Abstract
In summer 2013, an excess of paediatric cases of haemolytic uraemic syndrome (HUS) in a southern region of Italy prompted the investigation of a community-wide outbreak of Shiga toxin 2-producing Escherichia coli (STEC) O26:H11 infections. Case finding was based on testing patients with HUS or bloody diarrhoea for STEC infection by microbiological and serological methods. A case–control study was conducted to identify the source of the outbreak. STEC O26 infection was identified in 20 children (median age 17 months) with HUS, two of whom reported severe neurological sequelae. No cases in adults were detected. Molecular typing showed that two distinct STEC O26:H11 strains were involved. The case–control study showed an association between STEC O26 infection and consumption of dairy products from two local plants, but not with specific ready-to-eat products. E.coli O26:H11 strains lacking the stx genes were isolated from bulk milk and curd samples, but their PFGE profiles did not match those of the outbreak isolates. This outbreak supports the view that infections with Stx2-producing E. coli O26 in children have a high probability of progressing to HUS and represent an emerging public health problem in Europe.
Highlights
Haemolytic uraemic syndrome (HUS) is a rare disorder characterised by microangiopathic haemolysis, platelet consumption, and multi-organ damage [1]
Shiga toxin 2-producing Escherichia coli (STEC) O157 is the predominant cause of paediatric HUS worldwide [1], cases associated with infections with STEC belonging to non-O157 serogroups have been increasingly reported [2,3,4,5]
This report describes the largest outbreak of STECassociated HUS ever observed in Italy
Summary
Haemolytic uraemic syndrome (HUS) is a rare disorder characterised by microangiopathic haemolysis, platelet consumption, and multi-organ damage (mainly to the kidneys) [1]. HUS is the most common cause of acute renal failure in childhood and occurs in ca 15% of children with STEC O157 infections [1]. STEC O157 is the predominant cause of paediatric HUS worldwide [1], cases associated with infections with STEC belonging to non-O157 serogroups have been increasingly reported [2,3,4,5]. In Italy, surveillance of HUS in children (< 15 years) was established in 1988 through the National Registry of HUS, carried out by the Italian Society for Paediatric Nephrology in cooperation with the National Reference Laboratory for E. coli [4]. Between 1988 and 2012, an average of 33 sporadic cases of HUS per year were observed in Italy, with a mean annual incidence of 0.4 cases per 100,000 residents aged 0–15 years. The STEC serogroups most frequently reported were O157 (35%), O26 (26%), O145 (12%), O111 (10%) and O103 (5%) [6]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
