.2%), respiratory (14.4%), fever (5.2%), neurologic (3.1%) and other (3.1%). At admission, 75.3% of patients had microangiopathic haemolytic anaemia, 95.9% thrombocytopenia and 94.8% acute kidney injury. Of the total sample, 57.7% of patients received a diagnosis of Shiga toxin-associated haemolytic uraemic syndrome (HUS), 14.4% of Streptococcus pneumoniae-associated HUS, 15.6% of atypical HUS, 10.3% of secondary TMA and 2.1% of thrombotic thrombocytopenic purpura. Eighty-seven patients (89.7%) developed arterial hypertension, and 49.5% gastrointestinal, 22.7% respiratory, 25.8% neurologic and 12.4% cardiac manifestations. Also, 60.8% required renal replacement therapy and 2.1% plasma exchange. Twenty patients received eculizumab. The median PICU stay was 8.5 days (IQR, 5-16.5). Two children died. CONCLUSIONS The MATUCIP registry demonstrates the clinical variability of TMA cases requiring admission to the PICU. Knowledge of the presentation and outcomes of TMAs can facilitate early aetiological diagnosis. This registry can help improve our understanding of the clinical spectrum of these diseases, for which there is a dearth of published data.
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Muacevic A, Adler JR, Abdulqader MA, Yolmo D, Shaikh M, Rupasinghe PCD, Patel AA. Trends and Outcomes of Hospitalizations Due to Hemolytic Uremic Syndrome: A National Perspective. Cureus 2022; 14:e32315. [PMID: 36628001 PMCID: PMC9825057 DOI: 10.7759/cureus.32315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hemolytic uremic syndrome (HUS) is a rare but challenging disease with varying degrees of mortality and prognosis. We aim to evaluate the trends and outcomes of hospitalizations due to HUS by utilizing a large population-based dataset. METHODS We derived a study cohort from the Nationwide Inpatient Sample (NIS) for the years 2007-2018. Our primary outcomes were in-hospital mortality, discharge disposition, and predictors of poor outcomes. We then utilized the Cochran Armitage trend test and multivariable survey logistic regression models to analyze the trends, outcomes, and predictors. RESULTS A total of 8043 hospitalizations ranging from age zero to above 65 years of age occurred due to HUS from 2007-2018. The number of hospitalizations with HUS increased steadily from 528 in 2007 to 800 in 2013, but afterwards, we noticed a steady decline to 620 in 2018. Additionally, trends of in-hospital mortality slowly increased over the study period but we noticed a decline in the rate of discharge to skilled nursing facilities (SNFs). Furthermore, in multivariable regression analysis, predictors of increased mortality in hospitalized HUS patients were advanced age (95%CI: 1.221-1.686; p-value <0.0001) and requirement for dialysis (95%CI: 1.141-4.167; p-value: <0.0001). Advanced age >65 years (OR: 2.599, 95%CI: 1.406-4.803; p-value: 0.0023), as well as comorbidities such as diabetes mellitus and pulmonary circulatory diseases, which are under vascular events (OR: 1.467, 95%CI:1.075-2.000; p-value: 0.0156), were shown to have a higher rate of discharge to SNFs. Moreover, patients needing intravenous immunoglobulin (IVIG) and plasmapheresis had high odds of discharge to SNFs ((OR: 1.99, 95%CI: 1.307-3.03; p-value: 0.0013) and (OR: 5.509, 95%CI: 2.807- 10.809; p-value <0.0001), respectively), as well as smaller hospital bed size and hospital type (OR: 1.849, 95%CI: 1.142-2.993; p-value: 0.012). CONCLUSION In this national representative study, we observed a total decrease in hospitalizations as well as discharge to SNFs; however we saw an increase in inpatient mortality. We also identified multiple predictors significantly associated with increased mortality, some of which are potentially modifiable and can be points of interest for future studies.
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Microangiopatías trombóticas en niños críticamente enfermos. Registro español MATUCIP. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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13
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de Castro JTDS, Appenzeller S, Colella MP, Yamaguti-Hayakawa G, Paula EVD, Annichinno-Bizzachi J, Cendes F, Fabiano R, Orsi FA. Neurological manifestations in thrombotic microangiopathy: Imaging features, risk factors and clinical course. PLoS One 2022; 17:e0272290. [PMID: 36129939 PMCID: PMC9491546 DOI: 10.1371/journal.pone.0272290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 07/15/2022] [Indexed: 11/19/2022] Open
Abstract
Background and purpose Thrombotic microangiopathy (TMA) is a group of microvascular occlusive disorders that presents with neurological involvement in up to 87% of the cases. Although the central nervous system (CNS) is an important target organ in TMA, the role of neurological manifestations in the disease clinical course is not well established. In this study, we described the neurological manifestations and CNS radiological aspects in patients with a first, acute TMA event. We also examined the association between severe neurological involvement and adverse clinical outcomes in TMA. Methods A cohort of patients diagnosed with a first TMA event between 1995 and 2016 was included, their medical charts and imaging tests were retrospectively evaluated. Results A total of 49 patients were included, 85.7% were women and the mean age was 36.5 years-old (SD 13.0). Neurological manifestations were described in 85.7% of the patients, most of them (88%) were considered severe and consisted of confusion, compromised sensorimotor function, stupor, seizures, and personality change. Imaging tests were performed in 62% of the patients with neurological manifestations and detected acute CNS lesions, such as posterior reversible encephalopathy syndrome, hemorrhagic and ischemic stroke were observed, in 7 (27%) of them. While the need for intensive care unit admission was greater and longer among patients with severe neurological manifestations, the number of plasma exchange sessions, the total duration of hospitalization and in-hospital death were similar between groups. Conclusions Severe neurological manifestations are common in first TMA events and are responsible for a worse disease presentation at admission. While the effect of neurological manifestations on acute TMA clinical course seems to be modest, these manifestations may have an important impact on the development of chronic cognitive impairment, which highlights the need for proper diagnosis and treatment.
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Affiliation(s)
- José Thiago de Souza de Castro
- School of Medical Sciences, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
- Department of Radiology, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
- * E-mail:
| | - Simone Appenzeller
- Rheumatology Unit, School of Medical Science, University of Campinas, Campinas, São Paulo, Brazil
| | - Marina Pereira Colella
- Thrombosis and Hemostasis Unit, Hematology and Hemotherapy Center, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
| | - Gabriela Yamaguti-Hayakawa
- Thrombosis and Hemostasis Unit, Hematology and Hemotherapy Center, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
| | - Erich Vinícius De Paula
- Thrombosis and Hemostasis Unit, Hematology and Hemotherapy Center, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
- Discipline of Hematology and Hemotherapy, Department of Internal Medicine, School of Medical Sciences, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
| | - Joyce Annichinno-Bizzachi
- Thrombosis and Hemostasis Unit, Hematology and Hemotherapy Center, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
- Discipline of Hematology and Hemotherapy, Department of Internal Medicine, School of Medical Sciences, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
| | - Fernando Cendes
- Department of Neurology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Reis Fabiano
- School of Medical Sciences, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
- Department of Radiology, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
| | - Fernanda Andrade Orsi
- Department of Clinical Pathology, School of Medical Sciences, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
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14
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Ruas AFL, Lébeis GM, de Castro NB, Palmeira VA, Costa LB, Lanza K, Simões E Silva AC. Acute kidney injury in pediatrics: an overview focusing on pathophysiology. Pediatr Nephrol 2022; 37:2037-2052. [PMID: 34845510 DOI: 10.1007/s00467-021-05346-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 01/12/2023]
Abstract
Acute kidney injury (AKI) is defined as an abrupt decline in glomerular filtration rate, with increased serum creatinine and nitrogenous waste products due to several possible etiologies. Incidence in the pediatric population is estimated to be 3.9 per 1,000 hospitalizations, and prevalence among children admitted to intensive care units is 26.9%. Despite being a condition with important incidence and morbimortality, further evidence on pathophysiology and management among the pediatric population is still lacking. This narrative review aimed to summarize and discuss current data on AKI pathophysiology in the pediatric population, considering all the physiological particularities of this age range and common etiologies. Additionally, we reported current diagnostic tools, novel biomarkers, and newly proposed medications that have been studied with the aim of early diagnosis and appropriate treatment of AKI in the future.
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Affiliation(s)
- Ana Flávia Lima Ruas
- Interdisciplinary Laboratory of Medical Investigation, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Alfredo Balena Avenue, Number 190, 2nd floor, Room #281, Belo Horizonte, MG, 30130100, Brazil
| | - Gabriel Malheiros Lébeis
- Interdisciplinary Laboratory of Medical Investigation, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Alfredo Balena Avenue, Number 190, 2nd floor, Room #281, Belo Horizonte, MG, 30130100, Brazil
| | - Nicholas Bianco de Castro
- Interdisciplinary Laboratory of Medical Investigation, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Alfredo Balena Avenue, Number 190, 2nd floor, Room #281, Belo Horizonte, MG, 30130100, Brazil
| | - Vitória Andrade Palmeira
- Interdisciplinary Laboratory of Medical Investigation, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Alfredo Balena Avenue, Number 190, 2nd floor, Room #281, Belo Horizonte, MG, 30130100, Brazil
| | - Larissa Braga Costa
- Interdisciplinary Laboratory of Medical Investigation, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Alfredo Balena Avenue, Number 190, 2nd floor, Room #281, Belo Horizonte, MG, 30130100, Brazil
| | - Katharina Lanza
- Interdisciplinary Laboratory of Medical Investigation, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Alfredo Balena Avenue, Number 190, 2nd floor, Room #281, Belo Horizonte, MG, 30130100, Brazil
| | - Ana Cristina Simões E Silva
- Interdisciplinary Laboratory of Medical Investigation, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Alfredo Balena Avenue, Number 190, 2nd floor, Room #281, Belo Horizonte, MG, 30130100, Brazil.
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15
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Waggie KS, Snyder JM, Treuting PM. Acute renal injury from thrombotic microangiopathy associated with enteritis in New Zealand white rabbits. J Vet Diagn Invest 2022; 34:879-883. [PMID: 35949153 PMCID: PMC9446289 DOI: 10.1177/10406387221115139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Over a 3-y period, 12 adult New Zealand white (NZW) rabbits were presented for postmortem examination following variably long periods of inappetence and soft-to-liquid stool production. Postmortem findings included serosanguineous fluid in abdominal and thoracic cavities, dark-red-to-white renal foci, reddened intestinal serosa, and pulmonary edema. Microscopically, mesangial changes and thrombi were observed in renal glomeruli, and mild-to-severe enteritis was observed. These findings resemble hemolytic uremic syndrome, which typically follows enterocolitis associated with Shiga toxin (Stx)-producing Escherichia coli infection. In our case series, various gram-negative bacteria, most commonly E. coli, were isolated from the intestinal tracts; however, Stx production was not demonstrated. Evidence of Encephalitozoon cuniculi infection, a common cause of renal disease in rabbits, was also not found. Our cases suggest that gram-negative enteric bacteria should be included in the differential diagnosis of renal disease in NZW rabbits, especially in cases with an accompanying clinical history of gastrointestinal disorder.
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Affiliation(s)
- Kimberly S. Waggie
- Department of Comparative Medicine, School of Medicine,
University of Washington, Seattle, WA, USA
| | - Jessica M. Snyder
- Department of Comparative Medicine, School of Medicine,
University of Washington, Seattle, WA, USA
| | - Piper M. Treuting
- Department of Comparative Medicine, School of Medicine,
University of Washington, Seattle, WA, USA
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16
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Duan Y, Hu Z, Jin L, Zong T, Huang Y, Sun J, Zhou W, Li G. Isolation, characterization and anticomplementary activity of polysaccharides from the rhizomes of Belamcanda chinensis (L.) DC. Chem Biodivers 2022; 19:e202200525. [PMID: 35841390 DOI: 10.1002/cbdv.202200525] [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: 05/29/2022] [Accepted: 07/13/2022] [Indexed: 11/10/2022]
Abstract
The polysaccharides from the rhizomes of Belamcanda chinensis (L.) DC. (BCPs) were obtained by optimal water extraction (extraction temperature 84℃, liquid to solid ratio 42 mL/g and extraction time 100 min), the extraction yield of BCPs was 23.01 ± 0.27% (n=3). Furthermore, two novel polysaccharides (BCP-A1 and BCP-B1) were purified by column chromatography. The BCP-A1 (6.0820×104 kDa) was composed of β -D-Manp-(1→, β -D-Glcp-(1→, →4)-α-D-Galp-(1→ and →3,4)- β-D-Galp-(1→, and BCP-B1 (2.2744×104 kDa) was composed of →5)-α-L-Araf -(1→, β -D-Manp-(1→, β-D-Glcp-(1→, →4)-α-D-Glcp, →4)-α-D-Galp-(1→, →4)-α-D-Galp A-(1→ and →3,4)-β-D-Galp-(1→. In anticomplementary experiments, BCP-A1 (CH50: 0.009 ± 0.003 mg/mL; AP50: 0.015 ± 0.003 mg/mL) and BCP-B1 (CH50: 0.004 ± 0.001 mg/mL; AP50: 0.028 ± 0.005 mg/mL) exhibited potent anticomplementary activity, and acted on C2-, C4- and Factor B components. Our study provides a foundation for BCP-A1 and BCP-B1 as potential complement inhibitors to treat diseases involving with excessive activation of the complement system.
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Affiliation(s)
- Yuanqi Duan
- Yanbian University, Pharmacy, 977 Gongyuan Road, Yanji, CHINA
| | - Zhengyu Hu
- Yanbian University, Pharmacy, 977 Gongyuan Road, Yanji, CHINA
| | - Long Jin
- Yanbian University, Pharmacy, 977 Gongyuan Road, Yanji, CHINA
| | - Tieqiang Zong
- Yanbian University, Pharmacy, 977 Gongyuan Road, Yanji, CHINA
| | - Yanyan Huang
- Yanbian University, Pharmacy, 977 Gongyuan Road, Yanji, CHINA
| | - Jinfeng Sun
- Yanbian University, Pharmacy, 977 Gongyuan Road, Yanji, CHINA
| | - Wei Zhou
- Yanbian University, Pharmacy, 977 Gongyuan Road, Yanji, CHINA
| | - Gao Li
- Yanbian University, Pharmacy, 977 Gongyuan Road, 133002, Yanji, CHINA
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17
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Hemophagocytic Lymphohistiocytosis Associated With Hemolytic Uremic Syndrome in a Child: A Case Report and Systematic Literature Review. J Pediatr Hematol Oncol 2022; 44:e905-e910. [PMID: 35731942 DOI: 10.1097/mph.0000000000002265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/08/2021] [Indexed: 11/26/2022]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disorder resulting from excessive activation and nonmalignant proliferation of T-lymphocytes and macrophages. Hemolytic uremic syndrome (HUS) is a disease characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. Reports pertaining to the association between HLH and HUS are rarely published; however, we report on a 4-year-old boy who was diagnosed with both conditions and treated successfully with high-dose steroid and intravenous immunoglobulin. Differentiating HUS from HLH can be challenging because of their clinical similarities. Therefore, prompt diagnosis and immunosuppressive treatment are essential and life-saving to these patients.
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18
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The causes and consequences of paediatric kidney disease on adult nephrology care. Pediatr Nephrol 2022; 37:1245-1261. [PMID: 34389906 DOI: 10.1007/s00467-021-05182-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 05/29/2021] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
Abstract
Adult nephrologists often look after patients who have been diagnosed with kidney disease in childhood. This does present unique challenges to the adult nephrologist, who may be unfamiliar with the underlying cause of kidney disease as well as the complications of chronic kidney disease (CKD) that may have accumulated during childhood. This review discusses common causes of childhood CKD, in particular congenital anomalies of the kidney and urinary tract (CAKUT), autosomal dominant tubulointerstitial kidney disease (ADTKD), polycystic kidney disease, hereditary stone disease, nephrotic syndrome and atypical haemolytic uraemic syndrome. The long-term consequences of childhood CKD, such as the cardiovascular consequences, cognition and education as well as bone health, nutrition and growth are also discussed.
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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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20
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Eliglustat prevents Shiga toxin 2 cytotoxic effects in human renal tubular epithelial cells. Pediatr Res 2022; 91:1121-1129. [PMID: 34155339 DOI: 10.1038/s41390-021-01622-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/03/2021] [Accepted: 05/31/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Shiga toxin-producing Escherichia coli is responsible for post-diarrheal (D+) hemolytic uremic syndrome (HUS), which is a cause of acute renal failure in children. The glycolipid globotriaosylceramide (Gb3) is the main receptor for Shiga toxin (Stx) in kidney target cells. Eliglustat (EG) is a specific and potent inhibitor of glucosylceramide synthase, first step of glycosphingolipid biosynthesis, actually used for the treatment of Gaucher's disease. The aim of the present work was to evaluate the efficiency of EG in preventing the damage caused by Stx2 in human renal epithelial cells. METHODS Human renal tubular epithelial cell (HRTEC) primary cultures were pre-treated with different dilutions of EG followed by co-incubation with EG and Stx2 at different times, and cell viability, proliferation, apoptosis, tubulogenesis, and Gb3 expression were assessed. RESULTS In HRTEC, pre-treatments with 50 nmol/L EG for 24 h, or 500 nmol/L EG for 6 h, reduced Gb3 expression and totally prevented the effects of Stx2 on cell viability, proliferation, and apoptosis. EG treatment also allowed the development of tubulogenesis in 3D-HRTEC exposed to Stx2. CONCLUSIONS EG could be a potential therapeutic drug for the prevention of acute kidney injury caused by Stx2. IMPACT For the first time, we have demonstrated that Eliglustat prevents Shiga toxin 2 cytotoxic effects on human renal epithelia, by reducing the expression of the toxin receptor globotriaosylceramide. The present work also shows that Eliglustat prevents Shiga toxin 2 effects on tubulogenesis of renal epithelial cells. Eliglustat, actually used for the treatment of patients with Gaucher's disease, could be a therapeutic strategy to prevent the renal damage caused by Shiga toxin.
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21
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Formeck CL, Manrique-Caballero CL, Gómez H, Kellum JA. Uncommon Causes of Acute Kidney Injury. Crit Care Clin 2022; 38:317-347. [DOI: 10.1016/j.ccc.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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22
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Pang L, Chen J, Yu H, Huang H, Jin B, Wang X, Li H. Case Report: A Rare Case of Thrombotic Microangiopathy Induced by Remethylation Disorders. Front Med (Lausanne) 2022; 9:837253. [PMID: 35308551 PMCID: PMC8924285 DOI: 10.3389/fmed.2022.837253] [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: 12/16/2021] [Accepted: 01/31/2022] [Indexed: 11/25/2022] Open
Abstract
In this research, we described a very rare case of thrombotic microangiopathy induced by remethylation disorders. A 16-year-old boy presented to the emergency department with 5 months of weakness and fatigue. He was diagnosed with thrombotic microangiopathy based on clinical manifestation and laboratory information, which showed microangiopathic hemolytic anemia, renal impairment, and thrombocytopenia. After a complex diagnostic workup, the metabolite screening parameters and sequencing results guided us toward the diagnosis of remethylation disorders. The patient was diagnosed with thrombotic microangiopathy induced by remethylation disorders (cblC).
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Affiliation(s)
- Lu Pang
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Jian Chen
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Haiyan Yu
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Haiming Huang
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Bo Jin
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Xin Wang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haixia Li
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
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23
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Palela M, Giol ED, Amzuta A, Ologu OG, Stan RC. Fever temperatures impair hemolysis caused by strains of Escherichia coli and Staphylococcus aureus. Heliyon 2022; 8:e08958. [PMID: 35243078 PMCID: PMC8859000 DOI: 10.1016/j.heliyon.2022.e08958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/04/2022] [Accepted: 02/10/2022] [Indexed: 11/25/2022] Open
Abstract
Hemolysis modulates susceptibility to bacterial infections and predicts poor sepsis outcome. Hemolytic bacteria use hemolysins to induce erythrocyte lysis and obtain the heme that is essential for bacterial growth. Hemolysins are however potent immunogens and infections with hemolytic bacteria may cause a reversible fever response from the host that will aid in pathogen clearance. We hypothesized that fever temperatures impact the growth and infectivity of two hemolytic bacteria that are known to evoke fever in patients. To that end, we used high-sensitivity microcalorimetry to measure the evolution of heat production in fever-inducing strains of Escherichia coli and Staphylococcus aureus, under different temperature conditions. We determined specific bacterial aggregation profiles at temperatures equal to or exceeding 38.5 °C. Two melting temperatures peaks ranged from 38 °C to 43 °C for either species, a feature that we assigned to the formation of hemolysin aggregates of different oligomerization order. In order to measure the role of fever temperatures on hemolysis, we incubated the pathogens on blood agar plates at relevant temperatures, measuring the presence of hemolysis at 37 °C and its absence at 40.5 °C, respectively. We conclude that fever temperatures affect the kinetics of hemolysin pore formation and subsequently the hemolysis of red blood cells in vitro. We reveal the potential of microcalorimetry to monitor heat response from fever inducing bacterial species. Furthermore, these results help establish an additional positive role of febrile temperatures in modulating the immune response to infections, through the abolishment of hemolysis.
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Affiliation(s)
- Mihaela Palela
- Cantacuzino Military-Medical Research and Development National Institute, Romania
| | - Elena Diana Giol
- Cantacuzino Military-Medical Research and Development National Institute, Romania
| | - Andreia Amzuta
- Cantacuzino Military-Medical Research and Development National Institute, Romania
| | - Oxana G Ologu
- Cantacuzino Military-Medical Research and Development National Institute, Romania
| | - Razvan C Stan
- Cantacuzino Military-Medical Research and Development National Institute, Romania.,Chonnam National University Medical School, South Korea
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Ramírez-Lara M, González-Moctezuma K. 50 Years Ago in TheJournalofPediatrics: 50 Years into Understanding Hemolytic-Uremic Syndrome. J Pediatr 2022; 241:132. [PMID: 35067281 DOI: 10.1016/j.jpeds.2021.10.060] [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: 10/19/2022]
Affiliation(s)
- Mariana Ramírez-Lara
- Pediatrics Residency Program, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México
| | - Karen González-Moctezuma
- Pediatrics Residency Program, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México
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Adragão F, Nabais I, Reis R, Pereira B, Ramos A. Acute Pancreatitis as a Trigger for Thrombotic Microangiopathy: A Case Report. Cureus 2021; 13:e20103. [PMID: 34993042 PMCID: PMC8720237 DOI: 10.7759/cureus.20103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/05/2022] Open
Abstract
Thrombotic microangiopathies (TMA) are a group of disorders characterized by generalized microvascular occlusion, thrombocytopenia, and microangiopathic hemolytic anemia, which may present with organ dysfunction. These include hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) among others. The triad of anemia, thrombocytopenia, and acute kidney injury is the hallmark of HUS. It can be associated with Shiga toxin-producing Escherichia coli infection, complement-mediated (atypical HUS), coagulation or metabolism-mediated (predominantly in children of less than one year of age), or secondary HUS with the coexisting disease. HUS is a potentially fatal condition irrespective of its cause, and hence the diagnosis and management approach must be swift. The treatment is support-based; however, in severe cases, the use of plasmapheresis has shown favorable outcomes. In this report, we discuss a case of a 30-year-old male who presented with acalculous acute pancreatitis with HUS, a rare case of secondary HUS previously reported in a few case reports.
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Affiliation(s)
- Francisco Adragão
- Internal Medicine, Centro Hospitalar Universitário Do Algarve - Unidade Hospitalar de Portimão, Portimão, PRT
| | - Inês Nabais
- Internal Medicine, Hospital de Cascais Dr. José de Almeida, Cascais, PRT
| | - Rúben Reis
- Internal Medicine, Centro Hospitalar Barreiro Montijo, Barreiro, PRT
| | - Bernardo Pereira
- Critical Care Medicine, Hospital de Cascais Dr. José de Almeida, Cascais, PRT
| | - Armindo Ramos
- Critical Care Medicine, Hospital de Cascais Dr. José de Almeida, Cascais, PRT
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Fründt T, Leuffert J, Groth S, Rösch T, Steurer S, Lohse AW, Ullrich S, Lüth S. Low incidence of colonic complications after severe Shiga toxin-producing E. coli O104:H4 infection. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 60:1104-1110. [PMID: 34820797 DOI: 10.1055/a-1545-5322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In summer 2011, Shiga toxin producing Escherichia coli (EHEC) serotype O104:H4 caused the most severe EHEC outbreak in Germany to date. The case of a previously recovered patient with symptomatic postinflammatory colonic stenosis following EHEC- infection prompted us to conduct a prospective study to assess the macro- and microscopic intestinal long-term damage in a cohort of patients who had suffered from severe EHEC colitis. METHODS Following EHEC infection in 2011, 182 patients were offered to participate in this study between January 2013 and October 2014 as part of the post-inpatient follow-up care at the University Medical Center Hamburg-Eppendorf and to undergo colonoscopy with stepwise biopsies. Prior to colonoscopy, medical history and persistent post-infectious complaints were assessed. RESULTS Out of 182 patients, 22 (12%) participated in the study, 18 (82%) were female. All patients had been hospitalized due severe EHEC enterocolitis: 20 patients (90%) had subsequently developed hemolytic uremic syndrome (HUS), 16 patients (72%) had additionally required dialysis. On assessment prior to colonoscopy, all patients denied any abdominal complaints before EHEC-infection but 8 (36%) patients reported persistent post-infectious symptoms. According to the ROME IV criteria, 4 (18%) patients met the definition for post-infectious irritable bowel syndrome (PI-IBS). In all patients with persistent symptoms, colonoscopies and histological examination were unremarkable. Only in one symptom-free patient, biopsy revealed a locally limited cryptitis of the caecum, while all patients without complaints had inconspicuous histological and endoscopical findings. CONCLUSION Following infection colonic stenosis is a serious but rare long-term complication in patients who had suffered from severe enterocolitis. However, a significant proportion of these patients develop PI-IBS.
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Affiliation(s)
- Thorben Fründt
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Leuffert
- Department of Anatomy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Thomas Rösch
- Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Steurer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Ullrich
- Department of Gastroenterology, Städtisches Krankenhaus Kiel, Kiel, Germany
| | - Stefan Lüth
- Zentrum für Innere Medizin II, Städtisches Klinikum Brandenburg GmbH, Brandenburg an der Havel, Germany
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Luz D, Gómez FD, Ferreira RL, Melo BS, Guth BEC, Quintilio W, Moro AM, Presta A, Sacerdoti F, Ibarra C, Chen G, Sidhu SS, Amaral MM, Piazza RMF. The Deleterious Effects of Shiga Toxin Type 2 Are Neutralized In Vitro by FabF8:Stx2 Recombinant Monoclonal Antibody. Toxins (Basel) 2021; 13:toxins13110825. [PMID: 34822608 PMCID: PMC8621789 DOI: 10.3390/toxins13110825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/10/2021] [Accepted: 11/15/2021] [Indexed: 12/26/2022] Open
Abstract
Hemolytic Uremic Syndrome (HUS) associated with Shiga-toxigenic Escherichia coli (STEC) infections is the principal cause of acute renal injury in pediatric age groups. Shiga toxin type 2 (Stx2) has in vitro cytotoxic effects on kidney cells, including human glomerular endothelial (HGEC) and Vero cells. Neither a licensed vaccine nor effective therapy for HUS is available for humans. Recombinant antibodies against Stx2, produced in bacteria, appeared as the utmost tool to prevent HUS. Therefore, in this work, a recombinant FabF8:Stx2 was selected from a human Fab antibody library by phage display, characterized, and analyzed for its ability to neutralize the Stx activity from different STEC-Stx2 and Stx1/Stx2 producing strains in a gold standard Vero cell assay, and the Stx2 cytotoxic effects on primary cultures of HGEC. This recombinant Fab showed a dissociation constant of 13.8 nM and a half maximum effective concentration (EC50) of 160 ng/mL to Stx2. Additionally, FabF8:Stx2 neutralized, in different percentages, the cytotoxic effects of Stx2 and Stx1/2 from different STEC strains on Vero cells. Moreover, it significantly prevented the deleterious effects of Stx2 in a dose-dependent manner (up to 83%) in HGEC and protected this cell up to 90% from apoptosis and necrosis. Therefore, this novel and simple anti-Stx2 biomolecule will allow further investigation as a new therapeutic option that could improve STEC and HUS patient outcomes.
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Affiliation(s)
- Daniela Luz
- Laboratório de Bacteriologia, Instituto Butantan, Sao Paulo 05503-900, Brazil; (D.L.); (R.L.F.); (B.S.M.)
| | - Fernando D. Gómez
- Laboratorio de Fisiopatogenia, Instituto de Fisiología y Biofísica Bernardo Houssay (IFIBIO Houssay-CONICET), Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires 1121, Argentina; (F.D.G.); (A.P.); (F.S.); (C.I.)
| | - Raíssa L. Ferreira
- Laboratório de Bacteriologia, Instituto Butantan, Sao Paulo 05503-900, Brazil; (D.L.); (R.L.F.); (B.S.M.)
| | - Bruna S. Melo
- Laboratório de Bacteriologia, Instituto Butantan, Sao Paulo 05503-900, Brazil; (D.L.); (R.L.F.); (B.S.M.)
| | - Beatriz E. C. Guth
- Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de Sāo Paulo, Sao Paulo 04023-062, Brazil;
| | - Wagner Quintilio
- Laboratório de Biofármacos, Instituto Butantan, Sao Paulo 05503-900, Brazil; (W.Q.); (A.M.M.)
| | - Ana Maria Moro
- Laboratório de Biofármacos, Instituto Butantan, Sao Paulo 05503-900, Brazil; (W.Q.); (A.M.M.)
| | - Agostina Presta
- Laboratorio de Fisiopatogenia, Instituto de Fisiología y Biofísica Bernardo Houssay (IFIBIO Houssay-CONICET), Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires 1121, Argentina; (F.D.G.); (A.P.); (F.S.); (C.I.)
| | - Flavia Sacerdoti
- Laboratorio de Fisiopatogenia, Instituto de Fisiología y Biofísica Bernardo Houssay (IFIBIO Houssay-CONICET), Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires 1121, Argentina; (F.D.G.); (A.P.); (F.S.); (C.I.)
| | - Cristina Ibarra
- Laboratorio de Fisiopatogenia, Instituto de Fisiología y Biofísica Bernardo Houssay (IFIBIO Houssay-CONICET), Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires 1121, Argentina; (F.D.G.); (A.P.); (F.S.); (C.I.)
| | - Gang Chen
- Banting and Best Department of Medical Research, Terrence Donnelly Centre for Cellular and Biomolecular Research, University of Toronto, Toronto, OT M5S 3E1, Canada; (G.C.); (S.S.S.)
| | - Sachdev S. Sidhu
- Banting and Best Department of Medical Research, Terrence Donnelly Centre for Cellular and Biomolecular Research, University of Toronto, Toronto, OT M5S 3E1, Canada; (G.C.); (S.S.S.)
| | - María Marta Amaral
- Laboratorio de Fisiopatogenia, Instituto de Fisiología y Biofísica Bernardo Houssay (IFIBIO Houssay-CONICET), Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires 1121, Argentina; (F.D.G.); (A.P.); (F.S.); (C.I.)
- Correspondence: (M.M.A.); (R.M.F.P.)
| | - Roxane M. F. Piazza
- Laboratório de Bacteriologia, Instituto Butantan, Sao Paulo 05503-900, Brazil; (D.L.); (R.L.F.); (B.S.M.)
- Correspondence: (M.M.A.); (R.M.F.P.)
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López-Trascasa M, Alonso-Melgar Á, Melgosa-Hijosa M, Espinosa-Román L, Lledín-Barbancho MD, García-Fernández E, Rodríguez de Córdoba S, Sánchez-Corral P. Case Report: Combined Liver-Kidney Transplantation to Correct a Mutation in Complement Factor B in an Atypical Hemolytic Uremic Syndrome Patient. Front Immunol 2021; 12:751093. [PMID: 34721423 PMCID: PMC8551365 DOI: 10.3389/fimmu.2021.751093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/27/2021] [Indexed: 12/12/2022] Open
Abstract
Pathogenic gain-of-function variants in complement Factor B were identified as causative of atypical Hemolytic Uremic syndrome (aHUS) in 2007. These mutations generate a reduction on the plasma levels of complement C3. A four-month-old boy was diagnosed with hypocomplementemic aHUS in May 2000, and he suffered seven recurrences during the following three years. He developed a severe hypertension which required 6 anti-hypertensive drugs and presented acrocyanosis and several confusional episodes. Plasma infusion or exchange, and immunosuppressive treatments did not improve the clinical evolution, and the patient developed end-stage renal disease at the age of 3 years. Hypertension and vascular symptoms persisted while he was on peritoneal dialysis or hemodialysis, as well as after bilateral nephrectomy. C3 levels remained low, while C4 levels were normal. In 2005, a heterozygous gain-of-function mutation in Factor B (K323E) was found. A combined liver and kidney transplantation (CLKT) was performed in March 2009, since there was not any therapy for complement inhibition in these patients. Kidney and liver functions normalized in the first two weeks, and the C3/C4 ratio immediately after transplantation, indicating that the C3 activation has been corrected. After remaining stable for 4 years, the patient suffered a B-cell non-Hodgkin lymphoma that was cured by chemotherapy and reduction of immunosuppressive drugs. Signs of liver rejection with cholangitis were observed a few months later, and a second liver graft was done 11 years after the CLKT. One year later, the patient maintains normal kidney and liver functions, also C3 and C4 levels are within the normal range. The 12-year follow-up of the patient reveals that, in spite of severe complications, CLKT was an acceptable therapeutic option for this aHUS patient.
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Affiliation(s)
- Margarita López-Trascasa
- Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.,Complement Research Group, Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain
| | | | - Marta Melgosa-Hijosa
- Complement Research Group, Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain.,Pediatric Nephrology Service, La Paz University Hospital, Madrid, Spain
| | - Laura Espinosa-Román
- Complement Research Group, Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain.,Pediatric Nephrology Service, La Paz University Hospital, Madrid, Spain
| | | | | | - Santiago Rodríguez de Córdoba
- Department of Molecular Biomedicine, Centro de Investigaciones Biológicas (CSIC), Madrid, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER), Madrid, Spain
| | - Pilar Sánchez-Corral
- Complement Research Group, Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER), Madrid, Spain
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Thrombotic microangiopathy triggered by podocytopathy. Clin Nephrol Case Stud 2021; 9:110-116. [PMID: 34646728 PMCID: PMC8507413 DOI: 10.5414/cncs110534] [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: 02/16/2021] [Accepted: 07/22/2021] [Indexed: 11/18/2022] Open
Abstract
Thrombotic microangiopathy (TMA) is a rare group of diseases characterized by microangiopathic hemolytic anemia, thrombocytopenia, and target organ damage. It can be divided into primary and secondary TMA. Herein we report a case of TMA associated to a primary glomerular disease. We report the case of a 31-year-old Black male from Cape Verde admitted in March 2018 with nephrotic syndrome and upper gastrointestinal bleeding, the latter due to severe erythematous gastritis. He was discharged after clinical stabilization. The patient came to Portugal 8 months later. On admission, he presented with rapid deterioration of kidney function and hyperkalemia. The etiologic study revealed microangiopathic hemolytic anemia, nephrotic syndrome and microscopic hematuria. Immunologic study and viral serology were negative. ADAMTS13 activity and inhibitor testing were within normal range, genetic complement evaluation showed CFH-H3 in homozygosity, functional complement studies revealed decreased function of alternative pathway. Kidney biopsy was consistent with the diagnosis of TMA, and electron microscopy was compatible with minimal change disease. Patient underwent plasmapheresis with resolution of hemolysis, fluid overload and recovery of renal function. Two months later, he presented with nephrotic syndrome and started prednisolone with remission. Six months later, the nephrotic syndrome relapsed, and it became steroid-, MMF-, and rituximab-resistant. Tacrolimus was initiated, achieving partial remission. Atypical hemolytic uremic syndrome is an uncommon disease and is rarely reported as secondary to glomerular diseases. This case showcases the challenges regarding treatment options in a resistant glomerulopathy and the implications of therapeutic choices and kidney outcomes with the coexisting TMA.
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Familial Atypical Hemolytic Uremic Syndrome with Positive p.S1191L (c.3572C>T) Mutation on the CFH Gene: A Single-center Experience. Balkan J Med Genet 2021; 24:81-88. [PMID: 34447663 PMCID: PMC8366473 DOI: 10.2478/bjmg-2021-0007] [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] [Indexed: 11/20/2022] Open
Abstract
The atypical hemolytic uremic syndrome (aHUS) is characterized by thrombocytopenia, microangiopathic hemolytic anemia and acute kidney injury (AKI), which can exhibit a poor prognosis. Complement factor H (CFH) gene mutations play a key role in this disease, which may be sporadic or familial. We studied 13 people from the same family, investigated for gene mutations of the familial aHUS after a family member presented to our emergency clinic with the aHUS and reported a family history of chronic renal failure. The p.S1191L mutation on the CFH gene was heterozygous in six people from the patient’s family with the aHUS. One of these family members is our patient with acute kidney injury, and the other two are followed at the Nephrology Clinic, Medeniyat University, Goztepe Training and Research Hospital, Istanbul, Turkey, due to chronic renal failure. The other three family members showed no evidence of renal failure. The index case had a history of six sibling deaths; three died of chronic renal failure. Plasmapheresis and fresh frozen plasma treatment were administered to our patient. When the patient showed no response to this treatment, eculizumab (ECZ) therapy was started. The study demonstrated that thorough family history should be taken in patients with the aHUS. These patients may have the familial type of the disease, and they should be screened genetically. Eculizumab should be the first choice in the treatment with plasmapheresis. It should be kept in mind that the use of ECZ as prophylaxis in posttransplant therapy is extremely important for preventing rejection.
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Thompson R, Peng L, Zarmbinski B, Tierney DM. Adult Shigatoxin-mediated hemolytic uremic syndrome masked by alcohol use and inflammatory bowel disease. BMJ Case Rep 2021; 14:e244115. [PMID: 34413043 PMCID: PMC8378347 DOI: 10.1136/bcr-2021-244115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/03/2022] Open
Abstract
Diagnosing uncommon diseases in individuals with underlying medical conditions can be challenging. Cognitive bias can lead to delayed or missed disease management. We present a case of Shiga-toxin mediated hemolytic uremic syndrome (ST-HUS) in a 46-year-old man with ulcerative colitis and alcohol use disorder who presented with acute alcohol intoxication, non-bloody diarrhoea and coffee ground emesis. He was admitted to the hospital for alcoholic ketoacidosis, alcohol withdrawal and possible upper gastrointestinal bleed, but ultimately, he developed severe thrombocytopaenia, hemolytic anaemia, acute renal failure and prolonged altered mentation. Given that ST-HUS is uncommon in adults, his initial report of diarrhoea was attributed to alcohol use or underlying active ulcerative colitis and not connected to his haematologic abnormalities. He was initially started on plasmapheresis; however, thrombotic microangiopathy work up revealed Shiga-toxin in his stool and ADAMST13 levels within normal limits. Subsequently, he was transitioned to supportive care for management of ST-HUS.
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Affiliation(s)
- Rachel Thompson
- Medical School, University of Minnesota - Twin Cities, Minneapolis, Minnesota, USA
| | - Lisa Peng
- Graduate Medical Education, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Breanna Zarmbinski
- Graduate Medical Education, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - David M Tierney
- Graduate Medical Education, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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Tavasoli A, Zafaranloo N, Hoseini R, Otukesh H, Nakhaiee S. Frequency of neurological involvement in patients with/without diarrhea hemolytic uremic syndrome: A Systematic review and meta-analysis. Med J Islam Repub Iran 2021; 35:91. [PMID: 34956937 PMCID: PMC8683803 DOI: 10.47176/mjiri.35.91] [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: 10/20/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Diarrhea-associated-hemolytic-uremic-syndrome (D+HUS) is a common from of HUS. Central-nervous-system (CNS) involvement is one of the most common extrarenal organ involvements in children with D+HUS. This systematic review and meta-analysis aim to recognize the frequency of neurological complications in pts with HUS. Methods: Databases of PubMed, Embase, and Web of Science were searched systematically to find the papers on neurological involvement in HUS pts. Two researchers independently assessed the papers' quality and extracted data. CMA v. 2.2.064. was used for data analysis. Heterogeneity was evaluated using the I-squared (I2) test, and a fixed/random-effects model was used when appropriate. Results: In this review, 21 studies including 2,189 participants with a median age between 1.3-40-year-old, entered the meta-analysis. The meta-analysis in D+HUS patients indicated 27.0% with neurological complications (95% CI, 22.0%-32.6%), 25.5% of symptoms weren't categorized (95% CI, 15.9%-38.3%), 20.8% of them developed the seizures (95% CI, 2.3%-74.4%). In D-HUS pts, 20.8% of them were presented neurological symptoms (95% CI, 17.9%-24.0%), of which 29.0% weren't categorized (95% CI, 19.2%-41.2%), 17.5% of pts got into coma (95% CI, 9.6%-29.7%), 5.6 % showed hemiparesis (95% CI, 2.8%-10.9%), 17.2% experienced lethargy (95% CI, 5.2%-44.1%), 30.5% developed the seizures (95% CI, 18.2%-46.2%), 7.4% manifested speech abnormalities (95% CI, 0.2%-7.22%), 6.4% of D-HUS pts presented visual-disturbances (95% CI, 3.4%-11.6%). Conclusion: This systematic review and meta-analysis indicated more than one-fourth of both D+HUS and D-HUS patients were presented with neurological symptoms, and the most prevalent symptoms were seizures, which can lead to an epilepsy sequel.
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Affiliation(s)
- Azita Tavasoli
- Ali-Asghar Children Hospital, Iran University of Medical and Sciences, Tehran, Iran
| | - Nazanin Zafaranloo
- Ali-Asghar Children Hospital, Iran University of Medical and Sciences, Tehran, Iran
| | - Rozita Hoseini
- Ali-Asghar Children Hospital, Iran University of Medical and Sciences, Tehran, Iran
| | - Hasan Otukesh
- Ali-Asghar Children Hospital, Iran University of Medical and Sciences, Tehran, Iran
| | - Shahrbanoo Nakhaiee
- Ali-Asghar Children Hospital, Iran University of Medical and Sciences, Tehran, Iran
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Tahir MA, Dina NE, Cheng H, Valev VK, Zhang L. Surface-enhanced Raman spectroscopy for bioanalysis and diagnosis. NANOSCALE 2021; 13:11593-11634. [PMID: 34231627 DOI: 10.1039/d1nr00708d] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
In recent years, bioanalytical surface-enhanced Raman spectroscopy (SERS) has blossomed into a fast-growing research area. Owing to its high sensitivity and outstanding multiplexing ability, SERS is an effective analytical technique that has excellent potential in bioanalysis and diagnosis, as demonstrated by its increasing applications in vivo. SERS allows the rapid detection of molecular species based on direct and indirect strategies. Because it benefits from the tunable surface properties of nanostructures, it finds a broad range of applications with clinical relevance, such as biological sensing, drug delivery and live cell imaging assays. Of particular interest are early-stage-cancer detection and the fast detection of pathogens. Here, we present a comprehensive survey of SERS-based assays, from basic considerations to bioanalytical applications. Our main focus is on SERS-based pathogen detection methods as point-of-care solutions for early bacterial infection detection and chronic disease diagnosis. Additionally, various promising in vivo applications of SERS are surveyed. Furthermore, we provide a brief outlook of recent endeavours and we discuss future prospects and limitations for SERS, as a reliable approach for rapid and sensitive bioanalysis and diagnosis.
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Affiliation(s)
- Muhammad Ali Tahir
- Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention, Department of Environmental Science & Engineering, Fudan University, Shanghai, 200433, Peoples' Republic of China.
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Galarce N, Sánchez F, Escobar B, Lapierre L, Cornejo J, Alegría-Morán R, Neira V, Martínez V, Johnson T, Fuentes-Castillo D, Sano E, Lincopan N. Genomic Epidemiology of Shiga Toxin-Producing Escherichia coli Isolated from the Livestock-Food-Human Interface in South America. Animals (Basel) 2021; 11:ani11071845. [PMID: 34206206 PMCID: PMC8300192 DOI: 10.3390/ani11071845] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Shiga toxin-producing Escherichia coli (STEC) are zoonotic pathogens that cause food-borne diseases in humans, where cattle and derived products play a key role as reservoirs and vehicles. We analyzed the genomic data of STEC strains circulating at the livestock-food-human interface in South America, extracting clinically and epidemiologically relevant information (serotypes, virulome, resistance genes, sequence types, and phylogenomics). This study included 130 STEC genomes obtained from cattle (n = 51), beef (n = 48), and human (n = 31) samples. The successful expansion of O157:H7 (ST11) and non-O157 (ST16, ST21, ST223, ST443, ST677, ST679, ST2388) clones is highlighted, suggesting common activities, such as multilateral trade and travel. Circulating STEC strains analyzed exhibit high genomic diversity and harbor several genetic determinants associated with severe illness in humans, highlighting the need to establish official surveillance of this pathogen that should be focused on detecting molecular determinants of virulence and clonal relatedness, in the whole beef production chain. Abstract Shiga toxin-producing Escherichia coli (STEC) are zoonotic pathogens responsible for causing food-borne diseases in humans. While South America has the highest incidence of human STEC infections, information about the genomic characteristics of the circulating strains is scarce. The aim of this study was to analyze genomic data of STEC strains isolated in South America from cattle, beef, and humans; predicting the antibiotic resistome, serotypes, sequence types (STs), clonal complexes (CCs) and phylogenomic backgrounds. A total of 130 whole genome sequences of STEC strains were analyzed, where 39.2% were isolated from cattle, 36.9% from beef, and 23.8% from humans. The ST11 was the most predicted (20.8%) and included O-:H7 (10.8%) and O157:H7 (10%) serotypes. The successful expansion of non-O157 clones such as ST16/CC29-O111:H8 and ST21/CC29-O26:H11 is highlighted, suggesting multilateral trade and travel. Virulome analyses showed that the predominant stx subtype was stx2a (54.6%); most strains carried ehaA (96.2%), iha (91.5%) and lpfA (77.7%) genes. We present genomic data that can be used to support the surveillance of STEC strains circulating at the livestock-food-human interface in South America, in order to control the spread of critical clones “from farm to table”.
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Affiliation(s)
- Nicolás Galarce
- Departamento de Medicina Preventiva Animal, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago 8820808, Chile; (F.S.); (B.E.); (L.L.); (J.C.); (R.A.-M.); (V.N.)
- Correspondence:
| | - Fernando Sánchez
- Departamento de Medicina Preventiva Animal, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago 8820808, Chile; (F.S.); (B.E.); (L.L.); (J.C.); (R.A.-M.); (V.N.)
- Programa de Doctorado en Ciencias Silvoagropecuarias y Veterinarias, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago 8820808, Chile
| | - Beatriz Escobar
- Departamento de Medicina Preventiva Animal, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago 8820808, Chile; (F.S.); (B.E.); (L.L.); (J.C.); (R.A.-M.); (V.N.)
| | - Lisette Lapierre
- Departamento de Medicina Preventiva Animal, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago 8820808, Chile; (F.S.); (B.E.); (L.L.); (J.C.); (R.A.-M.); (V.N.)
| | - Javiera Cornejo
- Departamento de Medicina Preventiva Animal, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago 8820808, Chile; (F.S.); (B.E.); (L.L.); (J.C.); (R.A.-M.); (V.N.)
| | - Raúl Alegría-Morán
- Departamento de Medicina Preventiva Animal, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago 8820808, Chile; (F.S.); (B.E.); (L.L.); (J.C.); (R.A.-M.); (V.N.)
- Facultad de Ciencias Agropecuarias y Ambientales, Universidad Pedro de Valdivia, Santiago 8370007, Chile
| | - Víctor Neira
- Departamento de Medicina Preventiva Animal, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago 8820808, Chile; (F.S.); (B.E.); (L.L.); (J.C.); (R.A.-M.); (V.N.)
| | - Víctor Martínez
- Departamento de Fomento de la Producción Animal, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago 8820808, Chile;
| | - Timothy Johnson
- Department of Veterinary and Biomedical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA;
| | - Danny Fuentes-Castillo
- Departamento de Patología, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo 05508-270, Brazil;
| | - Elder Sano
- Departamento de Microbiología, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo 05508-900, Brazil; (E.S.); (N.L.)
| | - Nilton Lincopan
- Departamento de Microbiología, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo 05508-900, Brazil; (E.S.); (N.L.)
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Streptococcus Pneumoniae-Associated Hemolytic Uremic Syndrome in the Era of Pneumococcal Vaccine. Pathogens 2021; 10:pathogens10060727. [PMID: 34207609 PMCID: PMC8227211 DOI: 10.3390/pathogens10060727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 01/09/2023] Open
Abstract
Streptococcus pneumoniae-associated hemolytic uremic syndrome (Sp-HUS) is a serious complication of invasive pneumococcal disease that is associated with increased mortality in the acute phase and morbidity in the long term. Recently, Sp-HUS definition has undergone revision and cases are categorized as definite, probable, and possible, based on less invasive serological investigations that evaluate Thomsen-Friedenreich crypt antigen (T-antigen) activation. In comparison to the pre-vaccine era, Sp-HUS incidence seems to be decreasing after the introduction of 7-serotype valence and 13-serotype valence pneumococcal vaccines in 2000 and 2010, respectively. However, Sp-HUS cases continue to occur secondary to vaccine failure and emergence of non-vaccine/replacement serotypes. No single hypothesis elucidates the molecular basis for Sp-HUS occurrence, although pneumococcal neuraminidase production and formation of T-antigen antibody complexes on susceptible endothelial and red blood cells continues to remain the most acceptable explanation. Management of Sp-HUS patients remains supportive in nature and better outcomes are being reported secondary to earlier recognition, better diagnostic tools and improved medical care. Recently, the addition of eculizumab therapy in the management of Sp-HUS for control of dysregulated complement activity has demonstrated good outcomes, although randomized clinical trials are awaited. A sustained pneumococcal vaccination program and vigilance for replacement serotypes will be the key for persistent reduction in Sp-HUS cases worldwide.
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Volume Resuscitation and Progression to Organ Failure in Shiga Toxin-Producing Escherichia coli Infection in Adults. Crit Care Explor 2021; 3:e0423. [PMID: 34036274 PMCID: PMC8133128 DOI: 10.1097/cce.0000000000000423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES: Shiga toxin-producing Escherichia coli infection is associated with dysentery and the hemolytic uremic syndrome, marked by the triad of microangiopathic hemolytic anemia, acute kidney failure, and thrombocytopenia. Descriptions of Shiga toxin-producing Escherichia coli outbreaks causing hemolytic uremic syndrome in adults are sparse, and management strategies are largely adapted from pediatric literature where aggressive fluid administration is recommended. However, these may not be ideal for adults. DESIGN: We present a case series of an Shiga toxin-producing Escherichia coli outbreak in U.S. Marine Corps recruits. SETTING: We review the clinical course, laboratory data, and fluid resuscitation used in hospitalized patients during the 2017 Shiga toxin-producing Escherichia coli outbreak at Marine Corps Recruit Depot, San Diego. PATIENTS: Patients admitted to the hospital for complications from Shiga toxin-producing Escherichia coli infection. All were previously healthy men between the ages of 17 and 20 years. INTERVENTIONS: Isotonic crystalloid fluid resuscitation during the first 72 hours. MEASUREMENTS AND MAIN RESULTS: Of 244 identified cases of Shiga toxin-producing Escherichia coli infection, 30 required hospitalization, 15 progressed to hemolytic uremic syndrome, and five required hemodialysis. Patients were admitted and given aggressive IV fluid hydration. Those who progressed to hemolytic uremic syndrome received on average 8.4 L of isotonic crystalloid over the initial 72 hours, with up to 18% of body weight delivered. The six critically ill patients received a mean 12.2 L in the first 72 hours. Those who did not progress to hemolytic uremic syndrome received a mean 3.0 L of crystalloid. If oligoanuria developed, a net-even fluid balance was maintained. The amount of volume infused was not associated with improved outcomes. The patients with the highest fluid balance totals more often required dialysis than those who received less fluid. One hemolytic uremic syndrome patient developed flash pulmonary edema. CONCLUSIONS: The aggressive IV hydration protocols (as a percentage of body weight) in the pediatric literature may not be applicable to adults diagnosed with hemolytic uremic syndrome. A more conservative fluid strategy in adults with hemolytic uremic syndrome merits further investigation.
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Mikolajczyk K, Bereznicka A, Szymczak-Kulus K, Haczkiewicz-Lesniak K, Szulc B, Olczak M, Rossowska J, Majorczyk E, Kapczynska K, Bovin N, Lisowska M, Kaczmarek R, Miazek A, Czerwinski M. Missing the sweet spot: one of the two N-glycans on human Gb3/CD77 synthase is expendable. Glycobiology 2021; 31:1145-1162. [PMID: 33978735 DOI: 10.1093/glycob/cwab041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/23/2021] [Accepted: 04/29/2021] [Indexed: 02/07/2023] Open
Abstract
N-glycosylation is a ubiquitous posttranslational modification that may influence folding, subcellular localization, secretion, solubility and oligomerization of proteins. In this study, we examined the effects of N-glycans on the activity of human Gb3/CD77 synthase, which catalyzes the synthesis of glycosphingolipids with terminal Galα1 → 4Gal (Gb3 and the P1 antigen) and Galα1 → 4GalNAc disaccharides (the NOR antigen). The human Gb3/CD77 synthase contains two occupied N-glycosylation sites at positions N121 and N203. Intriguingly, we found that while the N-glycan at N203 is essential for activity and correct subcellular localization, the N-glycan at N121 is dispensable and its absence did not reduce, but, surprisingly, even increased the activity of the enzyme. The fully N-glycosylated human Gb3/CD77 synthase and its glycoform missing the N121 glycan correctly localized in the Golgi, whereas a glycoform without the N203 site partially mislocalized in the endoplasmic reticulum. A double mutein missing both N-glycans was inactive and accumulated in the endoplasmic reticulum. Our results suggest that the decreased specific activity of human Gb3/CD77 synthase glycovariants results from their improper subcellular localization and, to a smaller degree, a decrease in enzyme solubility. Taken together, our findings show that the two N-glycans of human Gb3/CD77 synthase have opposing effects on its properties, revealing a dual nature of N-glycosylation and potentially a novel regulatory mechanism controlling the biological activity of proteins.
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Affiliation(s)
- Krzysztof Mikolajczyk
- Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Rudolfa Weigla St. 12, 53-114 Wroclaw, Poland
| | - Anna Bereznicka
- Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Rudolfa Weigla St. 12, 53-114 Wroclaw, Poland
| | - Katarzyna Szymczak-Kulus
- Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Rudolfa Weigla St. 12, 53-114 Wroclaw, Poland
| | - Katarzyna Haczkiewicz-Lesniak
- Department of Ultrastructural Research, Faculty of Medicine, Wroclaw Medical University, Chalubinskiego St. 6a, 50-368, Wroclaw, Poland
| | - Bozena Szulc
- Faculty of Biotechnology, University of Wroclaw, Joliot-Curie St. 14A, 50-383 Wroclaw, Poland
| | - Mariusz Olczak
- Faculty of Biotechnology, University of Wroclaw, Joliot-Curie St. 14A, 50-383 Wroclaw, Poland
| | - Joanna Rossowska
- Flow Cytometry Core Facility, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Rudolfa Weigla St. 12, 53-114 Wroclaw, Poland
| | - Edyta Majorczyk
- Faculty of Physiotherapy and Physical Education, Opole University of Technology, Proszkowska St. 76, 45-758 Opole, Poland
| | - Katarzyna Kapczynska
- Department of Immunology of Infectious Diseases, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Rudolfa Weigla St. 12, 53-114 Wroclaw, Poland
| | - Nicolai Bovin
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry Russian Academy of Sciences, Miklukho-Maklaya St 16/10, Moscow 117997 Russia
| | - Marta Lisowska
- Department of Tumor Immunology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Rudolfa Weigla St. 12, 53-114 Wroclaw, Poland
| | - Radoslaw Kaczmarek
- Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Rudolfa Weigla St. 12, 53-114 Wroclaw, Poland
| | - Arkadiusz Miazek
- Department of Tumor Immunology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Rudolfa Weigla St. 12, 53-114 Wroclaw, Poland
| | - Marcin Czerwinski
- Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Rudolfa Weigla St. 12, 53-114 Wroclaw, Poland
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Sacras ML, Ladeira C, Pereira SC, Alves R. Colon stricture after hemolytic uremic syndrome. WORLD JOURNAL OF PEDIATRIC SURGERY 2021; 4:e000261. [DOI: 10.1136/wjps-2021-000261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 11/04/2022] Open
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Sánchez F, Fuenzalida V, Ramos R, Escobar B, Neira V, Borie C, Lapierre L, López P, Venegas L, Dettleff P, Johnson T, Fuentes-Castillo D, Lincopan N, Galarce N. Genomic features and antimicrobial resistance patterns of Shiga toxin-producing Escherichia coli strains isolated from food in Chile. Zoonoses Public Health 2021; 68:226-238. [PMID: 33619864 DOI: 10.1111/zph.12818] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/18/2020] [Accepted: 01/18/2021] [Indexed: 02/06/2023]
Abstract
Shiga toxin-producing Escherichia coli (STEC) is a zoonotic pathogen that causes severe illness in humans, often associated with foodborne outbreaks. Antimicrobial resistance among foodborne E. coli has increased over the last decades becoming a public health issue. In this study, the presence and features of STEC were investigated in samples of meat, seafood, vegetables and ready-to-eat street-vended food collected in Chile, using a genomic and microbiological approach. Phenotypic and genotypic antimicrobial resistance profiles were determined, and serotype, phylogroup, sequence type (ST) and phylogenomics were predicted using bioinformatic tools. Three thousand three hundred samples collected in 2019 were screened, of which 18 were positive for STEC strains (0.5%), with stx2a (61.1%) being the predominant stx subtype. The presence of the virulence genes lpfA (100%), iha and ehaA (94.4%), and ehxA, hlyA and saa (83.3%) was confirmed among the STEC strains; the Locus of adhesion and autoaggregation (LAA) was predicted in 14 (77.8%) strains. Strains displayed resistance to colistin (100%), and intermediate resistance to enrofloxacin (11.1%) and chloramphenicol (5.6%). In this regard, mutations in the two-component regulatory system genes pmrA (S29G), pmrB (D283G) and phoP (I44L), and the presence of the qnrB19 gene were confirmed. STEC strains belonged to ST11231 (38.9%), ST297 and ST58 (16.7% each), and ST1635, ST11232, ST446, ST442 and ST54 (5.6% each), and the most frequently detected serotypes were O113:H21 (44.4%), O130:H11 and O116:H21 (16.7% each), and O174:H21 (11.1%). Strains belonging to the international ST58 showed genomic relatedness with worldwide strains from human and non-human sources. Our study reports for the first time the genomic profile of STEC strains isolated from food in Chile, highlighting the presence of international clones and sequence types commonly associated with human infections in different geographical regions, as well as the convergence of virulence and resistance in STEC lineages circulating in this country.
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Affiliation(s)
- Fernando Sánchez
- Facultad de Ciencias Veterinarias y Pecuarias, Departamento de Medicina Preventiva Animal, Universidad de Chile, Santiago, Chile.,Programa de Magíster en Ciencias Animales y Veterinarias, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago, Chile
| | - Verónica Fuenzalida
- Facultad de Ciencias Veterinarias y Pecuarias, Departamento de Medicina Preventiva Animal, Universidad de Chile, Santiago, Chile
| | - Romina Ramos
- Facultad de Ciencias Veterinarias y Pecuarias, Departamento de Medicina Preventiva Animal, Universidad de Chile, Santiago, Chile
| | - Beatriz Escobar
- Facultad de Ciencias Veterinarias y Pecuarias, Departamento de Medicina Preventiva Animal, Universidad de Chile, Santiago, Chile
| | - Víctor Neira
- Facultad de Ciencias Veterinarias y Pecuarias, Departamento de Medicina Preventiva Animal, Universidad de Chile, Santiago, Chile
| | - Consuelo Borie
- Facultad de Ciencias Veterinarias y Pecuarias, Departamento de Medicina Preventiva Animal, Universidad de Chile, Santiago, Chile
| | - Lisette Lapierre
- Facultad de Ciencias Veterinarias y Pecuarias, Departamento de Medicina Preventiva Animal, Universidad de Chile, Santiago, Chile
| | - Paulina López
- Facultad de Ciencias Veterinarias y Pecuarias, Departamento de Medicina Preventiva Animal, Universidad de Chile, Santiago, Chile
| | - Lucas Venegas
- Facultad de Ciencias Veterinarias y Pecuarias, Departamento de Medicina Preventiva Animal, Universidad de Chile, Santiago, Chile
| | - Phillip Dettleff
- Laboratorio FAVET-INBIOGEN, Facultad de Ciencias Veterinarias y Pecuarias, Departamento de Fomento de la Producción Animal, Universidad de Chile, Santiago, Chile.,Escuela de Medicina Veterinaria, Facultad de Recursos Naturales y Medicina Veterinaria, Universidad Santo Tomás, Santiago, Chile
| | - Timothy Johnson
- Department of Veterinary and Biomedical Sciences, College of Veterinary Medicine, University of Minnesota, MI, USA
| | - Danny Fuentes-Castillo
- Faculdade de Medicina Veterinária e Zootecnia, Departamento de Patología, Universidade de São Paulo, São Paulo, Brazil
| | - Nilton Lincopan
- Departamento de Microbiología, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Nicolás Galarce
- Facultad de Ciencias Veterinarias y Pecuarias, Departamento de Medicina Preventiva Animal, Universidad de Chile, Santiago, Chile
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Patel RA, Hall DA, Eichenseer S, Bailey M. Movement Disorders and Hematologic Diseases. Mov Disord Clin Pract 2021; 8:193-207. [PMID: 33553488 DOI: 10.1002/mdc3.13129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/27/2020] [Accepted: 11/13/2020] [Indexed: 11/11/2022] Open
Abstract
Background Movement disorders can be associated with or caused by hematological abnormalities. The objective of this review is to highlight features that will aid in the clinician's recognition and treatment of these disorders. Methods MESH terms relevant to movement disorders and hematologic diseases were searched to identify conditions included in this narrative, educational review. Results Several conditions were identified, and they were organized by hematologic categories to include red blood cell abnormalities, white blood cell abnormalities, disorders of clotting and bleeding, hematologic malignancies, and others. Conclusions This review will increase providers' understanding of disorders that include movement disorders and hematologic abnormalities. Basic hematologic laboratories can aid in assessment of these disorders, to include complete blood count/hemogram and peripheral blood smear. Recognition is key, especially in the setting of underlying malignancy, vitamin deficiency, or other disorder in which treatment is available.
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Affiliation(s)
- Roshni Abee Patel
- Department of Neurological Sciences Rush University Medical Center Chicago Illinois USA
| | - Deborah A Hall
- Department of Neurological Sciences Rush University Medical Center Chicago Illinois USA
| | - Sheila Eichenseer
- Department of Neurology Medical College of Wisconsin Milwaukee Wisconsin USA
| | - Meagan Bailey
- Department of Neurological Sciences Rush University Medical Center Chicago Illinois USA
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41
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Golomidova AK, Efimov AD, Kulikov EE, Kuznetsov AS, Belalov IS, Letarov AV. O antigen restricts lysogenization of non-O157 Escherichia coli strains by Stx-converting bacteriophage phi24B. Sci Rep 2021; 11:3035. [PMID: 33542282 PMCID: PMC7862636 DOI: 10.1038/s41598-021-82422-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 01/18/2021] [Indexed: 11/23/2022] Open
Abstract
Acquisition of new prophages that are able to increase the bacterial fitness by the lysogenic conversion is believed to be an important strategy of bacterial adaptation to the changing environment. However, in contrast to the factors determining the range of bacteriophage lytic activity, little is known about the factors that define the lysogenization host range. Bacteriophage phi24B is the paradigmal model of Stx-converting phages, encoding the toxins of the Shiga-toxigenic E. coli (STEC). This virus has been shown to lysogenize a wide range of E. coli strains that is much broader than the range of the strains supporting its lytic growth. Therefore, phages produced by the STEC population colonizing the small or large intestine are potentially able to lysogenize symbiotic E. coli in the hindgut, and these secondary lysogens may contribute to the overall patient toxic load and to lead to the emergence of new pathogenic STEC strains. We demonstrate, however, that O antigen effectively limit the lysogenization of the wild E. coli strains by phi24B phage. The lysogens are formed from the spontaneous rough mutants and therefore have increased sensitivity to other bacteriophages and to the bactericidal activity of the serum if compared to their respective parental strains.
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Affiliation(s)
- A K Golomidova
- Winogradsky Institute of Microbiology, RC Biotechnology RAS, Prospekt 60-letiya Oktyabrya 7 bld. 2, Moscow, Russia, 117312
| | - A D Efimov
- Winogradsky Institute of Microbiology, RC Biotechnology RAS, Prospekt 60-letiya Oktyabrya 7 bld. 2, Moscow, Russia, 117312
| | - E E Kulikov
- Winogradsky Institute of Microbiology, RC Biotechnology RAS, Prospekt 60-letiya Oktyabrya 7 bld. 2, Moscow, Russia, 117312.,Phystech School of Biological and Medical Physics, Moscow Institute of Physics and Technology, Moscow, Russia
| | - A S Kuznetsov
- Winogradsky Institute of Microbiology, RC Biotechnology RAS, Prospekt 60-letiya Oktyabrya 7 bld. 2, Moscow, Russia, 117312.,Faculty of Biology, Lomonosov Moscow State University, Moscow, Russia
| | - I Sh Belalov
- Winogradsky Institute of Microbiology, RC Biotechnology RAS, Prospekt 60-letiya Oktyabrya 7 bld. 2, Moscow, Russia, 117312
| | - A V Letarov
- Winogradsky Institute of Microbiology, RC Biotechnology RAS, Prospekt 60-letiya Oktyabrya 7 bld. 2, Moscow, Russia, 117312. .,Faculty of Biology, Lomonosov Moscow State University, Moscow, Russia.
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Szymczak-Kulus K, Weidler S, Bereznicka A, Mikolajczyk K, Kaczmarek R, Bednarz B, Zhang T, Urbaniak A, Olczak M, Park EY, Majorczyk E, Kapczynska K, Lukasiewicz J, Wuhrer M, Unverzagt C, Czerwinski M. Human Gb3/CD77 synthase produces P1 glycotope-capped N-glycans, which mediate Shiga toxin 1 but not Shiga toxin 2 cell entry. J Biol Chem 2021; 296:100299. [PMID: 33460651 PMCID: PMC7949097 DOI: 10.1016/j.jbc.2021.100299] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 12/15/2022] Open
Abstract
The human Gb3/CD77 synthase, encoded by the A4GALT gene, is an unusually promiscuous glycosyltransferase. It synthesizes the Galα1→4Gal linkage on two different glycosphingolipids (GSLs), producing globotriaosylceramide (Gb3, CD77, Pk) and the P1 antigen. Gb3 is the major receptor for Shiga toxins (Stxs) produced by enterohemorrhagic Escherichia coli. A single amino acid substitution (p.Q211E) ramps up the enzyme's promiscuity, rendering it able to attach Gal both to another Gal residue and to GalNAc, giving rise to NOR1 and NOR2 GSLs. Human Gb3/CD77 synthase was long believed to transfer Gal only to GSL acceptors, therefore its GSL products were, by default, considered the only human Stx receptors. Here, using soluble, recombinant human Gb3/CD77 synthase and p.Q211E mutein, we demonstrate that both enzymes can synthesize the P1 glycotope (terminal Galα1→4Galβ1→4GlcNAc-R) on a complex type N-glycan and a synthetic N-glycoprotein (saposin D). Moreover, by transfection of CHO-Lec2 cells with vectors encoding human Gb3/CD77 synthase and its p.Q211E mutein, we demonstrate that both enzymes produce P1 glycotopes on N-glycoproteins, with the mutein exhibiting elevated activity. These P1-terminated N-glycoproteins are recognized by Stx1 but not Stx2 B subunits. Finally, cytotoxicity assays show that Stx1 can use P1 N-glycoproteins produced in CHO-Lec2 cells as functional receptors. We conclude that Stx1 can recognize and use P1 N-glycoproteins in addition to its canonical GSL receptors to enter and kill the cells, while Stx2 can use GSLs only. Collectively, these results may have important implications for our understanding of the Shiga toxin pathology.
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Affiliation(s)
- Katarzyna Szymczak-Kulus
- Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland
| | - Sascha Weidler
- Department of Bioorganic Chemistry, University of Bayreuth, Bayreuth, Germany
| | - Anna Bereznicka
- Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland
| | - Krzysztof Mikolajczyk
- Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland
| | - Radoslaw Kaczmarek
- Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland
| | - Bartosz Bednarz
- Laboratory of Molecular Biology of Microorganisms, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland
| | - Tao Zhang
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Anna Urbaniak
- Department of Biochemistry and Molecular Biology, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Mariusz Olczak
- Department of Biochemistry, Faculty of Biotechnology, University of Wroclaw, Wroclaw, Poland
| | - Enoch Y Park
- Laboratory of Biotechnology, Shizuoka University, Shizuoka, Japan
| | - Edyta Majorczyk
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
| | - Katarzyna Kapczynska
- Laboratory of Medical Microbiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland
| | - Jolanta Lukasiewicz
- Laboratory of Microbial Immunochemistry and Vaccines, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Carlo Unverzagt
- Department of Bioorganic Chemistry, University of Bayreuth, Bayreuth, Germany
| | - Marcin Czerwinski
- Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland.
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Markic J, Polic B, Kovacevic T, Rogulj M, Ardalic TC. Pediatric Pneumococcal Hemolytic Uremic Syndrome Treated with Sequence Tandem Therapeutic Plasma Exchange and Continuous Venovenous Hemodiafiltration: A Case Report. JOURNAL OF CHILD SCIENCE 2020. [DOI: 10.1055/s-0040-1721450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractHemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Approximately 5% of HUS cases are associated with Streptococcus pneumoniae infections (pHUS). Treatment includes supportive care with appropriate antimicrobial therapy, fluid and blood product resuscitation, and renal replacement therapy. We presented a case of a 22-month-old previously healthy girl, who was hospitalized at University Hospital of Split. Left-sided pneumonia and sepsis caused by S. pneumoniae were confirmed. The course of illness was complicated with development of pHUS. Since the pathogenesis of pHUS is only partially understood, the treatment remains controversial. Our patient was successfully treated with daily sequence tandem continuous venovenous hemodiafiltration and therapeutic plasma exchange with albumins, along with other supportive measures. Therefore, in our opinion, plasmapheresis should be considered as a part of standard treatment of children with pHUS. Additionally, the incidence of pHUS appears to be increasing. S. pneumoniae is a particularly important among pediatric pathogens and it can cause wide spectrum of illnesses. Therefore, due to the significant burden of invasive pneumococcal disease, pneumococcal vaccination should be encouraged.
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Affiliation(s)
- Josko Markic
- Department of Pediatrics, University Hospital of Split, Split, Croatia
- Department of Pediatrics, University of Split School of Medicine, Split, Croatia
| | - Branka Polic
- Department of Pediatrics, University Hospital of Split, Split, Croatia
- Department of Pediatrics, University of Split School of Medicine, Split, Croatia
| | - Tanja Kovacevic
- Department of Pediatrics, University Hospital of Split, Split, Croatia
| | - Marijana Rogulj
- Department of Pediatrics, University Hospital of Split, Split, Croatia
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44
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Abdelrahman A, Nada A, Park E, Humera A. Neurological involvement and MRI brain findings in an adult with hemolytic uremic syndrome: A case report. Radiol Case Rep 2020; 15:2056-2058. [PMID: 32944099 PMCID: PMC7481498 DOI: 10.1016/j.radcr.2020.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/09/2020] [Accepted: 08/13/2020] [Indexed: 11/30/2022] Open
Abstract
Hemolytic uremic syndrome is a frequent complication of shiga toxin producing Escherichia coli in pediatric population. It rarely affects adults with extremely rare neurological manifestation. We present a case of hemolytic uremic syndrome in a 64-year-old male who presented with a bloody diarrhea 30 minutes after eating an expired meat sandwich. Shiga-toxin producing Escherichia coli O157:H7 was confirmed as the causative agent. The patient developed neurological manifestations with persistent encephalopathy that ultimately leads to his death after 22 days of hospitalization. Magnetic resonance imaging findings was significant for signal changes in the thalami, tectum, insulae, and central pons, impressive of hemolytic uremic syndrome.
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Key Words
- ADC, Apparent diffusion coefficient
- CNS, Central nervous system
- CT, Computed tomography
- DWI, Diffusion weighted imaging
- E. Coli, Escherichia coli
- EHEC, Enterohemorrhagic Escherichia Coli
- FLAIR, Fluid attenuated inversion recovery
- GCS, Glasgow coma scale
- HUS, Hemolytic Uremic Syndrome
- Hemolytic uremic syndrome
- IV, Intravenous
- MRI
- MRI, Magnetic resonance imaging
- NICU, Neurological intensive care unit
- Neurological complications
- STEC, Shiga toxin producing E. Coli
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Affiliation(s)
- A Abdelrahman
- Department of Radiology, University of Missouri, 3500 S Scott Blvd, Apt 5, Columbia, MO 65203, USA
| | - A Nada
- Department of Radiology, University of Missouri, 3500 S Scott Blvd, Apt 5, Columbia, MO 65203, USA
| | - E Park
- Department of Radiology, University of Missouri, 3500 S Scott Blvd, Apt 5, Columbia, MO 65203, USA
| | - A Humera
- Department of Radiology, University of Missouri, 3500 S Scott Blvd, Apt 5, Columbia, MO 65203, USA
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45
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Gholizad-Kolveiri S, Hooman N, Alizadeh R, Hoseini R, Otukesh H, Talebi S, Akouchekian M. Whole exome sequencing revealed a novel homozygous variant in the DGKE catalytic domain: a case report of familial hemolytic uremic syndrome. BMC MEDICAL GENETICS 2020; 21:169. [PMID: 32838746 PMCID: PMC7446132 DOI: 10.1186/s12881-020-01097-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 07/28/2020] [Indexed: 11/13/2022]
Abstract
Background Atypical hemolytic uremic syndrome (aHUS) is a rare disease characterized by microangiopathic hemolytic anemia caused by small vessel thrombosis, thrombocytopenia, and renal failure. The common cause of aHUS is a dysregulation in the alternative complement pathway. Mutations in none complement genes such as diacylglycerol kinase epsilon (DGKE) can also result in this syndrome. Case presentation Here, we report on a 19-year-old female with the clinical diagnosis of aHUS, who has unaffected consanguineous parents and an older sibling who was deceased from aHUS when she was seven months old. We performed whole exome sequencing (WES) followed by evaluation of detected variants for functional significance, using several online prediction tools. Next, in order to confirm the detected pathogenic variant in proband and segregation analysis in her family, Sanger sequencing was done. The novel variant was analyzed in terms of its impact on the protein 3-dimensional structure by computational structural modeling. The results revealed that the proband carried a novel homozygous missense variant in DGKE located in exon 6 of the gene (NM_003647.3, c.942C > G [p.Asn314Lys]), and in silico analysis anticipated it as damaging. Protein computational study confirmed the influence of potential pathogenic variant on structural stability and protein function. Conclusion We suggest that some variations in the catalytic domain of DGKE like p.Asn314Lys which can cause alterations in secondary and 3-D structure of protein, might lead to aHUS.
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Affiliation(s)
- Soraya Gholizad-Kolveiri
- Department of Medical Genetics and Molecular Biology, school of medicine, Iran University of Medical Sciences, P.O.Box: 1449614525, Tehran, Iran
| | - Nakysa Hooman
- Department of Pediatric Nephrology, Ali-Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Rasoul Alizadeh
- Department of Medical Genetics and Molecular Biology, school of medicine, Iran University of Medical Sciences, P.O.Box: 1449614525, Tehran, Iran
| | - Rozita Hoseini
- Department of Pediatric Nephrology, Ali-Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Otukesh
- Department of Pediatric Nephrology, Ali-Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Talebi
- Department of Medical Genetics and Molecular Biology, school of medicine, Iran University of Medical Sciences, P.O.Box: 1449614525, Tehran, Iran.
| | - Mansoureh Akouchekian
- Department of Medical Genetics and Molecular Biology, school of medicine, Iran University of Medical Sciences, P.O.Box: 1449614525, Tehran, Iran.
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46
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Al-Ahmad M, Kharita L, Wannous H. Atypical hemolytic uremic syndrome with peripheral gangrene and homocysteinemia in a child. Oxf Med Case Reports 2020; 2020:omaa048. [PMID: 32728451 PMCID: PMC7376982 DOI: 10.1093/omcr/omaa048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/05/2020] [Accepted: 05/29/2020] [Indexed: 11/12/2022] Open
Abstract
Atypical hemolytic uremic syndrome (aHUS) is a rare, progressive, life-threating disease that frequently has a genetic component; it is usually caused by familial, sporadic or idiopathic reasons. We report a case of aHUS in a 21-month-old girl with coexisting of methylenetetrahydrofolate reductase mutations, homocysteinemia and thalassemia minor complicated by peripheral gangrene as extrarenal manifestation.
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Affiliation(s)
| | - Lubna Kharita
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Hala Wannous
- Faculty of Medicine, Damascus University, Damascus, Syria.,Department of Pediatric Nephrology, Damascus University, Children's Hospital, Damascus, Syria
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47
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Galarce N, Sánchez F, Fuenzalida V, Ramos R, Escobar B, Lapierre L, Paredes-Osses E, Arriagada G, Alegría-Morán R, Lincopán N, Fuentes-Castillo D, Vera-Leiva A, González-Rocha G, Bello-Toledo H, Borie C. Phenotypic and Genotypic Antimicrobial Resistance in Non-O157 Shiga Toxin-Producing Escherichia coli Isolated From Cattle and Swine in Chile. Front Vet Sci 2020; 7:367. [PMID: 32754621 PMCID: PMC7365902 DOI: 10.3389/fvets.2020.00367] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/27/2020] [Indexed: 01/09/2023] Open
Abstract
Non-O157 Shiga toxin-producing Escherichia coli (STEC) is a zoonotic pathogen that causes bloody diarrhea and hemolytic-uremic syndrome in humans, and a major cause of foodborne disease. Despite antibiotic treatment of STEC infections in humans is not recommended, the presence of antimicrobial-resistant bacteria in animals and food constitutes a risk to public health, as the pool of genes from which pathogenic bacteria can acquire antibiotic resistance has increased. Additionally, in Chile there is no information on the antimicrobial resistance of this pathogen in livestock. Thus, the aim of this study was to characterize the phenotypic and genotypic antimicrobial resistance of STEC strains isolated from cattle and swine in the Metropolitan region, Chile, to contribute relevant data to antimicrobial resistance surveillance programs at national and international level. We assessed the minimal inhibitory concentration of 18 antimicrobials, and the distribution of 12 antimicrobial resistance genes and class 1 and 2 integrons in 54 STEC strains. All strains were phenotypically resistant to at least one antimicrobial drug, with a 100% of resistance to cefalexin, followed by colistin (81.5%), chloramphenicol (14.8%), ampicillin and enrofloxacin (5.6% each), doxycycline (3.7%), and cefovecin (1.9%). Most detected antibiotic resistance genes were dfrA1 and tetA (100%), followed by tetB (94.4%), blaTEM−1 (90.7%), aac(6)-Ib (88.9%), blaAmpC (81.5%), cat1 (61.1%), and aac(3)-IIa (11.1%). Integrons were detected only in strains of swine origin. Therefore, this study provides further evidence that non-O157 STEC strains present in livestock in the Metropolitan region of Chile exhibit phenotypic and genotypic resistance against antimicrobials that are critical for human and veterinary medicine, representing a major threat for public health. Additionally, these strains could have a competitive advantage in the presence of antimicrobial selective pressure, leading to an increase in food contamination. This study highlights the need for coordinated local and global actions regarding the use of antimicrobials in animal food production.
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Affiliation(s)
- Nicolás Galarce
- Departamento de Medicina Preventiva Animal, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago, Chile
| | - Fernando Sánchez
- Departamento de Medicina Preventiva Animal, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago, Chile
| | - Verónica Fuenzalida
- Departamento de Medicina Preventiva Animal, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago, Chile
| | - Romina Ramos
- Departamento de Medicina Preventiva Animal, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago, Chile
| | - Beatriz Escobar
- Departamento de Medicina Preventiva Animal, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago, Chile
| | - Lisette Lapierre
- Departamento de Medicina Preventiva Animal, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago, Chile
| | - Esteban Paredes-Osses
- Departamento de Salud Ambiental, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Gabriel Arriagada
- Instituto de Ciencias Agroalimentarias, Animales y Ambientales, Universidad de O'Higgins, San Fernando, Chile
| | - Raúl Alegría-Morán
- Departamento de Medicina Preventiva Animal, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago, Chile.,Facultad de Ciencias Agropecuarias, Universidad Pedro de Valdivia, Santiago, Chile
| | - Nilton Lincopán
- Departamento de Microbiología, Instituto de Ciências Biomedicas, Universidade de São Paulo, São Paulo, Brazil
| | - Danny Fuentes-Castillo
- Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, Brazil
| | - Alejandra Vera-Leiva
- Laboratorio de Investigación en Agentes Antibacterianos, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
| | - Gerardo González-Rocha
- Laboratorio de Investigación en Agentes Antibacterianos, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile.,Millenium Nucleus on Interdisciplinary Approach to Antimicrobial Resistance, Santiago, Chile
| | - Helia Bello-Toledo
- Laboratorio de Investigación en Agentes Antibacterianos, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile.,Millenium Nucleus on Interdisciplinary Approach to Antimicrobial Resistance, Santiago, Chile
| | - Consuelo Borie
- Departamento de Medicina Preventiva Animal, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago, Chile
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48
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Valid Presumption of Shiga Toxin-Mediated Damage of Developing Erythrocytes in EHEC-Associated Hemolytic Uremic Syndrome. Toxins (Basel) 2020; 12:toxins12060373. [PMID: 32512916 PMCID: PMC7354503 DOI: 10.3390/toxins12060373] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023] Open
Abstract
The global emergence of clinical diseases caused by enterohemorrhagic Escherichia coli (EHEC) is an issue of great concern. EHEC release Shiga toxins (Stxs) as their key virulence factors, and investigations on the cell-damaging mechanisms toward target cells are inevitable for the development of novel mitigation strategies. Stx-mediated hemolytic uremic syndrome (HUS), characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal injury, is the most severe outcome of an EHEC infection. Hemolytic anemia during HUS is defined as the loss of erythrocytes by mechanical disruption when passing through narrowed microvessels. The formation of thrombi in the microvasculature is considered an indirect effect of Stx-mediated injury mainly of the renal microvascular endothelial cells, resulting in obstructions of vessels. In this review, we summarize and discuss recent data providing evidence that HUS-associated hemolytic anemia may arise not only from intravascular rupture of erythrocytes, but also from the extravascular impairment of erythropoiesis, the development of red blood cells in the bone marrow, via direct Stx-mediated damage of maturing erythrocytes, leading to “non-hemolytic” anemia.
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49
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Hummel K, Glotzbach K, Menon S, Griffiths E, Lal AK. Thrombotic microangiopathy following heart transplant in pediatric Danon disease. Pediatr Transplant 2020; 24:e13669. [PMID: 32067323 DOI: 10.1111/petr.13669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/16/2020] [Indexed: 11/28/2022]
Abstract
This case describes an uncommon acute complication of diffuse thrombotic angiopathy and associated aHUS/TTP in an 11-year-old girl with Danon disease who underwent orthotopic heart transplant. Shortly after transplant, despite an uncomplicated operative course, the patient developed severe kidney injury and progressive altered mental status, culminating in cerebral edema, brain herniation, and death. She had received a single dose of tacrolimus (FK506) and a single dose of antithymocyte globulin. Sources of progressive somnolence, including oversedation from impaired renal clearance of opiates, and severe myopathy as has been previously described in Danon disease, were ruled out, and the patient continued to decline. Initial brain CT scan early after transplant showed no signs of cerebral edema, but repeat CT indicated severe cerebral edema. Based on autopsy, diffuse thrombotic angiopathy, with signs of hemolytic anemia with schistocytes, was likely responsible for her deterioration in the broader condition of aHUS/TTP.
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Affiliation(s)
- Kevin Hummel
- Division of Pediatric Critical Care Medicine, University of Utah, Salt Lake City, Utah.,Intermountain Healthcare Primary Children's Hospital, Salt Lake City, Utah
| | - Kristi Glotzbach
- Division of Pediatric Critical Care Medicine, University of Utah, Salt Lake City, Utah.,Intermountain Healthcare Primary Children's Hospital, Salt Lake City, Utah
| | - Shaji Menon
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah.,Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Eric Griffiths
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Ashwin K Lal
- Intermountain Healthcare Primary Children's Hospital, Salt Lake City, Utah.,Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah
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50
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Manrique-Caballero CL, Peerapornratana S, Formeck C, Del Rio-Pertuz G, Gomez Danies H, Kellum JA. Typical and Atypical Hemolytic Uremic Syndrome in the Critically Ill. Crit Care Clin 2020; 36:333-356. [PMID: 32172817 DOI: 10.1016/j.ccc.2019.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Hemolytic uremic syndrome is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, and hemolytic uremic syndrome have a similar clinical presentation. Diagnostic needs to be prompt to decrease mortality, because identifying the different disorders can help to tailor specific, effective therapies. However, diagnosis is challenging and morbidity and mortality remain high, especially in the critically ill population. Development of clinical prediction scores and rapid diagnostic tests for hemolytic uremic syndrome based on mechanistic knowledge are needed to facilitate early diagnosis and assign timely specific treatments to patients with hemolytic uremic syndrome variants.
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Affiliation(s)
- Carlos L Manrique-Caballero
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3347 Forbes Avenue Suite 220, Pittsburgh, PA 15213, USA; The CRISMA (Clinical Research, Investigation and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, Scaife Hall, Suite 600, Pittsburgh, PA 15213, USA
| | - Sadudee Peerapornratana
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3347 Forbes Avenue Suite 220, Pittsburgh, PA 15213, USA; The CRISMA (Clinical Research, Investigation and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, Scaife Hall, Suite 600, Pittsburgh, PA 15213, USA; Excellence Center for Critical Care Nephrology, Division of Nephrology, Department of Medicine, Chulalongkorn University, 1873 Rama 4 Road, Pathumwan, Bangkok 10330, Thailand; Department of Laboratory Medicine, Chulalongkorn University, 1873 Rama 4 Road, Pathumwan, Bangkok 10330, Thailand
| | - Cassandra Formeck
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3347 Forbes Avenue Suite 220, Pittsburgh, PA 15213, USA; The CRISMA (Clinical Research, Investigation and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, Scaife Hall, Suite 600, Pittsburgh, PA 15213, USA; Department of Nephrology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Floor 3, Pittsburgh, PA 15224, USA
| | - Gaspar Del Rio-Pertuz
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3347 Forbes Avenue Suite 220, Pittsburgh, PA 15213, USA; The CRISMA (Clinical Research, Investigation and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, Scaife Hall, Suite 600, Pittsburgh, PA 15213, USA
| | - Hernando Gomez Danies
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3347 Forbes Avenue Suite 220, Pittsburgh, PA 15213, USA; The CRISMA (Clinical Research, Investigation and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, Scaife Hall, Suite 600, Pittsburgh, PA 15213, USA
| | - John A Kellum
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3347 Forbes Avenue Suite 220, Pittsburgh, PA 15213, USA; The CRISMA (Clinical Research, Investigation and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, Scaife Hall, Suite 600, Pittsburgh, PA 15213, USA.
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