Epidemiology and Characterization of Shiga Toxin-Producing Escherichia Coli of Hemolytic Uremic Syndrome in Argentina.

Jeronimo F Torti,Marcela Pizarro,Andrea Nardello,Paula Cuervo

doi:10.7759/cureus.17213

Jeronimo F Torti, Marcela Pizarro + Show 2 more

Open Access

https://doi.org/10.7759/cureus.17213

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Journal: Cureus	Publication Date: Aug 16, 2021
Citations: 10	License type: cc-by

Affiliation: National University of Cuyo

Abstract

Argentina has one of the highest prevalence in Shiga toxin-producing Escherichia coli (STEC) and the high rate of hemolytic uremic syndrome (HUS) in the world. Though preventive steps such as food safety have been implemented as a way to reduce STEC infections, these have proven to be insufficient. STEC's pathogenesis, virulence factors, relationship with the environment, and emerging strains have been studied in the past few years in the country. Many factors that contribute to the morbidity and mortality of STEC infections include the expression of pathologic genes, alternative characteristics (inhibition of phagocytosis, invasion, cytotoxicity, and bacterial attachment), and host factors (age, immune status, treatments, medical history). However, research studies in combination with epidemiological data suggest trends of the prognosis, with the relationship between and genetic combinations of adherence, Shiga toxin (Stx) genes, and virulence genes, which significantly influence disease outcomes. This review explains the characteristics and epidemiology of STEC in Argentina. All these facts show that the application of molecular subtyping techniques in real-time is essential for detecting and controlling outbreaks. Applying molecular subtyping techniques in hemorrhagic diarrhea can avoid severe consequences caused by progression to HUS, and help the epidemiological analysis of the outbreak.

Highlights

BackgroundEscherichia coli (E. coli) is part of the healthy microbiota of any mammal gastrointestinal tract
The Stx2a and Stx2c subtypes are frequently associated with bloody diarrhea (BD) and hemolytic uremic syndrome (HUS) cases, but the risk of developing HUS after infection with Shiga toxin-producing E. coli (STEC) of the Stx2a genotype has been significantly lower than after infection with STEC of the Stx2c genotype [19]
The strain harbored Stx2a associated with STEC and AggR genes associated with enteroaggregative E. coli (EAEC) [30]

Summary

Introduction

Escherichia coli (E. coli) is part of the healthy microbiota of any mammal gastrointestinal tract. The Stx2a and Stx2c subtypes are frequently associated with BD and HUS cases, but the risk of developing HUS after infection with STEC of the Stx2a genotype has been significantly lower than after infection with STEC of the Stx2c genotype [19] These strains, whose predominant Stx genotype is Stx2a + Stx2c, have acquired factors that increase their ability to cause severe disease and circulate almost exclusively in Argentina, representing more than 80% of human clinical isolates [25]. AREXHX01.011 pattern was the most common pattern, associated with human disease and food and animals, with circulation throughout the country [23] This pattern corresponds to E. coli O157 strains carrying the Stx2/ Stx2c genotype with high pathogenic power. The strain harbored Stx2a associated with STEC and AggR genes associated with EAEC [30]

Conclusions

Disclosures

Findings

Wolf MK