Abstract
Gastrointestinal infection with Shiga toxin-producing Escherichia coli (STEC) causes diarrhea, hemorrhagic colitis, and hemolytic uremic syndrome (HUS), characterized by hemolytic anemia, thrombocytopenia and acute renal failure. The main virulence factor of STEC is Shiga toxin (Stx), which is responsible for HUS development. STEC can produce Stx type 1 and/or 2 (Stx1, Stx2) and their variants, Stx2 being more frequently associated with severe cases of HUS. This pathology occurs in 5–15% of cases with STEC infection when Stx gain access to the bloodstream and causes damage in the target organs such as the kidney and brain. STEC infections affect mainly young children, although the large HUS outbreak with a new Stx2-producing STEC O104:H4 in Europe in 2011 involved more adults than children, and women were over-represented. Maternal infections during pregnancy are associated with adverse pregnancy outcomes. Studies in rats showed that Stx2 binds to the utero-placental unit and causes adverse pregnancy outcomes. In this article, we provide a brief overview of Stx2 action on placental tissues and discuss whether they might cause pregnancy loss or preterm birth.
Highlights
Shiga toxin-producing Escherichia coli (STEC) cause a significant public health risk due to contamination of food and water supplies
STEC produces gastrointestinal infections that may produce diarrhea and hemorrhagic colitis, and is the principal cause of hemolytic uremic syndrome (HUS), a systemic complication that is attributed to the action of Shiga toxins (Stx) [1]
Multiple serotypes of STEC have been isolated from hemorrhagic colitis cases, E. coli O157:H7 is the most prevalent serotype associated with HUS in children
Summary
Shiga toxin-producing Escherichia coli (STEC) cause a significant public health risk due to contamination of food and water supplies. STEC produces gastrointestinal infections that may produce diarrhea and hemorrhagic colitis, and is the principal cause of hemolytic uremic syndrome (HUS), a systemic complication that is attributed to the action of Shiga toxins (Stx) [1]. In Argentina, HUS is endemic and has the highest rate of pediatric cases globally over the last 10 years, with approximately 400 HUS cases reported annually. This results in an incidence of 10–17 cases per 100,000 children less than 5 years of age, and lethality of 1 and 4% [6]. Infections during pregnancy have been associated with higher incidence of spontaneous abortion, preterm birth or placental dysfunction [8,9]. To our knowledge, an increased risk of spontaneous abortion or preterm delivery in humans linked to STEC infection has not yet been evaluated
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