Management of STEC Gastroenteritis: Is There a Role for Probiotics?

Mario Giordano,Maria Elisabetta Baldassarre,Federica Di Mauro,Diletta D Torres,Manuela Capozza,Raffaella Panza,Vincenza Carbone,Nicola Laforgia,Viviana Palmieri,Antonio Di Mauro,Luisa Santangelo,Federico Gentile

doi:10.3390/ijerph16091649

Abstract

Shiga toxin-producing Escherichia Coli (STEC) infections routinely run as a common gastroenteritis, but in many cases they may evolve towards hemolytic uremic syndrome (HUS). HUS is a rare disease characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. Gut microorganisms have a fundamental impact on human physiology, because they modulate normal intestinal functions and play a pivotal role in influencing the local and systemic immune responses. Despite surveillance established in many countries and major progresses in the understanding of STEC-HUS mechanisms, no specific treatment is currently available. Targeting the gut microbiota could represent a new potential therapeutic strategy in STEC infection. In this paper, we reviewed the current knowledge about microbiota characteristics of patients with STEC infections, as well as in vitro and in vivo evidence of probiotic supplementation in managing STEC gastroenteritis and in HUS onset prevention.

Highlights

These results represent the first evidence of changes occurring in the intestinal microbiota of children during Shiga toxin-producing Escherichia Coli (STEC) infection [32]
We reviewed the scientific evidence of gut microbiota manipulation with probiotic in STEC gastroenteritis
Data obtained in vivo and in vitro cannot be extrapolated to humans and only clinical trials in humans will allow the determination of effective probiotic strains and doses

Summary

Introduction

Shiga Toxin-Producing Escherichia Coli (STEC) Gastroenteritis and Hemolytic Uremic Syndrome. In 15% of cases, STEC infection evolves into HUS, which features a pathognomonic symptomatic triad: anemia, thrombocytopenia and acute kidney injury [3]. Mortality rates are 1–4% in children during the acute phase of the disease [16]. Long-term sequelae (proteinuria, hypertension, chronic kidney disease, and neurological impairment) are estimated to occur in 25% of STEC-HUS patients four years later; 3% develop end-stage renal disease [17]. Dialysis was required in 48% of affected children during the acute phase [18]. These data are substantially in line with those found in developed countries. Strong information about the same data in less developed countries, where childhood diarrheal diseases are endemic, is missing [19]

The Human Gut Microbiota

Methods

Probiotics

Findings

Conclusions