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Hamza A, El-Sissy C, Yousfi N, Martins PV, Rafat C, Masliah-Planchon J, Frémeaux-Bacchi V, Mesnard L. The absence of CFHR3 and CFHR1 genes from the T2T-CHM13 assembly can limit the molecular diagnosis of complement-related diseases. Eur J Hum Genet 2023; 31:730-732. [PMID: 37032353 PMCID: PMC10325998 DOI: 10.1038/s41431-023-01350-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 04/11/2023] Open
Affiliation(s)
- Abderaouf Hamza
- Department of Genetics, Institut Curie, PSL Research University, Paris, France
| | - Carine El-Sissy
- Department of Biological Immunology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nadhir Yousfi
- Unité Mixte de Recherche S1155, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Paula Vieira Martins
- Department of Biological Immunology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cédric Rafat
- Service de Soins Intensifs Néphrologiques et Rein Aigu (SINRA), French Intensive Renal Network, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Sorbonne Université, Paris, France
| | | | - Véronique Frémeaux-Bacchi
- Department of Biological Immunology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Unité Mixte de Recherche S1138, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche des Cordeliers, Paris, France
| | - Laurent Mesnard
- Unité Mixte de Recherche S1155, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.
- Service de Soins Intensifs Néphrologiques et Rein Aigu (SINRA), French Intensive Renal Network, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France.
- Faculté de Médecine, Sorbonne Université, Paris, France.
- Institut des Sciences du Calcul et des Données, Sorbonne Université, Paris, France.
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Den Ouden A, Greig DR, Rodwell EV, Tripodo F, Olonade I, Swift C, Jenkins C. Escherichia coli encoding Shiga toxin subtype Stx2f causing human infections in England, 2015-2022. J Med Microbiol 2023; 72. [PMID: 37294302 DOI: 10.1099/jmm.0.001707] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Introduction. Shiga toxin-producing Escherichia coli (STEC) belong to a diverse group of gastrointestinal pathogens defined by the presence of Shiga toxin genes (stx) of which there are at least ten subtypes (Stx1a-Stx1d and Stx2a-Stx2g).Gap Statement. Initially thought to be associated with mild symptoms, more recently STEC encoding stx2f have been isolated from cases of haemolytic uraemic syndrome (HUS) and the clinical significance and public health burden require further investigation.Aim. We analysed clinical outcomes and genome-sequencing data linked to patients infected with STEC encoding-stx2f in England to assess the risk to public health.Methodology. One hundred and twelve E. coli (n=58 isolates encoded stx2f; n=54 isolates E. coli belonging to CC122 or CC722 that had eae but were negative for stx) isolated from patients' faecal specimens between 2015 and 2022 were genome sequenced and linked to epidemiological and clinical outcome data. All isolates were investigated for the presence of virulence genes and a maximum-likelihood phylogeny of isolates belonging to CC122 and CC722 was constructed.Results. There were 52 cases infected with STEC harbouring stx2f between 2015 and 2022, with the majority identified in 2022. Most cases resided in the North of England (n=39/52, 75 %), were female (n=31, 59.6 %) and/or aged five and under (n=29, 55.8 %). Clinical outcome data were available for 40/52 cases (76.9 %) and 7/40(17.5 %) were diagnosed with STEC-HUS. In the two most common clonal complexes, CC122 and CC722, the presence of the stx2f-encoding prophage correlated with the presence of additional virulence genes, astA, bfpA and cdt, located on an 85kbp IncFIB plasmid.Conclusions. Certain serotypes of E. coli harbouring stx2f cause severe clinical outcomes, including STEC-HUS. Public health advice and possible interventions are limited, as little is known about the animal and environmental reservoirs and transmission routes. We recommend more comprehensive and standardized collection of microbiological and epidemiological data, and routine sharing of sequencing data between public health agencies worldwide.
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Affiliation(s)
- Anouschka Den Ouden
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK
| | - David R Greig
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK
- NIHR HPRU in Gastrointestinal Infections at University of Liverpool, Liverpool, UK
| | - Ella V Rodwell
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK
- NIHR HPRU in Gastrointestinal Infections at University of Liverpool, Liverpool, UK
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Francesco Tripodo
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK
| | - Israel Olonade
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK
| | - Craig Swift
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK
| | - Claire Jenkins
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK
- NIHR HPRU in Gastrointestinal Infections at University of Liverpool, Liverpool, UK
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Kiss C, Kotsanas D, Francis MJ, Sait M, Valcanis M, Lacey J, Connelly K, Rogers B, Ballard SA, Howden BP, Graham M. Molecular epidemiology, clinical features and significance of Shiga toxin detection from routine testing of gastroenteritis specimens. Pathology 2023:S0031-3025(23)00119-8. [PMID: 37271611 DOI: 10.1016/j.pathol.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/20/2023] [Accepted: 03/07/2023] [Indexed: 06/06/2023]
Abstract
After introduction of faecal multiplex PCR that includes targets for stx1 and stx2 genes, we found stx genes were detected in 120 specimens from 111 patients over a 31-month period from 2018-2020 from a total of 14,179 separate tests performed. The proportion of stx1 only vs stx2 only vs stx1 and stx2 was 35%, 22% and 42%, respectively. There were 54 specimens which were culture positive, with 33 different serotypes identified, the predominant serotype being O157:H7 (19%). Eighty-two patients had clinical data available; we found a high rate of fever (35%), bloody diarrhoea (34%), acute kidney injury (27%), hospital admission (80%) and detection of faecal co-pathogens (23%). Only one patient developed haemolytic uraemic syndrome. We found no significant association with stx genotype and any particular symptom or complication. We found a significant association of serotypes O157:H7 and O26:H11 with bloody stool, but no significant association with any other symptom or complication.
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Affiliation(s)
- Christopher Kiss
- Department of Microbiology, Monash Health, Clayton, Vic, Australia.
| | - Despina Kotsanas
- Monash Infectious Diseases, Monash Health, Clayton, Vic, Australia
| | | | - Michelle Sait
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - Mary Valcanis
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - Jake Lacey
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - Kathryn Connelly
- Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Vic, Australia; Monash University School of Clinical Sciences, Monash Health, Clayton, Vic, Australia
| | - Benjamin Rogers
- Monash Infectious Diseases, Monash Health, Clayton, Vic, Australia; Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Vic, Australia
| | - Susan A Ballard
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - Maryza Graham
- Department of Microbiology, Monash Health, Clayton, Vic, Australia; Monash Infectious Diseases, Monash Health, Clayton, Vic, Australia; Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Vic, Australia
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4
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Rodwell EV, Simpson A, Chan YW, Godbole G, McCarthy ND, Jenkins C. The epidemiology of Shiga toxin-producing Escherichia coli O26:H11 (clonal complex 29) in England, 2014-2021. J Infect 2023; 86:552-562. [PMID: 37060924 DOI: 10.1016/j.jinf.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 04/17/2023]
Abstract
OBJECTIVES We aimed to describe the genomic epidemiology of the foodborne gastrointestinal pathogen, Shiga toxin-producing Escherichia coli (STEC) serotype O26:H11 belonging to clonal complex 29 (CC29) in England. METHODS Between 01 January 2014 and 31 December 2021, 834 human isolates belonging to CC29 were sequenced at the UK Health Security Agency, and the genomic data was integrated with epidemiological data. RESULTS Diagnoses of STEC O26:H11 in England have increased each year from 19 in 2014 to 144 in 2021. Most isolates had the Shiga toxin subtype profiles stx1a (47%), stx1a,stx2a (n=24%) or stx2a (n=28%). Most cases were female (57%), and the highest proportion of cases belonged to the 0-5 age group (38%). Clinical symptoms included diarrhoea (93%), blood-stained stool (48%), and abdominal pain (74%). Haemolytic Uraemic Syndrome (HUS) was diagnosed in 40/459 (9%) cases and three children died. All isolates causing STEC-HUS had stx2a either alone (n=33) or in combination with stx1a (n=7). CONCLUSIONS STEC O26:H11 are a clinically significant, emerging threat to public health in England. Determining the true incidence and prevalence is challenging due to inconsistent national surveillance strategies. Improved diagnostics and surveillance algorithms are required to monitor the true burden, detect outbreaks and to implement effective interventions.
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Affiliation(s)
- Ella V Rodwell
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK; Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK; NIHR HPRU in Gastrointestinal Infections at University of Liverpool, UK
| | - Alex Simpson
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK
| | - Yung-Wai Chan
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK
| | - Gauri Godbole
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK
| | - Noel D McCarthy
- NIHR HPRU in Gastrointestinal Infections at University of Liverpool, UK
| | - Claire Jenkins
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK; NIHR HPRU in Gastrointestinal Infections at University of Liverpool, UK
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5
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Wong W, Prestidge C, Dickens A, Ronaldson J. Diarrhoea-associated haemolytic uraemic syndrome and Shiga toxin-producing Escherichia coli infections in New Zealand children: Clinical features and short-term complications from a 23-year cohort study. J Paediatr Child Health 2023; 59:493-498. [PMID: 36655863 DOI: 10.1111/jpc.16332] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/26/2022] [Accepted: 01/08/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Diarrhoea-associated haemolytic uraemic syndrome (D+HUS) is an important cause of acute kidney injury (AKI) in young children and it is most commonly associated with Shiga toxin-producing Escherichia coli (STEC). Gastrointestinal infections caused by STEC have been increasing in New Zealand over the past two decades, but little is known regarding the acute and short-term outcomes of New Zealand children who develop D+HUS. AIM To describe the clinical characteristics, complications and short-term outcomes of New Zealand children with D+HUS identified between 1 January 1998 and 31 December 2020. METHODS The New Zealand Paediatric Surveillance Unit sends out a monthly survey to all practising paediatricians regarding conditions under active surveillance. Paediatricians caring for a child aged 0-15 years of age with D+HUS over the prior month were requested to report their patient. Reporting clinicians were then contacted by the principal investigator and sent a questionnaire requesting patient clinical and laboratory information. RESULTS Two hundred and twenty-six children had D+HUS; median age 2.8 years (interquartile range 1.7-4.9). Acute dialysis was required in 128/226 (56.2%) of children for a median of 9 days (range 1-38). Children with shorter diarrhoeal prodrome, higher neutrophil count and haemoglobin had a longer duration of dialysis. Seizures occurred in 31/226 (13.7%) and were not associated with a greater HUS severity score. Acute mortality was 1.3%, all resulting from thrombotic microangiopathic cerebral injury. CONCLUSION D+HUS is a major cause of AKI in previously healthy young children. Earlier recognition of STEC infections in young children may reduce the need for dialysis and other extra-renal complications. The New Zealand incidence of acute dialysis, other major complications and mortality are consistent with other reported studies.
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Affiliation(s)
- William Wong
- Department of Paediatric Nephrology, Starship Children's Health, Te Whatu Ora Auckland, Auckland, New Zealand
| | - Chanel Prestidge
- Department of Paediatric Nephrology, Starship Children's Health, Te Whatu Ora Auckland, Auckland, New Zealand
| | - Amanda Dickens
- Department of Paediatric Nephrology, Starship Children's Health, Te Whatu Ora Auckland, Auckland, New Zealand
| | - Jane Ronaldson
- Department of Paediatric Nephrology, Starship Children's Health, Te Whatu Ora Auckland, Auckland, New Zealand
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Abstract
Thrombotic microangiopathy (TMA) is characterized by thrombocytopenia, microangiopathic haemolytic anaemia and end organ damage. TMAs have varying underlying pathophysiology and can therefore present with an array of clinical presentations. Renal involvement is common as the kidney is particularly susceptible to the endothelial damage and microvascular occlusion. TMAs require rapid assessment, diagnosis, and commencement of appropriate treatment due to the high morbidity and mortality associated with them. Ground-breaking research into the pathogenesis of TMAs over the past 20 years has driven the successful development of targeted therapeutics revolutionizing patient outcomes. This review outlines the clinical presentations, pathogenesis, diagnostic tests and treatments for TMAs.
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Affiliation(s)
- Gemma L Thompson
- Complement Therapeutics Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,National Renal Complement Therapeutics Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - David Kavanagh
- Complement Therapeutics Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,National Renal Complement Therapeutics Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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7
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Rodwell EV, Vishram B, Smith R, Browning L, Smith-Palmer A, Allison L, Holmes A, Godbole G, McCarthy N, Dallman TJ, Jenkins C. Epidemiology and genomic analysis of Shiga toxin-producing Escherichia coli clonal complex 165 in the UK. J Med Microbiol 2021; 70. [PMID: 34919511 PMCID: PMC8744276 DOI: 10.1099/jmm.0.001471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Shiga toxin-producing Escherichia coli (STEC) is a zoonotic, foodborne gastrointestinal pathogen that has the potential to cause severe clinical outcomes, including haemolytic uraemic syndrome (HUS). STEC-HUS is the leading cause of renal failure in children and can be fatal. Over the last decade, STEC clonal complex 165 (CC165) has emerged as a cause of STEC-HUS.Gap Statement. There is a need to understand the pathogenicity and prevalence of this emerging STEC clonal complex in the UK, to facilitate early diagnosis, improve clinical management, and prevent and control outbreaks.Aim. The aim of this study was to characterize CC165 through identification of virulence factors (VFs) and antimicrobial resistance (AMR) determinants in the genome and to integrate the genome data with the available epidemiological data to better understand the incidence and pathogenicity of this clonal complex in the UK.Methodology. All isolates belonging to CC165 in the archives at the UK public health agencies were sequenced and serotyped, and the virulence gene and AMR profiles were derived from the genome using PHE bioinformatics pipelines and the Centre for Genomic Epidemiology virulence database.Results. There were 48 CC165 isolates, of which 43 were STEC, four were enteropathogenic E. coli (EPEC) and one E. coli. STEC serotypes were predominately O80:H2 (n=28), and other serotypes included O45:H2 (n=9), O55:H9 (n=4), O132:H2 (n=1) and O180:H2 (n=1). All but one STEC isolate had Shiga toxin (stx) subtype stx2a or stx2d and 47/48 isolates had the eae gene encoding intimin involved in the intimate attachment of the bacteria to the human gut mucosa. We detected extra-intestinal virulence genes including those associated with iron acquisition (iro) and serum resistance (iss), indicating that this pathogen has the potential to translocate to extra-intestinal sites. Unlike other STEC clonal complexes, a high proportion of isolates (93%, 40/43) were multidrug-resistant, including resistance to aminoglycosides, beta-lactams, chloramphenicol, sulphonamides, tetracyclines and trimethoprim.Conclusion. The clinical significance of this clonal complex should not be underestimated. Exhibiting high levels of AMR and a combination of STEC and extra-intestinal pathogenic E. coli (ExPEC) virulence profiles, this clonal complex is an emerging threat to public health.
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Affiliation(s)
- Ella V Rodwell
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5AT, UK.,Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,NIHR HPRU in Gastrointestinal Infections at University of Liverpool, Liverpool, UK
| | - Bhavita Vishram
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5AT, UK
| | - Robert Smith
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, Wales, UK
| | | | | | - Lesley Allison
- Scottish E. coli O157/STEC Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Anne Holmes
- Scottish E. coli O157/STEC Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Gauri Godbole
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5AT, UK
| | - Noel McCarthy
- NIHR HPRU in Gastrointestinal Infections at University of Liverpool, Liverpool, UK.,Public Health and Primary Care, Trinity College, Dublin, Ireland
| | - Timothy J Dallman
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5AT, UK.,NIHR HPRU in Gastrointestinal Infections at University of Liverpool, Liverpool, UK
| | - Claire Jenkins
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5AT, UK.,NIHR HPRU in Gastrointestinal Infections at University of Liverpool, Liverpool, UK
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Sandino-Pérez J, Gutiérrez E, Caravaca-Fontán F, Morales E, Aubert-Girbal L, Delgado-Lillo R, Praga M. Haemolytic uraemic syndrome associated with pancreatitis: report of four cases and review of the literature. Clin Kidney J 2021; 14:1946-1952. [PMID: 34345418 PMCID: PMC8323133 DOI: 10.1093/ckj/sfaa245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/19/2020] [Indexed: 01/05/2023] Open
Abstract
Background The incidence of acute kidney injury (AKI) in patients with acute pancreatitis ranges from 15% to 40% and is associated with poor prognosis. Haemolytic uraemic syndrome (HUS) in the setting of acute pancreatitis is an uncommon association with fewer than 30 cases reported in the literature. Methods A retrospective review of the clinical records at our institution between January 1981 and December 2019 was carried out to identify patients with acute pancreatitis and HUS. Additionally, a literature review was conducted on this topic. The aims of the study were to describe the clinical course and outcomes of patients affected by this condition. Results Four cases of HUS following an acute pancreatitis were identified. The mean (±SD) age of the study group was 30 ± 6 years, all of which were males. Excessive alcohol consumption was the main cause of acute pancreatitis in all four patients. HUS with progressive AKI developed in a median interval of 2 days from the onset of pancreatitis (range 1-3 days). All patients required kidney replacement therapy during the course of follow-up. A kidney biopsy was performed in two patients, showing typical thrombotic microangiopathic features. One case was treated with eculizumab, whereas the rest were treated with supportive care and/or plasma exchange. A normalization of haematological parameters and complete recovery of kidney function were observed in all patients at last follow-up, although this improvement was significantly faster in the patient treated with eculizumab. Conclusions HUS may infrequently develop in patients with acute pancreatitis. An early identification of this complication is mandatory, and complement blockade with eculizumab may be associated with a faster kidney function recovery.
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Affiliation(s)
| | | | | | - Enrique Morales
- Department of Nephrology, Hospital Universitario, Madrid, Spain
| | | | | | - Manuel Praga
- Department of Nephrology, Hospital Universitario, Madrid, Spain
- Department of Nephrology, Instituto de Investigación Hospital Universitario, Madrid, Spain
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Vishram B, Jenkins C, Greig DR, Godbole G, Carroll K, Balasegaram S, Byrne L. The emerging importance of Shiga toxin-producing Escherichia coli other than serogroup O157 in England. J Med Microbiol 2021; 70. [PMID: 34309502 PMCID: PMC8493422 DOI: 10.1099/jmm.0.001375] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction Shiga toxin-producing Escherichia coli (STEC) can cause severe disease and large outbreaks. In England, the incidence and clinical significance of STEC serogroups other than O157 (non-O157) is unknown due to a testing bias for detection of STEC O157. Since 2013, the implementation of PCR to detect all STEC serogroups by an increasing number of diagnostic laboratories has led to an increase in the detection of non-O157 STEC. Hypothesis/Gap statement Due to a bias in testing methodologies to select for STEC serogroup O157 in frontline diagnostic laboratories in most countries, very little surveillance data have been previously generated on non-O157 STEC. Aim Five years (2014–2018) of STEC national surveillance data were extracted and descriptive analysis undertaken to assess disease severity of non-O157 STEC strains. Methods Data from 1 January 2014 to 31 December 2018 were extracted from the National Enhanced Surveillance System for STEC and analysed. Results The implementation of Gastrointestinal Polymerase Chain Reaction (GI-PCR) has resulted in a four-fold increase in the detection of non-O157 STEC cases between 2014 and 2018. There were 2579 cases infected with 97 different non-O157 serogroups. The gender distribution was similar amongst STEC O157 and non-O157 STEC cases with 57 and 56 % of cases being female respectively, but a significantly higher proportion of cases (P <0.001) under 5 years of age was observed among STEC O157 (22 %) cases compared to non-O157 STEC (14 %). The most common non-O157 serogroups were O26 (16 %), O146 (11 %), O91 (10 %), O128 (7 %), O103 (5 %) and O117 (3 %). Overall, rates of bloody diarrhoea were highest in O26 (44 %) and O103 (48 %) cases and lowest in STEC O117 cases (17 %). Strains harbouring Shiga toxin stx1a caused the highest proportion of diarrhoea (93 %) and caused the same level of bloody diarrhoea as stx2a (39 %). However, stx2a caused the highest proportion of vomiting (46 %), hospitalisation (49 %) and considerably more HUS (29 %) than other stx profiles. Conclusion The implementation of PCR targeting stx at diagnostic laboratories has shown that non-O157 STEC, most notably STEC O26, are an emerging risk to public health.
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Affiliation(s)
- Bhavita Vishram
- National Infection Service, Public Health England, London, UK
| | - Claire Jenkins
- National Infection Service, Public Health England, London, UK
| | - David R Greig
- National Infection Service, Public Health England, London, UK.,Division of Infection and Immunity, The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, EH25 9RG, UK
| | - Gauri Godbole
- National Infection Service, Public Health England, London, UK
| | - Kevin Carroll
- PHE South East, Surrey and Sussex HPT, Parkside, Chart Way, Horsham RH12 1XA, UK
| | | | - Lisa Byrne
- National Infection Service, Public Health England, London, UK
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10
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Abstract
Thrombotic microangiopathy with renal dysfunction is a haematological and renal emergency warranting urgent diagnosis and intervention. As the potential underlying causes may be complex, assessment and management can be challenging for treating clinicians, and a timely and collaborative approach between general physicians, haematologists and nephrologists may be extremely helpful in order to optimise clinical outcomes. This paper will aim to build an understanding of different potential presentations of thrombotic microangiopathies and provide a practical framework for diagnosis and management, using a case-based discussion format, for acute and general physicians. Some aspects of subsequent specialist management are also discussed.
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Affiliation(s)
- Zay Htet
- Department of Renal Medicine, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK,
| | - Mahzuz Karim
- Department of Renal Medicine, Norfolk and Norwich University Hospital, Norwich, UK
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11
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Monet-Didailler C, Chevallier A, Godron-Dubrasquet A, Allard L, Delmas Y, Contin-Bordes C, Brissaud O, Llanas B, Harambat J. Outcome of children with Shiga toxin-associated haemolytic uraemic syndrome treated with eculizumab: a matched cohort study. Nephrol Dial Transplant 2021; 35:2147-2153. [PMID: 31411695 DOI: 10.1093/ndt/gfz158] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/27/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Treatment with eculizumab in Shiga toxin-associated haemolytic and uraemic syndrome (STEC-HUS) remains controversial despite its increasing utilization. The aim of our study was to evaluate the outcomes of children treated with eculizumab for STEC-HUS in a single-centre matched cohort study. METHODS Data were retrospectively collected from medical records of children diagnosed with STEC-HUS. The outcomes of patients treated with eculizumab for STEC-HUS were compared with those of a control group of untreated patients matched for age, sex and severity of acute kidney injury with a 1:2 matching scheme. RESULTS Eighteen children (median age 40.6 months) with STEC-HUS treated with eculizumab were compared with 36 matched control patients (median age 36.4 months) who did not receive eculizumab. All patients survived in the two groups. Within 1 month of HUS onset, the evolution of haematological and renal parameters did not differ between the two groups. At 12 months of follow-up, renal outcome was not significantly different between the two groups. At the last follow-up, the prevalence of decreased glomerular filtration rate in the eculizumab group (27%) was not statistically different from that in controls (38%), as was the prevalence of proteinuria and high blood pressure. Children who received eculizumab more often had extrarenal sequelae during follow-up. Eculizumab treatment appeared to be safe in children with STEC-HUS. CONCLUSION The benefit of eculizumab on renal and extrarenal outcomes in STEC-HUS could not be established based on our findings. However, efficacy and safety are not best assessed by the observational design and small sample size of our study. Randomized controlled trials are thus required to determine the efficacy of eculizumab in this indication.
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Affiliation(s)
- Catherine Monet-Didailler
- Service de Pédiatrie, Unité de Néphrologie, Centre de référence Maladies Rénales Rares du Sud-ouest, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Audrey Chevallier
- Service de Pédiatrie, Unité de Néphrologie, Centre de référence Maladies Rénales Rares du Sud-ouest, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Astrid Godron-Dubrasquet
- Service de Pédiatrie, Unité de Néphrologie, Centre de référence Maladies Rénales Rares du Sud-ouest, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Lise Allard
- Service de Pédiatrie, Unité de Néphrologie, Centre de référence Maladies Rénales Rares du Sud-ouest, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Yahsou Delmas
- Service de Néphrologie, Centre de référence Maladies Rénales Rares du Sud-ouest, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Cécile Contin-Bordes
- Laboratoire d'Immunologie et Immunogénétique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Olivier Brissaud
- Service de Réanimation Pédiatrique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Brigitte Llanas
- Service de Pédiatrie, Unité de Néphrologie, Centre de référence Maladies Rénales Rares du Sud-ouest, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Jérôme Harambat
- Service de Pédiatrie, Unité de Néphrologie, Centre de référence Maladies Rénales Rares du Sud-ouest, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Université de Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
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12
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Govindarajan S, Bhatia P, Dawman L, Tiewsoh K. Usefulness of automated fragmented red blood cell percentage in the diagnosis of paediatric haemolytic uraemic syndrome. Int J Lab Hematol 2020; 43:40-43. [PMID: 32851810 DOI: 10.1111/ijlh.13324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/21/2020] [Accepted: 08/05/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Presence of schistocytes in peripheral blood smear supporting haemolysis is important for diagnosis and decision-making in paediatric haemolytic uraemic syndrome (HUS). High observer dependency and requirement of expertise for peripheral smear evaluation propels us to think of other modalities to overcome these issues. We envisage that newer techniques like automated fragmented red blood cell percentage (FRC %), whose role has been described in transplant associated HUS and thrombotic thrombocytopenic purpura, can serve the purpose. METHODS Twenty-eight children with HUS after excluding secondary causes were enrolled in this study. Blood samples were analysed for FRC% at admission, using SYSMEX XN-1000 (Japan) haematology analyser, and simultaneously, schistocytes in peripheral smear were reported by a single expert haematopathologist. RESULTS Median age was 56 months ranging from 2 to 140 months. FRC% was elevated in 85.8% (n-24/28) with a mean of 4.56 ± 3.1%. FRC% had a sensitivity of 95.4% (C.I: 77.16% to 99.88%) in children who had FRC% >1.49% with an accuracy of 85.71% (C.I: 67.33% to 95.97%). However, specificity was only 50% (C.I: 11.81% to 88.19%) with a positive likelihood ratio of 1.91. Receiver-operator curve showed an AUC value of 0.841. CONCLUSION We suggest automated FRC% as a rapid and highly sensitive index for screening of paediatric HUS; however, a peripheral blood film examination is a must in cases with count >2% to avoid false positives as the index has low specificity.
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Affiliation(s)
| | - Prateek Bhatia
- Division of Paediatric Haematology and Oncology, Department of Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Lesa Dawman
- Division of Paediatric Nephrology, Department of Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Karalanglin Tiewsoh
- Division of Paediatric Nephrology, Department of Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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13
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Abstract
In this issue of Clinical Kidney Journal, Plasse et al. report on the use of high-dose aliskiren as an adjunct therapy in a patient treated with eculizumab for haemolytic uraemic syndrome (HUS). This follows the recent description of the complement factor 3 (C3) activating activity of the enzyme renin and the successful therapeutic use of the direct renin inhibitor aliskiren in three cases of C3 glomerulopathy/dense deposit disease. We discuss the potential clinical and pathophysiological implications of these reports on nephropathies linked to complement, from HUS to C3 glomerulopathy to immunoglobulin A nephropathy as well as the concept of dual complement inhibition for kidney disease.
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Affiliation(s)
- Maria Vanessa Perez-Gomez
- IIS-Fundacion Jimenez Diaz, School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
- Fundacion Renal Iñigo Alvarez de Toledo-IRSIN, Madrid, Spain
- REDINREN, Madrid, Spain
| | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz, School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
- Fundacion Renal Iñigo Alvarez de Toledo-IRSIN, Madrid, Spain
- REDINREN, Madrid, Spain
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14
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Smith AM, Tau NP, Kalule BJ, Nicol MP, McCulloch M, Jacobs CA, McCarthy KM, Ismail A, Allam M, Kleynhans J. Shiga toxin-producing Escherichia coli O26:H11 associated with a cluster of haemolytic uraemic syndrome cases in South Africa, 2017. Access Microbiol 2019; 1:e000061. [PMID: 32974561 PMCID: PMC7472548 DOI: 10.1099/acmi.0.000061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/22/2019] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Shiga toxin-producing Escherichia coli (STEC) are foodborne pathogens that may cause diarrhoeal outbreaks and occasionally are associated with haemolytic-uraemic syndrome (HUS). We report on STEC O26:H11 associated with a cluster of four HUS cases in South Africa in 2017. METHODOLOGY All case-patients were female and aged 5 years and under. Standard microbiological tests were performed for culture and identification of STEC from specimens (human stool and food samples). Further analysis of genomic DNA extracted from bacterial cultures and specimens included PCR for specific virulence genes, whole-genome sequencing and shotgun metagenomic sequencing. RESULTS For 2/4 cases, stool specimens revealed STEC O26:H11 containing eae, stx2a and stx2b virulence genes. All food samples were found to be negative for STEC. No epidemiological links could be established between the HUS cases. Dried meat products were the leading food item suspected to be the vehicle of transmission for these cases, as 3/4 case-patients reported they had eaten this. However, testing of dried meat products could not confirm this. CONCLUSION Since STEC infection does not always lead to severe symptoms, it is possible that many more cases were associated with this cluster and largely went unrecognized.
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Affiliation(s)
- Anthony M. Smith
- Centre for Enteric Diseases, National Institute for Communicable Diseases (NICD), National Health Laboratory Service (NHLS), Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nomsa P. Tau
- Centre for Enteric Diseases, National Institute for Communicable Diseases (NICD), National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Bosco J. Kalule
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mark P. Nicol
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - Mignon McCulloch
- Red Cross Children’s Hospital, University of Cape Town, Cape Town, South Africa
| | - Charlene A. Jacobs
- Communicable Disease Control, Department of Health, Cape Town, South Africa
| | - Kerrigan M. McCarthy
- Division of Public Health Surveillance and Response, NICD, NHLS, Johannesburg, South Africa
| | - Arshad Ismail
- Sequencing Core Facility, NICD, NHLS, Johannesburg, South Africa
| | - Mushal Allam
- Sequencing Core Facility, NICD, NHLS, Johannesburg, South Africa
| | - Jackie Kleynhans
- South African Field Epidemiology Training Programme, NICD, NHLS, Johannesburg, South Africa
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15
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Schönermarck U, Ries W, Schröppel B, Pape L, Dunaj-Kazmierowska M, Burst V, Mitzner S, Basara N, Starck M, Schmidbauer D, Mellmann A, Dittmer R, Jeglitsch M, Haas CS. Relative incidence of thrombotic thrombocytopenic purpura and haemolytic uraemic syndrome in clinically suspected cases of thrombotic microangiopathy. Clin Kidney J 2019; 13:208-216. [PMID: 32296526 PMCID: PMC7147316 DOI: 10.1093/ckj/sfz066] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 04/29/2019] [Indexed: 12/27/2022] Open
Abstract
Background Data are lacking on the relative incidence of thrombotic thrombocytopenic purpura (TTP), haemolytic uraemic syndrome (HUS) caused by Shiga toxin–producing Escherichia coli (STEC) and atypical HUS (aHUS) in patients presenting with thrombotic microangiopathies (TMAs). Methods This was a prospective, cross-sectional, multicentre and non-interventional epidemiological study. Patients fulfilling criteria for TMAs (platelet consumption, microangiopathic haemolytic anaemia and organ dysfunction) were included in the study. The primary objective was to assess the relative incidence of TTP, STEC-HUS, aHUS and ‘other’ physician-defined diagnoses. The secondary objective was to develop an algorithm to predict a severe deficiency in ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) activity (≤10%) using routine laboratory parameters. A post hoc classification using the recent Kidney Disease: Improving Global Outcomes diagnostic criteria was then undertaken to further classify patient groups. Results aHUS was diagnosed with a relative incidence of 61%, whereas TTP, STEC-HUS and ‘other’ were diagnosed in 13, 6 and 20% of patients, respectively. In the post hoc analysis, 27% of patients with a TMA were classified as ‘primary aHUS’ and 53% as ‘secondary aHUS’. Multivariate analysis revealed that severe deficiency in ADAMTS13 activity (≤10%) was unlikely to underlie TMA if platelet and serum creatinine were above threshold values of 30 × 109/L and 1.8 mg/dL, respectively (negative predictive value of 92.3 and 98.1, respectively, if one or both values were above the threshold). Conclusions In this study, aHUS was the most common single diagnosis among patients presenting with a TMA. In the absence of an ADAMTS13 activity result, platelet count and serum creatinine may aid in the differential diagnosis.
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Affiliation(s)
- Ulf Schönermarck
- Medizinische Klinik IV, Klinikum der Universität, LMU, Munich, Germany
| | - Wolfgang Ries
- Internal Medicine, Diakonissenkrankenhaus, Flensburg, Germany
| | - Bernd Schröppel
- Medical Clinic I, Section of Nephrology, University of Ulm, Ulm, Germany
| | - Lars Pape
- Pediatric Nephrology, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Volker Burst
- Department II of Internal Medicine, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany.,Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Steffen Mitzner
- Division of Nephrology, Rostock University Medical Centre, Rostock, Germany.,Fraunhofer IZI Project Group 'Extracorporeal Immunomodulation', Rostock, Germany
| | - Nadezda Basara
- Medizinische Klinik I, St. Franziskus-Hospital, Flensburg, Germany
| | - Michael Starck
- Clinic for Hematology, Clinic Munich-Schwabing, Munich, Germany
| | | | | | | | | | - Christian S Haas
- Internal Medicine, Nephrology and Intensive Care Medicine, Phillips University of Marburg, Marburg, Germany
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16
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Abstract
A woman in her mid-70s with metastatic pancreatic adenocarcinoma presented with fatigue, nausea and bilateral leg swelling, 4 days after an intravenous gemcitabine infusion. Additional examination and laboratory tests showed mild hypertension, low haemoglobin, high lactate dehydrogenase, low platelet count and high serum creatinine. The patient was subsequently diagnosed with haemolytic uraemic syndrome (HUS), and gemcitabine administration was immediately ceased. The patient received a 5-day course of methylprednisolone, with a full recovery being made 10 days after diagnosis. Clinicians should be aware of the rare but serious complication of gemcitabine-induced HUS (GiHUS), as early diagnosis and management, which includes prompt discontinuation of gemcitabine, are crucial in promptly resolving this condition. This case report describes one treatment that can be used for the treatment of GiHUS, while briefly covering some other novel treatments that have been described in other studies.
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Affiliation(s)
- Adarsh Das
- Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Andrew Dean
- Department of Medical Oncology, Saint John of God Hospital Subiaco, Subiaco, Western Australia, Australia
| | - Tim Clay
- Department of Medical Oncology, Saint John of God Hospital Subiaco, Subiaco, Western Australia, Australia
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17
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Bruyand M, Mariani-Kurkdjian P, Le Hello S, King LA, Van Cauteren D, Lefevre S, Gouali M, Jourdan-da Silva N, Mailles A, Donguy MP, Loukiadis E, Sergentet-Thevenot D, Loirat C, Bonacorsi S, Weill FX, De Valk H. Paediatric haemolytic uraemic syndrome related to Shiga toxin-producing Escherichia coli, an overview of 10 years of surveillance in France, 2007 to 2016. Euro Surveill 2019; 24:1800068. [PMID: 30808442 PMCID: PMC6446949 DOI: 10.2807/1560-7917.es.2019.24.8.1800068] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 12/31/2018] [Indexed: 12/19/2022] Open
Abstract
IntroductionHaemolytic uraemic syndrome (HUS) related to Shiga toxin-producing Escherichia coli (STEC) is the leading cause of acute renal failure in young children. In France, HUS surveillance in children aged < 15 years was implemented starting from 1996.AimWe present the results of this surveillance between 2007 and 2016.MethodsA voluntary nationwide network of 32 paediatric departments notifies cases. Two national reference centres perform microbiological STEC confirmation.ResultsOver the study period, the paediatric HUS incidence rate (IR) was 1.0 per 100,000 children-years, with a median of 116 cases/year. In 2011, IR peaked at 1.3 per 100,000 children-years, and decreased to 1.0 per 100,000 children-years in 2016. STEC O157 associated HUS peaked at 37 cases in 2011 and decreased to seven cases in 2016. Cases of STEC O26-associated HUS have increased since 2010 and STEC O80 associated HUS has emerged since 2012, with 28 and 18 cases respectively reported in 2016. Four STEC-HUS food-borne outbreaks were detected (three STEC O157 linked to ground beef and raw-milk cheese and one STEC O104 linked to fenugreek sprouts). In addition, two outbreaks related to person-to-person transmission occurred in distinct kindergartens (STEC O111 and O26).ConclusionsNo major changes in HUS IRs were observed over the study period of 10 years. However, changes in the STEC serogroups over time and the outbreaks detected argue for continuing epidemiological and microbiological surveillance.
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Affiliation(s)
| | | | - Simon Le Hello
- Institut Pasteur, Unité des Bactéries Pathogènes Entériques, Centre National de Référence des E. coli, Shigella et Salmonella, Paris, France
| | | | | | - Sophie Lefevre
- Institut Pasteur, Unité des Bactéries Pathogènes Entériques, Centre National de Référence des E. coli, Shigella et Salmonella, Paris, France
| | - Malika Gouali
- Institut Pasteur, Unité des Bactéries Pathogènes Entériques, Centre National de Référence des E. coli, Shigella et Salmonella, Paris, France
| | | | | | | | - Estelle Loukiadis
- Université de Lyon, VetAgro Sup, Laboratoire National de Référence pour les Escherichia coli, Marcy l'Etoile, France
- Université de Lyon, CNRS, INRA, Université Claude Bernard Lyon 1, VetAgro Sup, Laboratoire d'Ecologie Microbienne, Villeurbanne, France
| | - Delphine Sergentet-Thevenot
- Université de Lyon, VetAgro Sup, Laboratoire National de Référence pour les Escherichia coli, Marcy l'Etoile, France
- Université de Lyon, CNRS, INRA, Université Claude Bernard Lyon 1, VetAgro Sup, Laboratoire d'Ecologie Microbienne, Villeurbanne, France
| | - Chantal Loirat
- Pediatric Nephrology Department, University Hospital Robert Debré, Paris, France
| | | | - François-Xavier Weill
- Institut Pasteur, Unité des Bactéries Pathogènes Entériques, Centre National de Référence des E. coli, Shigella et Salmonella, Paris, France
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18
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Jeantet G, Pernin V, Brunot V, Roccabianca A, Macombe A, Szwarc I, Klouche K, Loirat C, Mourad G, Frémeaux-Bacchi V, Le Quintrec M. Successful treatment of a Streptococcus pneumoniae-associated haemolytic uraemic syndrome by eculizumab. Clin Kidney J 2018; 12:106-109. [PMID: 30746136 PMCID: PMC6366139 DOI: 10.1093/ckj/sfy019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 02/02/2018] [Indexed: 12/27/2022] Open
Abstract
Haemolytic uraemic syndrome (HUS) is a rare complication of invasive infection by Streptococcus pneumoniae (SP-HUS), especially in adults. Here we report an unusual case of a 53-year-old man presenting SP-HUS with severe multivisceral involvement. After failure of supportive care and plasma exchanges, eculizumab (anti-C5 antibody) resulted in a favourable outcome.
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Affiliation(s)
- Guillaume Jeantet
- Department of Nephrology and Kidney Transplantation, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Vincent Pernin
- Department of Nephrology and Kidney Transplantation, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Vincent Brunot
- Critical Care Department, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Arnaud Roccabianca
- Department of Nephrology and Kidney Transplantation, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Anouk Macombe
- Department of Nephrology and Kidney Transplantation, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Ilan Szwarc
- Department of Nephrology and Kidney Transplantation, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Kada Klouche
- Critical Care Department, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Chantal Loirat
- Department of Pediatric Nephrology, Hôpital Universitaire Robert Debré, Paris, France
| | - Georges Mourad
- Department of Nephrology and Kidney Transplantation, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | | | - Moglie Le Quintrec
- Department of Nephrology and Kidney Transplantation, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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19
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Vygen-Bonnet S, Rosner B, Wilking H, Fruth A, Prager R, Kossow A, Lang C, Simon S, Seidel J, Faber M, Schielke A, Michaelis K, Holzer A, Kamphausen R, Kalhöfer D, Thole S, Mellmann A, Flieger A, Stark K. Ongoing haemolytic uraemic syndrome (HUS) outbreak caused by sorbitol-fermenting (SF) Shiga toxin-producing Escherichia coli (STEC) O157, Germany, December 2016 to May 2017. ACTA ACUST UNITED AC 2018; 22:30541. [PMID: 28597831 PMCID: PMC5479985 DOI: 10.2807/1560-7917.es.2017.22.21.30541] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/24/2017] [Indexed: 11/20/2022]
Abstract
We report an ongoing, protracted and geographically dispersed outbreak of haemolytic uraemic syndrome (HUS) and gastroenteritis in Germany, involving 30 cases since December 2016. The outbreak was caused by the sorbitol-fermenting immotile variant of Shiga toxin-producing (STEC) Escherichia coli O157. Molecular typing revealed close relatedness between isolates from 14 cases. One HUS patient died. Results of a case–control study suggest packaged minced meat as the most likely food vehicle. Food safety investigations are ongoing.
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Affiliation(s)
- Sabine Vygen-Bonnet
- Robert Koch-Institute, Department of Infectious Diseases Epidemiology, Berlin, Germany
| | - Bettina Rosner
- Robert Koch-Institute, Department of Infectious Diseases Epidemiology, Berlin, Germany
| | - Hendrik Wilking
- Robert Koch-Institute, Department of Infectious Diseases Epidemiology, Berlin, Germany
| | - Angelika Fruth
- Robert Koch-Institute, Department of Infectious Diseases, National Reference Centre for Salmonella and other Bacterial Enteric Pathogens, Wernigerode, Germany
| | - Rita Prager
- Robert Koch-Institute, Department of Infectious Diseases, National Reference Centre for Salmonella and other Bacterial Enteric Pathogens, Wernigerode, Germany
| | - Annelene Kossow
- University Hospital of Münster, Consultant Laboratory for HUS, Münster, Germany
| | - Christina Lang
- Robert Koch-Institute, Department of Infectious Diseases, National Reference Centre for Salmonella and other Bacterial Enteric Pathogens, Wernigerode, Germany
| | - Sandra Simon
- Robert Koch-Institute, Department of Infectious Diseases, National Reference Centre for Salmonella and other Bacterial Enteric Pathogens, Wernigerode, Germany
| | - Juliane Seidel
- Robert Koch-Institute, Department of Infectious Diseases Epidemiology, Berlin, Germany.,Postgraduate Training for Applied Epidemiology, Robert Koch Institute, Berlin, Germany.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Mirko Faber
- Robert Koch-Institute, Department of Infectious Diseases Epidemiology, Berlin, Germany
| | - Anika Schielke
- Robert Koch-Institute, Department of Infectious Diseases Epidemiology, Berlin, Germany
| | - Kai Michaelis
- Robert Koch-Institute, Department of Infectious Diseases Epidemiology, Berlin, Germany
| | - Alexandra Holzer
- Robert Koch-Institute, Department of Infectious Diseases Epidemiology, Berlin, Germany
| | - Rolf Kamphausen
- Ministry of Climate Protection, Environment, Agriculture, Nature Conservation and Consumer Protection of the state of North Rhine-Westphalia, Düsseldorf, Germany
| | - Daniela Kalhöfer
- North Rhine-Westphalia, Centre for Health, Department of Infectiology and Hygiene, Münster, Germany
| | - Sebastian Thole
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,North Rhine-Westphalia, Centre for Health, Department of Infectiology and Hygiene, Münster, Germany
| | - Alexander Mellmann
- University Hospital of Münster, Consultant Laboratory for HUS, Münster, Germany
| | - Antje Flieger
- Robert Koch-Institute, Department of Infectious Diseases, National Reference Centre for Salmonella and other Bacterial Enteric Pathogens, Wernigerode, Germany
| | - Klaus Stark
- Robert Koch-Institute, Department of Infectious Diseases Epidemiology, Berlin, Germany
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20
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Abstract
Haemolytic uraemic syndrome (HUS) is defined by the simultaneous occurrence of nonimmune haemolytic anaemia, thrombocytopenia and acute renal failure. This leads to the pathological lesion termed thrombotic microangiopathy, which mainly affects the kidney, as well as other organs. HUS is associated with endothelial cell injury and platelet activation, although the underlying cause may differ. Most cases of HUS are associated with gastrointestinal infection with Shiga toxin-producing enterohaemorrhagic Escherichia coli (EHEC) strains. Atypical HUS (aHUS) is associated with complement dysregulation due to mutations or autoantibodies. In this review, we will describe the causes of HUS. In addition, we will review the clinical, pathological, haematological and biochemical features, epidemiology and pathogenetic mechanisms as well as the biochemical, microbiological, immunological and genetic investigations leading to diagnosis. Understanding the underlying mechanisms of the different subtypes of HUS enables tailoring of appropriate treatment and management. To date, there is no specific treatment for EHEC-associated HUS but patients benefit from supportive care, whereas patients with aHUS are effectively treated with anti-C5 antibody to prevent recurrences, both before and after renal transplantation.
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Affiliation(s)
- Diana Karpman
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Sebastian Loos
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ramesh Tati
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ida Arvidsson
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
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21
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Severi E, Vial F, Peron E, Mardh O, Niskanen T, Takkinen J. Community-wide outbreaks of haemolytic uraemic syndrome associated with Shiga toxin-producing Escherichia coli O26 in Italy and Romania: a new challenge for the European Union. Euro Surveill 2016; 21:30420. [PMID: 27983509 PMCID: PMC5291129 DOI: 10.2807/1560-7917.es.2016.21.49.30420] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 12/08/2016] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ettore Severi
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Flavie Vial
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Emilie Peron
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Gastrointestinal, zoonosis and tropical diseases unit, Department of infectious diseases epidemiology, Robert Koch Institute, Berlin, Germany
| | - Otilia Mardh
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Taina Niskanen
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Johanna Takkinen
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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22
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Peron E, Zaharia A, Zota LC, Severi E, Mårdh O, Usein C, Bălgrădean M, Espinosa L, Jansa J, Scavia G, Rafila A, Serban A, Pistol A. Early findings in outbreak of haemolytic uraemic syndrome among young children caused by Shiga toxin-producing Escherichia coli, Romania, January to February 2016. ACTA ACUST UNITED AC 2016; 21:30170. [PMID: 27020906 DOI: 10.2807/1560-7917.es.2016.21.11.30170] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/17/2016] [Indexed: 11/20/2022]
Abstract
As at 29 February 2016, 15 cases of haemolytic uraemic syndrome with onset between 25 January and 22 February were reported among children between five and 38 months in Romania, and three of them died. Cases were mostly from southern Romania. Six cases tested positive for Escherichia coli O26 by serology. Fruits, vegetables, meat and dairy products were among the possible common food exposures. Investigations are ongoing in Romania to control the outbreak.
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Affiliation(s)
- Emilie Peron
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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23
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Abstract
Cancer-associated thrombotic microangiopathy refers to a group of disorders characterised by microvascular thrombosis, thrombocytopenia, and ischaemic end-organ damage. Haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura are the two major subtypes. It can be a manifestation of the malignancy itself or a complication of its therapy. The addition of several new drugs to the therapeutic armamentarium of cancer has brought to light several novel causative factors of this hitherto uncommon complication. This review covers the aetiology, pathogenesis, clinical manifestations, complications, and the management of cancer-associated thrombotic microangiopathy. Careful review of the patient’s medical records coupled with the correlation of clinical findings and laboratory reports can help clinch the diagnosis and institute appropriate treatment on time.
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Affiliation(s)
- K Govind Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Dr MH Marigowda road, Hombegowdanagar, Bangalore-560029, India
| | - Gita R Bhat
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Dr MH Marigowda road, Hombegowdanagar, Bangalore-560029, India
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24
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Fujii J, Mizoue T, Kita T, Kishimoto H, Joh K, Nakada Y, Ugajin S, Naya Y, Nakamura T, Tada Y, Okabe N, Maruyama Y, Saitoh K, Kurozawa Y. Risk of haemolytic uraemic syndrome caused by shiga-toxin-producing Escherichia coli infection in adult women in Japan. Epidemiol Infect 2016; 144:952-61. [PMID: 26470913 DOI: 10.1017/S0950268815002289] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Shiga-toxin-producing Escherichia coli (STEC) infections usually cause haemolytic uraemic syndrome (HUS) equally in male and female children. This study investigated the localization of globotriaosylceramide (Gb3) in human brain and kidney tissues removed from forensic autopsy cases in Japan. A fatal case was used as a positive control in an outbreak of diarrhoeal disease caused by STEC O157:H7 in a kindergarten in Urawa in 1990. Positive immunodetection of Gb3 was significantly more frequent in female than in male distal and collecting renal tubules. To correlate this finding with a clinical outcome, a retrospective analysis of the predictors of renal failure in the 162 patients of two outbreaks in Japan was performed: one in Tochigi in 2002 and the other in Kagawa Prefecture in 2005. This study concludes renal failure, including HUS, was significantly associated with female sex, and the odds ratio was 4·06 compared to male patients in the two outbreaks. From 2006 to 2009 in Japan, the risk factor of HUS associated with STEC infection was analysed. The number of males and females and the proportion of females who developed HUS were calculated by age and year from 2006 to 2009. In 2006, 2007 and 2009 in adults aged >20 years, adult women were significantly more at risk of developing HUS in Japan.
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25
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Volokhina EB, Westra D, van der Velden TJAM, van de Kar NCAJ, Mollnes TE, van den Heuvel LP. Complement activation patterns in atypical haemolytic uraemic syndrome during acute phase and in remission. Clin Exp Immunol 2015; 181:306-13. [PMID: 25079699 DOI: 10.1111/cei.12426] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2014] [Indexed: 02/01/2023] Open
Abstract
Atypical haemolytic uraemic syndrome (aHUS) is associated with (genetic) alterations in alternative complement pathway. Nevertheless, comprehensive evidence that the complement system in aHUS patients is more prone to activation is still lacking. Therefore, we performed a thorough analysis of complement activation in acute phase and in remission of this disease. Complement activation patterns of the aHUS patients in acute phase and in remission were compared to those of healthy controls. Background levels of complement activation products C3b/c, C3bBbP and terminal complement complex (TCC) were measured using enzyme-linked immunosorbent assay (ELISA) in ethylenediamine tetraacetic acid (EDTA) plasma. In vitro-triggered complement activation in serum samples was studied using zymosan-coating and pathway-specific assay. Furthermore, efficiencies of the C3b/c, C3bBbP and TCC generation in fluid phase during spontaneous activation were analysed. Patients with acute aHUS showed elevated levels of C3b/c (P < 0·01), C3bBbP (P < 0·0001) and TCC (P < 0·0001) in EDTA plasma, while values of patients in remission were normal, compared to those of healthy controls. Using data from a single aHUS patient with complement factor B mutation we illustrated normalization of complement activation during aHUS recovery. Serum samples from patients in remission showed normal in vitro patterns of complement activation and demonstrated normal kinetics of complement activation in the fluid phase. Our data indicate that while aHUS patients have clearly activated complement in acute phase of the disease, this is not the case in remission of aHUS. This knowledge provides important insight into complement regulation in aHUS and may have an impact on monitoring of these patients, particularly when using complement inhibition therapy.
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Affiliation(s)
- E B Volokhina
- Department of Pediatric Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - D Westra
- Department of Pediatric Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - T J A M van der Velden
- Department of Pediatric Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - N C A J van de Kar
- Department of Pediatric Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - T E Mollnes
- Department of Immunology, Oslo University Hospital, Oslo, Norway.,K. G. Jebsen IRC, University of Oslo, Oslo, Norway.,Research Laboratory, Nordland Hospital, Bodø, Norway.,Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - L P van den Heuvel
- Department of Pediatric Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium
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26
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Abstract
Eculizumab is an anti-C5 antibody that inhibits C5 cleavage and prevents the generation of the terminal complement complex C5b-9. Eculizumab is licensed to treat paroxysmal nocturnal haemoglobinuria or atypical haemolytic uraemic syndrome (aHUS). Clinical trials are ongoing for C3 glomerulopathy. Given the unfamiliarity of physicians with these rare diseases and the variability of clinical presentation, a delayed initiation of eculizumab therapy is common. Thus, the question arises as to what extent improvement of kidney function may be expected when patients have been dialysis dependent for weeks or months already when eculizumab is initiated. Furthermore, given the high cost and potential adverse effects of eculizumab, the question arises of when to stop therapy because of futility when patients with kidney-only manifestations remain dialysis dependent. In literature reports, eculizumab was stopped as early as after 3 weeks because the patient remained dialysis dependent. In this issue of CKJ, Inman et al. report on eculizumab-induced reversal of dialysis-dependent kidney failure from C3 glomerulonephritis, illustrating both the potential benefit of eculizumab for this complement-mediated disease and the need for lengthy therapy—dialysis independency was reached after 5 months of eculizumab. Indeed, there are reports of renal function recovery when eculizumab was initiated after 4 months on dialysis and of recovery of renal function 2.0–3.5 months after initiation of eculizumab in dialysis-dependent patients with C3 glomerulopathy or aHUS.
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Affiliation(s)
- Laura Rodriguez-Osorio
- IIS-Fundacion Jimenez Diaz, School of Medicine , Universidad Autonoma de Madrid , Madrid , Spain ; Fundacion Renal Iñigo Alvarez de Toledo-IRSIN and REDINREN , Madrid , Spain
| | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz, School of Medicine , Universidad Autonoma de Madrid , Madrid , Spain ; Fundacion Renal Iñigo Alvarez de Toledo-IRSIN and REDINREN , Madrid , Spain
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27
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Richter AM, Povolotsky TL, Wieler LH, Hengge R. Cyclic-di-GMP signalling and biofilm-related properties of the Shiga toxin-producing 2011 German outbreak Escherichia coli O104:H4. EMBO Mol Med 2015; 6:1622-37. [PMID: 25361688 PMCID: PMC4287979 DOI: 10.15252/emmm.201404309] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
In 2011, nearly 4,000 people in Germany were infected by Shiga toxin (Stx)-producing Escherichia coli O104:H4 with > 22% of patients developing haemolytic uraemic syndrome (HUS). Genome sequencing showed the outbreak strain to be related to enteroaggregative E. coli (EAEC), suggesting its high virulence results from EAEC-typical strong adherence and biofilm formation combined to Stx production. Here, we report that the outbreak strain contains a novel diguanylate cyclase (DgcX)--producing the biofilm-promoting second messenger c-di-GMP--that shows higher expression than any other known E. coli diguanylate cyclase. Unlike closely related E. coli, the outbreak strain expresses the c-di-GMP-controlled biofilm regulator CsgD and amyloid curli fibres at 37°C, but is cellulose-negative. Moreover, it constantly generates derivatives with further increased and deregulated production of CsgD and curli. Since curli fibres are strongly proinflammatory, with cellulose counteracting this effect, high c-di-GMP and curli production by the outbreak O104:H4 strain may enhance not only adherence but may also contribute to inflammation, thereby facilitating entry of Stx into the bloodstream and to the kidneys where Stx causes HUS.
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Affiliation(s)
- Anja M Richter
- Institute of Biology / Microbiology Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tatyana L Povolotsky
- Institute of Biology / Microbiology Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lothar H Wieler
- Institute of Microbiology and Epizootics Freie Universität Berlin, Berlin, Germany
| | - Regine Hengge
- Institute of Biology / Microbiology Humboldt-Universität zu Berlin, Berlin, Germany
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28
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Keithlin J, Sargeant J, Thomas MK, Fazil A. Systematic review and meta-analysis of the proportion of Campylobacter cases that develop chronic sequelae. BMC Public Health 2014; 14:1203. [PMID: 25416162 PMCID: PMC4391665 DOI: 10.1186/1471-2458-14-1203] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 09/30/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Understanding of chronic sequelae development after Campylobacter infection is limited. The objective of the study was to determine via systematic review and meta-analysis the proportion of Campylobacter cases that develop chronic sequelae. METHODS A systematic review of English language articles published prior to July 2011 located using Pubmed, Agricola, CabDirect, and Food Safety and Technology Abstracts. Observational studies reporting the number of Campylobacter cases that developed reactive arthritis (ReA), Reiter's syndrome (RS), haemolytic uraemic syndrome (HUS), irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) ,Guillain Barré syndrome (GBS) or Miller Fisher syndrome (MFS) were included. Data extraction through independent extraction of articles by four reviewers (two per article). Random effects meta-analysis was performed and heterogeneity was assessed using the I(2) value. Meta-regression was used to explore the influence of study level variables on heterogeneity. RESULTS A total of 31 studies were identified; 20 reported on ReA, 2 reported on RS, 9 reported on IBS, 3 studies reported on IBD, 8 reported on GBS, 1 reported on MFS and 3 reported on HUS. The proportion of Campylobacter cases that developed ReA was 2.86% (95% CI 1.40% - 5.61%, I(2) = 97.7%), irritable bowel syndrome was 4.01% (95% CI 1.41% - 10.88%, I(2) = 99.2%). Guillain Barré syndrome was 0.07% (95% CI 0.03% - 0.15%, I(2) = 72.7%). CONCLUSIONS A significant number of Campylobacter cases develop a chronic sequela. However, results should be interpreted with caution due to the high heterogeneity.
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Affiliation(s)
- Jessica Keithlin
- Centre for Public Health and Zoonoses, University of Guelph, Guelph, Ontario, Canada.
- Department of Population Medicine, Ontario Veterinary College, Guelph, Ontario, Canada.
| | - Jan Sargeant
- Centre for Public Health and Zoonoses, University of Guelph, Guelph, Ontario, Canada.
- Department of Population Medicine, Ontario Veterinary College, Guelph, Ontario, Canada.
| | - M Kate Thomas
- Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada.
| | - Aamir Fazil
- Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, Guelph, Ontario, Canada.
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29
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De Rauw K, Vincken S, Garabedian L, Levtchenko E, Hubloue I, Verhaegen J, Craeghs J, Glupczynski Y, Mossong J, Piérard D. Enteroaggregative Shiga toxin-producing Escherichia coli of serotype O104:H4 in Belgium and Luxembourg. New Microbes New Infect 2014; 2:138-43. [PMID: 25356363 PMCID: PMC4184478 DOI: 10.1002/nmi2.58] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/26/2014] [Accepted: 07/04/2014] [Indexed: 11/29/2022] Open
Abstract
In 2011, a large outbreak of infections caused by Shiga toxin-producing Escherichia coli (STEC) O104:H4 occurred in Germany. This exceptionally virulent strain combined virulence factors of enteroaggregative E. coli (EAggEC) and STEC. After the outbreak only a few sporadic cases of infection with this rare serotype were reported, most of which were related to travel to the Middle East or North Africa. Here we describe two cases of enteroaggregative STEC (Agg-STEC) O104:H4 infection that occurred in Belgium in 2012 and 2013 respectively. In both cases travel in a Mediterranean country preceded the infection. The first strain was isolated from the stool of a 42-year-old woman presenting bloody diarrhoea, who had travelled to Tunisia the week before. The second case involves a 14-year-old girl who, upon her return from Turkey to Belgium, suffered from an episode of bloody diarrhoea and haemolytic uraemic syndrome. Extended typing of the isolates with pulsed field gel electrophoresis revealed that the strains were closely related, though not exactly the same as the 2011 outbreak strain. This report supports the previously made hypothesis that Agg-STEC has a human reservoir and might be imported by travellers coming from an area where the pathogen is endemic. Furthermore, it emphasizes the concern that these bacteria may cause future outbreaks as evenly virulent O104:H4 isolates seem to be widespread.
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Affiliation(s)
- K De Rauw
- National Reference Centre for STEC/VTEC, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB)Brussels, Belgium
- Department of Microbiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB)Brussels, Belgium
| | - S Vincken
- Department of Internal Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB)Brussels, Belgium
| | - L Garabedian
- Department of Pediatric Nephrology, Universitair Ziekenhuis Leuven, Katholieke Universiteit Leuven (KUL)Leuven, Belgium
| | - E Levtchenko
- Department of Pediatric Nephrology, Universitair Ziekenhuis Leuven, Katholieke Universiteit Leuven (KUL)Leuven, Belgium
| | - I Hubloue
- Department of Emergency, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB)Brussels, Belgium
| | - J Verhaegen
- Department of Microbiology, Universitair Ziekenhuis Leuven, Katholieke Universiteit Leuven (KUL)Leuven, Belgium
| | - J Craeghs
- Department of Microbiology, Algemeen Ziekenhuis VesaliusTongeren, Belgium
| | - Y Glupczynski
- National Reference Centre ESBL and carbapenemase-producing Enterobacteriaceae, CHU Dinant-Godinne|UCL Namur, Université Catholique de Louvain (UCL)Yvoir, Belgium
| | - J Mossong
- Surveillance & Epidemiology of Infectious Diseases, National Health LaboratoryDudelange, Luxembourg
| | - D Piérard
- National Reference Centre for STEC/VTEC, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB)Brussels, Belgium
- Department of Microbiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB)Brussels, Belgium
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30
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Brocklebank V, Wong EKS, Fielding R, Goodship THJ, Kavanagh D. Atypical haemolytic uraemic syndrome associated with a CD46 mutation triggered by Shigella flexneri.. Clin Kidney J 2014; 7:286-288. [PMID: 24944786 PMCID: PMC4038258 DOI: 10.1093/ckj/sfu032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 03/13/2014] [Indexed: 11/29/2022] Open
Abstract
We present a case of haemolytic uraemic syndrome (HUS) triggered by Shigella flexneri. Of the Shigella species, only S. dysenteriae type 1 is said to produce Shiga toxin and consequently cause HUS. Investigation of the complement system in this patient revealed a CD46 mutation. In individuals with mutations in complement genes incomplete penetrance of atypical HUS (aHUS) is seen, suggesting that a trigger, such as infection, is required for disease to manifest. In an era of complement modulatory therapy for aHUS it is important to be alert to unusual presentations of diarrhoeal-associated disease.
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Affiliation(s)
| | - Edwin K S Wong
- The Institute of Genetic Medicine , Newcastle University , Newcastle upon Tyne , UK
| | - Rick Fielding
- Renal Services Centre , Freeman Hospital , Newcastle upon Tyne , UK
| | - Timothy H J Goodship
- Renal Services Centre , Freeman Hospital , Newcastle upon Tyne , UK ; The Institute of Genetic Medicine , Newcastle University , Newcastle upon Tyne , UK
| | - David Kavanagh
- Renal Services Centre , Freeman Hospital , Newcastle upon Tyne , UK ; The Institute of Genetic Medicine , Newcastle University , Newcastle upon Tyne , UK
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31
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Delmas Y, Vendrely B, Clouzeau B, Bachir H, Bui HN, Lacraz A, Hélou S, Bordes C, Reffet A, Llanas B, Skopinski S, Rolland P, Gruson D, Combe C. Outbreak of Escherichia coli O104:H4 haemolytic uraemic syndrome in France: outcome with eculizumab. Nephrol Dial Transplant 2013; 29:565-72. [PMID: 24293658 PMCID: PMC3938298 DOI: 10.1093/ndt/gft470] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background An outbreak of haemolytic uraemic syndrome (HUS) due to Shiga toxin-secreting Escherichia coli (STEC) O104:H4 from contaminated fenugreek sprouts occurred in June 2011 near Bordeaux, France. In the context of this outbreak, all patients were treated with the monoclonal anti-C5 antibody, eculizumab. Methods The diagnosis of HUS was made based on haemolytic anaemia, low platelet count and acute kidney injury. Data were obtained from initial gastrointestinal symptoms to the end of follow-up 10 weeks after the start of eculizumab. Results Among 24 cases of STEC gastroenteritis, HUS developed in nine patients (eight adults and one child), 6 (median; range 3–12) days after digestive symptoms begun. The median (range) highest or lowest biological values were platelet count 26 (range 14–93) G/L; haemoglobin 6.6 (range 5–10.7) g/dL; LDH 1520 (range 510–2568) IU/L; creatinine 152 (range 48–797) µmol/L. All patients had extra-renal complications (liver 9, pancreas 5, brain 3 and heart 3). Two patients were dialysed, and one was ventilated. After failure of plasma exchange to increase platelets in the first three patients, eculizumab was administered in all nine patients, 0–4 days after HUS diagnosis (median 1 day). One patient with very severe neurological HUS received immunoadsorption. Outcome was favourable in all patients, with rapid normalization of haemoglobin, platelets, LDH levels, renal function and neurological improvement. There were no deaths and no serious adverse events related to eculizumab. Conclusions Early treatment of O104:H4 STEC-HUS by eculizumab was associated with a rapid and efficient recovery. Controlled prospective evaluation of eculizumab in STEC-HUS is warranted.
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Affiliation(s)
- Yahsou Delmas
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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32
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Gomez SA, Abrey-Recalde MJ, Panek CA, Ferrarotti NF, Repetto MG, Mejías MP, Fernández GC, Vanzulli S, Isturiz MA, Palermo MS. The oxidative stress induced in vivo by Shiga toxin-2 contributes to the pathogenicity of haemolytic uraemic syndrome. Clin Exp Immunol 2013; 173:463-72. [PMID: 23607458 DOI: 10.1111/cei.12124] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2013] [Indexed: 12/19/2022] Open
Abstract
Typical haemolytic uraemic syndrome (HUS) is caused by Shiga toxin (Stx)-producing Escherichia coli infections and is characterized by thrombotic microangiopathy that leads to haemolytic anaemia, thrombocytopenia and acute renal failure. Renal or neurological sequelae are consequences of irreversible tissue damage during the acute phase. Stx toxicity and the acute inflammatory response raised by the host determine the development of HUS. At present there is no specific therapy to control Stx damage. The pathogenic role of reactive oxygen species (ROS) on endothelial injury has been largely documented. In this study, we investigated the in-vivo effects of Stx on the oxidative balance and its contribution to the development of HUS in mice. In addition, we analysed the effect of anti-oxidant agents as therapeutic tools to counteract Stx toxicity. We demonstrated that Stx induced an oxidative imbalance, evidenced by renal glutathione depletion and increased lipid membrane peroxidation. The increased ROS production by neutrophils may be one of the major sources of oxidative stress during Stx intoxication. All these parameters were ameliorated by anti-oxidants reducing platelet activation, renal damage and increasing survival. To conclude, Stx generates a pro-oxidative state that contributes to kidney failure, and exogenous anti-oxidants could be beneficial to counteract this pathogenic pathway.
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Affiliation(s)
- S A Gomez
- Servicio de Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, ANLIS 'Dr Carlos G. Malbrán', Buenos Aires, Argentina
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33
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Huynh-Moynot S, Eyrieux S, Moynot JC, Commandeur D, Fourel D, Ould-Ahmed M, Drouillard I. [Thrombotic microangiopathy mimicking a heparin-induced thrombocytopenia]. Ann Biol Clin (Paris) 2013; 71:113-9. [PMID: 23396435 DOI: 10.1684/abc.2012.0786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a case of a 47 years old woman. In her case of medical history, there were vein thrombosis and an allergic to tinzaparin. The patient entered in critical care unit under medical supervision for a multivisceral infarction due to an arterial mesenteric, renal and splenic thrombosis. An heparinotherapy was introduced. A laparotomy was realized because of an occlusion. Small intestine necrozed was removed. 8 days after the introduction of the heparin, there was a thrombocytopenia. Considering the background and the initiale situation, an heparin-induced thrombocytopenia of type II (HTI) was suspected. Whereas the heparinotherapy was stopped, the thrombocytopenia maked worse. Biological tests infirmed HIT's diagnosis. A recurrent anemia in spite transfusions associated to a renal failure suggest a thrombotic microangiopathy which was secondary confirmed. The intensivist is sensibilized to evoke an heparin induced thrombocytopenia when there is a thrombocytopenia under heparin. However, he must not forget diagnosis of thrombocytopenia which required specific investigations and emergency treatment such as thrombotic microangiopathy.
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34
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Gilbert RD, Stanley LK, Fowler DJ, Angus EM, Hardy SA, Goodship TH. Cisplatin-induced haemolytic uraemic syndrome associated with a novel intronic mutation of CD46 treated with eculizumab. Clin Kidney J 2013; 6:421-425. [PMID: 24422172 PMCID: PMC3888095 DOI: 10.1093/ckj/sft065] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 05/23/2013] [Indexed: 01/09/2023] Open
Abstract
A 2-year-old patient with a neuroblastoma developed haemolytic uraemic syndrome (HUS) following treatment with cisplatin and carboplatin. Following treatment with eculizumab, there was a substantial improvement in renal function with the recovery of the platelet count and the cessation of haemolysis. Subsequent investigations showed a novel, heterozygous CD46 splice site mutation with reduced peripheral blood neutrophil CD46 expression. Withdrawal of eculizumab was followed by the recurrence of disease activity, which resolved with re-introduction of therapy. Abnormal regulation of complement may be associated with other cases of cisplatin-induced HUS and treatment with eculizumab may be appropriate for other affected individuals.
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Affiliation(s)
- Rodney D Gilbert
- Regional Paediatric Nephro-Urology Unit , University Hospital Southampton NHS Foundation Trust , Southampton , UK ; School of Medicine , University of Southampton , Southampton , UK
| | - Louise K Stanley
- Northern Molecular Genetics Service , International Centre for Life, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
| | - Darren J Fowler
- Department of Histopathology , University Hospital Southampton NHS Foundation Trust , Southampton , UK
| | - Elizabeth M Angus
- Biomedical Imaging Unit , University Hospital Southampton NHS Foundation Trust , Southampton , UK
| | - Steven A Hardy
- Northern Molecular Genetics Service , International Centre for Life, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
| | - Timothy H Goodship
- Institute of Genetic Medicine , Newcastle University, International Centre for Life , Newcastle upon Tyne , UK
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Szilágyi A, Kiss N, Bereczki C, Tálosi G, Rácz K, Túri S, Györke Z, Simon E, Horváth E, Kelen K, Reusz GS, Szabó AJ, Tulassay T, Prohászka Z. The role of complement in Streptococcus pneumoniae-associated haemolytic uraemic syndrome. Nephrol Dial Transplant 2013; 28:2237-45. [PMID: 23787556 DOI: 10.1093/ndt/gft198] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Atypical forms of haemolytic uraemic syndrome (aHUS) include HUS caused by defects in the regulation of alternative complement pathway and HUS linked to neuraminidase-producing pathogens, such as Streptococcus pneumoniae. Increasing data support a pathogenic role of neuraminidase in the development of S. pneumoniae-associated haemolytic uraemic syndrome (SP-HUS), but the role of complement has never been clarified in detail. Therefore, we aimed to investigate whether the pathologic complement profile and genetic risk factors of aHUS are present in patients with SP-HUS. METHODS Enrolling five patients with SP-HUS classical and alternative pathway activity, besides C3, C4, factors H, B, I and anti-factor H autoantibody levels were determined. The coding regions of CFH, CFI, CD46 (MCP), THBD, C3 and CFB genes were sequenced and the copy number of CFI, CD46, CFH and related genes were also analyzed. RESULTS We found that in the acute phase samples of SP-HUS patients, complement components C4, C3 and activity of the classical and alternative pathways were decreased, indicating severe activation and complement consumption, but most of these alterations normalized later in remission. Three of the patients carried mutations and risk haplotypes in complement-mediated aHUS associated genes. The identified mutations include a previously published CFI variant (P50A) and two novel ones in CFH (R1149X) and THBD (T44I) genes. CONCLUSIONS Our results suggest that severe complement dysregulation and consumption accompany the progress of invasive pneumococcal disease (IPD)-associated SP-HUS and genetic variations of complement genes may contribute to the development of this complication in a proportion of the affected patients.
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Affiliation(s)
- Agnes Szilágyi
- 3rd Department of Medicine, Research Laboratory, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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Keir L, Coward RJM. Advances in our understanding of the pathogenesis of glomerular thrombotic microangiopathy. Pediatr Nephrol 2011; 26:523-33. [PMID: 20949284 PMCID: PMC3043262 DOI: 10.1007/s00467-010-1637-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 06/21/2010] [Accepted: 07/08/2010] [Indexed: 12/27/2022]
Abstract
Glomerular thrombotic microangiopathy is a hallmark feature of haemolytic uraemic syndrome, the leading cause of acute renal failure in childhood. This paper is a review of the different mechanistic pathways that lead to this histological picture in the kidney. It will focus on atypical HUS and complement dysregulation, but will also highlight some other recent advances in our understanding of this condition, including the potential role of the molecule vascular endothelial growth factor-A (VEGF-A).
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Affiliation(s)
- Lindsay Keir
- Department of Medical Pediatrics, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK
| | - Richard J. M. Coward
- Academic and Children’s Renal Unit, University of Bristol and Bristol Royal Hospital for Children, Bristol, UK
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Farinha A, Carrilho P, Felgueiras J, Natário A, Assunção J, Vinhas J. Haemolytic uraemic syndrome associated with H1N1 influenza. NDT Plus 2010; 3:447-8. [PMID: 25984049 PMCID: PMC4421702 DOI: 10.1093/ndtplus/sfq126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 06/30/2010] [Indexed: 11/14/2022] Open
Abstract
Haemolytic uraemic syndrome (HUS) is one of the two forms of thrombotic microangiopathies and is characterized by the triad of microangiopathic haemolytic anaemia, thrombocytopaenia, and acute renal failure. It has been associated with bacterial and viral infections as well as non-infective causes. We report a subject who presented with HUS associated with an influenza-like syndrome which was confirmed as an influenza A (H1N1) infection. There are reports of HUS associated with seasonal influenza, but there have been no reported cases of HUS after novel influenza A (H1N1) in the literature so far.
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Affiliation(s)
- Ana Farinha
- Nephrology Department , Centro Hospitalar de Setúbal , E.P.E., Setúbal Portugal
| | - Patrícia Carrilho
- Nephrology Department , Centro Hospitalar de Setúbal , E.P.E., Setúbal Portugal
| | - Joana Felgueiras
- Nephrology Department , Centro Hospitalar de Setúbal , E.P.E., Setúbal Portugal
| | - Ana Natário
- Nephrology Department , Centro Hospitalar de Setúbal , E.P.E., Setúbal Portugal
| | - José Assunção
- Nephrology Department , Centro Hospitalar de Setúbal , E.P.E., Setúbal Portugal
| | - José Vinhas
- Nephrology Department , Centro Hospitalar de Setúbal , E.P.E., Setúbal Portugal
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Cochat P, Fargue S, Mestrallet G, Jungraithmayr T, Koch-Nogueira P, Ranchin B, Zimmerhackl LB. Disease recurrence in paediatric renal transplantation. Pediatr Nephrol 2009; 24:2097-108. [PMID: 19247694 PMCID: PMC2753770 DOI: 10.1007/s00467-009-1137-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 12/18/2008] [Accepted: 12/19/2008] [Indexed: 12/22/2022]
Abstract
Renal transplantation (Tx) is the treatment of choice for end-stage renal disease. The incidence of acute rejection after renal Tx has decreased because of improving early immunosuppression, but the risk of disease recurrence (DR) is becoming relatively high, with a greater prevalence in children than in adults, thereby increasing patient morbidity, graft loss (GL) and, sometimes, mortality rate. The current overall graft loss to DR is 7-8%, mainly due to primary glomerulonephritis (70-80%) and inherited metabolic diseases. The more typical presentation is a recurrence of the full disease, either with a high risk of GL (focal and segmental glomerulosclerosis 14-50% DR, 40-60% GL; atypical haemolytic uraemic syndrome 20-80% DR, 10-83% GL; membranoproliferative glomerulonephritis 30-100% DR, 17-61% GL; membranous nephropathy approximately 30% DR, approximately 50% GL; lipoprotein glomerulopathy approximately 100% DR and GL; primary hyperoxaluria type 1 80-100% DR and GL) or with a low risk of GL [immunoglobulin (Ig)A nephropathy 36-60% DR, 7-10% GL; systemic lupus erythematosus 0-30% DR, 0-5% GL; anti-neutrophilic cytoplasmic antibody (ANCA)-associated glomerulonephritis]. Recurrence may also occur with a delayed risk of GL, such as insulin-dependent diabetes mellitus, sickle cell disease, endemic nephropathy, and sarcoidosis. In other primary diseases, the post-Tx course may be complicated by specific events that are different from overt recurrence: proteinuria or cancer in some genetic forms of nephrotic syndrome, anti-glomerular basement membrane antibodies-associated glomerulonephritis (Alport syndrome, Goodpasture syndrome), and graft involvement as a consequence of lower urinary tract abnormality or human immunodeficiency virus (HIV) nephropathy. Some other post-Tx conditions may mimic recurrence, such as de novo membranous glomerulonephritis, IgA nephropathy, microangiopathy, or isolated specific deposits (cystinosis, Fabry disease). Adequate strategies should therefore be added to kidney Tx, such as donor selection, associated liver Tx, plasmatherapy, specific immunosuppression protocols. In such conditions, very few patients may be excluded from kidney Tx only because of a major risk of DR and repeated GL. In the near future the issue of DR after kidney Tx may benefit from alternatives to organ Tx, such as recombinant proteins, specific monoclonal antibodies, cell/gene therapy, and chaperone molecules.
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Affiliation(s)
- Pierre Cochat
- Centre de référence des maladies rénales rares, Inserm U, Hôpital Femme Mère Enfant & Université de Lyon, Bron, France.
| | - Sonia Fargue
- Medical Research Council Laboratory for Molecular Cell Biology, University College London, London, UK
| | - Guillaume Mestrallet
- Centre de référence des maladies rénales rares, Service de Pédiatrie & Inserm U820, Hôpital Femme Mère Enfant & Université de Lyon, 59 boulevard Pinel, 69677 Bron, France
| | | | - Paulo Koch-Nogueira
- Department of Pediatrics, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, Brazil
| | - Bruno Ranchin
- Centre de référence des maladies rénales rares, Service de Pédiatrie & Inserm U820, Hôpital Femme Mère Enfant & Université de Lyon, 59 boulevard Pinel, 69677 Bron, France
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Mark Taylor C. Enterohaemorrhagic Escherichia coli and Shigella dysenteriae type 1-induced haemolytic uraemic syndrome. Pediatr Nephrol 2008; 23:1425-31. [PMID: 18493800 PMCID: PMC2459235 DOI: 10.1007/s00467-008-0820-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Revised: 02/28/2008] [Accepted: 02/28/2008] [Indexed: 11/30/2022]
Abstract
Haemolytic uraemic syndrome (HUS) can be classified according to the aetiology of the different disorders from which it is composed. The most prevalent form is that induced by shigatoxin producing Escherichia coli (STEC) and, in some tropical regions, by Shigella dysenteriae type 1. STEC cause a zoonosis, are widely distributed in nature, enter the food chain in different ways, and show regional differences. Not all STEC are human pathogens. Enterohaemorrhagic E. coli usually cause attachment and effacing lesions in the intestine. This is not essential, but production of a shigatoxin (Stx) is. Because Stx are encoded by a bacteriophage, this property is transferable to naïve strains. Laboratory methods have improved by identifying STEC either via the toxin or its bacteriophage. Shigella dysenteriae type 1 produces shigatoxin, identical to Stx-1, but also has entero-invasive properties that enterohaemorrhagic Escherichia coli (EHEC) do not. Shigella patients risk bacteremia and benefit from early antibiotic treatment, unlike those with EHEC.
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Affiliation(s)
- C. Mark Taylor
- Department of Nephrology, Birmingham Children’s Hospital, Birmingham, B4 6NH UK
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Abstract
Clopidogrel has been reported to be safe and effective in reducing vascular events. Nevertheless, there is growing evidence that clopidogrel may cause thrombotic thrombocytopenic purpura/haemolytic uraemic syndrome (TTP/HUS). This association has been debated, since in several cases alternative causes could not be excluded. Two new cases of TTP/HUS associated with clopidogrel are reported here. After discontinuation of clopidogrel and treatment with plasma exchange, both patients had a complete and sustained recovery from TTP/HUS. These cases corroborate previous observations that clopidogrel may indeed be a rare cause of TTP/HUS.
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Affiliation(s)
- F Andersohn
- Institute of Clinical Pharmacology, Charité-University Medicine, Campus Charité Mitte, Schumannstrasse 20/21, 10117 Berlin, Germany.
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Proulx F, Wagner E, Toledano B, Decaluwe H, Seidman EG, Rivard GE. Mannan-binding lectin in children with Escherichia coli O157:H7 haemmorrhagic colitis and haemolytic uraemic syndrome. Clin Exp Immunol 2003; 133:360-3. [PMID: 12930361 PMCID: PMC1808800 DOI: 10.1046/j.1365-2249.2003.02231.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mannan-binding lectin (MBL) triggers complement activation upon binding to microbial surfaces. MBL deficiency has been associated with increased susceptibility to severe bacterial infections. We hypothesized that MBL deficiency may predispose children to Shiga toxin-producing Escherichia coli (STEC) O157:H7 infections and the associated haemolytic uraemic syndrome (HUS). We compared circulating levels of MBL among children with uncomplicated O157:H7 haemorrhagic colitis (HC), patients with O157:H7 HUS, normal and diseases control groups. Circulating MBL concentrations on admission were as follows: 3.22 +/- 2.43 micro g/ml among normal controls (n = 23); 2.90 +/- 2.44 micro g/ml in patients with rotavirus enteritis (n = 10); 2.78 +/- 1.65 micro g/ml in children with HC due to non-STEC bacterial pathogen (n = 15); 2.67 +/- 2.44 micro g/ml in patients with uncomplicated O157:H7 HC (n = 27); 2.80 +/- 2.97 micro g/ml in children with O157:H7 HUS (n = 15); 6.70 +/- 4.49 micro g/ml in patients with chronic renal failure unrelated to O157:H7 infection (n = 6). Higher MBL levels were found in patients with chronic renal failure compared to O157:H7 HC (P < 0.047). However, MBL concentrations <0.5 micro g/ml, which have been associated with MBL deficiency in relation to increased susceptibility to infections, were noted at comparable rates between the different groups (P = NS). Our data does not support that MBL deficiency may predispose to O157:H7 infections nor than the development of diarrhoea associated HUS.
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Affiliation(s)
- F Proulx
- Department of Paediatrics, Section of Intensive Care Medicine, Section of Haematology and Oncology and Section of Gastroenterology, Sainte-Justine Hospital, Montreal, Canada.
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Palermo M, Alves-Rosa F, Rubel C, Fernández GC, Fernández-Alonso G, Alberto F, Rivas M, Isturiz M. Pretreatment of mice with lipopolysaccharide (LPS) or IL-1beta exerts dose-dependent opposite effects on Shiga toxin-2 lethality. Clin Exp Immunol 2000; 119:77-83. [PMID: 10606967 PMCID: PMC1905548 DOI: 10.1046/j.1365-2249.2000.01103.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Haemolytic uraemic syndrome (HUS) has been closely associated with infection with a group of Shiga toxin-producing enterohaemorrhagic Eschericchia coli in young children. Shiga toxins (Stx) have been implicated as pathogenic agents of HUS by binding to the surface receptor of endothelial cells. LPS is a central product of the Gram-negative bacteria and several reports have documented that both LPS and Stx are important for disease development. In this study the reciprocal interactions between LPS and Stx2 are analysed in a mouse model. The results demonstrated that LPS was able to reduce or enhance Stx2 toxicity, depending on the dose and the timing of the injection. The involvement of the main early cytokines induced by LPS, tumour necrosis factor alpha (TNF-alpha) and IL-1beta, in those LPS opposite effects on Stx2 toxicity was evaluated. Stx2 toxicity was enhanced by in vivo injection of murine TNF-alpha and low doses of murine IL-1beta. However, at higher doses of IL-1beta which induced corticosteroid increase in serum, Stx2 lethality was decreased. Considering that dexamethasone and IL-1beta reproduce the LPS protective effects, it is suggested that endogenous corticosteroids secondary to the inflammatory response induced by LPS, mediate the protection against Stx2. It can be concluded that the fine equilibrium between proinflammatory and anti-inflammatory activities strongly influences Stx2 toxicity.
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Affiliation(s)
- M Palermo
- División Inmunología, Instituto de Investigaciones Hematológicas, Academia Nacional de Medicina, Infecciosas, ANLIS, Buenos Aires, Argentina.
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Abstract
The haemolytic uraemic syndrome (HUS) is a clinical syndrome consisting of haemolytic anaemia, thrombocytopenia, and acute renal insufficiency. HUS is the most frequent cause of acute renal failure in childhood. It has been previously suggested that the presence of Shiga toxin (Stx) is necessary but not sufficient for HUS development, and cytokines such as tumour necrosis factor-alpha (TNF-alpha) and IL-1beta appear to be necessary to develop the syndrome. Since the mononuclear phagocytic system (MPS) is the major source of these cytokines, macrophages might be one of the relevant targets for Stx action in the pathophysiology of HUS. In this study our objective was to examine the role of the hepatic and splenic macrophages in a mouse model of HUS induced by injection of Shiga toxin type-2 (Stx2) or Stx2 plus lipopolysaccharide (LPS). For this purpose, depletion of mice macrophages by liposome-encapsulated clodronate (lip-clod), followed by injection of STx2 or Stx2 plus LPS, was assayed. In this study we show that depletion of hepatic and splenic macrophages by clodronate treatment induces a survival of 50% in animals treated with Stx2 alone or in presence of LPS. This maximal effect was observed when lip-clod was injected 48-72 h before Stx2 injection. Biochemical and histological parameters show characteristics of the lesion produced by Stx2, discarding non-specific damage due to LPS or lip-clod. In addition, we determined that the toxic action of Stx2 is similar in BALB/c and N:NIH nude mice, indicating the T cell compartment is not involved in the Stx2 toxicity. Briefly, we demonstrate that macrophages play a central role in the pathophysiology of HUS, and that the systemic production of cytokines by liver and/or spleen is for Stx2 to manifest its full cytotoxic effect. In addition, the toxicity of Stx2 alone, or in presence of LPS, is independent of the T cell compartment.
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Affiliation(s)
- M S Palermo
- División Inmunología, Instituto de Investigaciones Hematológicas, Academia Nacional de Medicina, Buenos Aires, Argentina
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