Abstract
The severity of human infection by one of the many Shiga toxin-producing Escherichia coli (STEC) is determined by a number of factors: the bacterial genome, the capacity of human societies to prevent foodborne epidemics, the medical condition of infected patients (in particular their hydration status, often compromised by severe diarrhea), and by our capacity to devise new therapeutic approaches, most specifically to combat the bacterial virulence factors, as opposed to our current strategies that essentially aim to palliate organ deficiencies. The last major outbreak in 2011 in Germany, which killed more than 50 people in Europe, was evidence that an effective treatment was still lacking. Herein, we review the current knowledge of STEC virulence, how societies organize the prevention of human disease, and how physicians treat (and, hopefully, will treat) its potentially fatal complications. In particular, we focus on STEC-induced hemolytic and uremic syndrome (HUS), where the intrusion of toxins inside endothelial cells results in massive cell death, activation of the coagulation within capillaries, and eventually organ failure.
Highlights
Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC-hemolytic and uremic syndrome (HUS)) belongs to the body of thrombotic microangiopathies [1], a heterogeneous group of diseases characterized by a triad of features: thrombocytopenia, mechanical hemolytic anemia with schistocytosis, and ischemic organ damage
These results could provide the rationale for the use of ART-123, a human recombinant thrombomodulin tested in the setting of disseminated intravascular coagulation [195] and acute exacerbations of idiopathic pulmonary fibrosis, in STEC-HUS
Likewise, during a diarrhea outbreak, rapid identification of enterohemorrhagic E. coli (EHEC) allows for timely epidemiological investigations and isolation measures that will prevent further spreading of the pathogen, as well as avoidance of antibiotic therapy and antimotility agents in cases of STEC-related disease [214]
Summary
Adrien Joseph 1 , Aurélie Cointe 2 , Patricia Mariani Kurkdjian 2 , Cédric Rafat 1 and Alexandre Hertig 3, *. Received: 29 December 2019; Accepted: 17 January 2020; Published: 21 January 2020
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