A case of haemolytic uraemic syndrome (HUS) revealed an outbreak of Shiga toxin-2-producing Escherichia coli O26:H11 infection in a nursery, with long-lasting shedders and person-to-person transmission, Italy 2015

Scavia, Gaia; Gianviti, Alessandra; Labriola, Vincenzo; Chiani, Paola; Maugliani, Antonella; Michelacci, Valeria; Minelli, Fabio; Tozzoli, Rosangela; Caprioli, Alfredo; Morabito, Stefano

doi:10.1099/jmm.0.000738

Cited by 20 publications

(13 citation statements)

References 74 publications

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“…The most common serogroup was O26 (36.1%), particularly in children aged less than 2 years (63.1%). These data were in accordance with the serogroup results reported for HUS cases in Italy and the Apulia region in particular over the last few years [13,15,22,23]. In a 1-year prospective cohort study conducted in a single hospital in Missouri on 108 patients younger than 18 years with BD, McKee et al found a STEC infection prevalence of 9% (10 cases) [20].…”

Section: Discussionsupporting

confidence: 88%

Case-management protocol for bloody diarrhea as a model to reduce the clinical impact of Shiga toxin-producing Escherichia coli infections. Experience from Southern Italy

Loconsole

Giordano

Laforgia

et al. 2019

Eur J Clin Microbiol Infect Dis

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To describe an operating protocol for bloody diarrhea (BD) in a pediatric population as a rapid response to a public health threat represented by an excess of pediatric HUS cases in the Apulia region (Southern Italy) starting from 2013. The protocol was set up with the goal of correct clinical management of Shiga toxin-producing Escherichia coli (STEC) infections, reductions in subsequent cases of hemolytic uremic syndrome (HUS), and improved short-and long-term disease outcomes. The protocol consisted of rapid hospitalization of children with bloody diarrhea (BD), hematochemical laboratory tests every 12-24 hours, and prompt laboratory diagnosis of STEC. No antibiotics were recommended until diagnosis. Children positive for STEC infections underwent early vigorous volume expansion. In June-December 2018, 438 children with BD were hospitalized, of which 53 (12.1%) had a STEC infection. The most common serogroups were O26 (36.1%), O111 (23.0%), and O157 (14.8%). Thirty-one samples carried the stx2 gene. Four cases evolved into HUS (7.5%), all with favorable outcome despite neurological involvement in two cases. Prompt and accurate laboratory diagnosis of STEC infections is of the utmost importance in patients with BD for correct clinical management. The strict adherence to the protocol could reduce the progression rate of STEC infections to HUS and prevents complications. Enhanced BD surveillance may help reduce cases of pediatric HUS in Southern Italy.

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Section: Discussionsupporting

confidence: 88%

Case-management protocol for bloody diarrhea as a model to reduce the clinical impact of Shiga toxin-producing Escherichia coli infections. Experience from Southern Italy

Loconsole

Giordano

Laforgia

et al. 2019

Eur J Clin Microbiol Infect Dis

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“…However, PFGE has limited typing resolution in some isolates, especially in EHEC O121 [13]. Therefore, we investigated the isolates in more detail by whole-genome sequence (WGS) analysis, which has been widely implemented in EHEC surveillance [6, 8, 14]. High-resolution phylogenetic analysis and the complete sequence of an extended-spectrum β-lactamase (ESBL) plasmid provided direct evidence of plasmid transfer from a non-toxigenic E.…”

Section: Introductionmentioning

confidence: 99%

“…If necessary, EHEC isolates are collected in the National Institute of Infectious Diseases, Japan, and nation-wide surveillance of the bacterium has been performed using multilocus variable-number tandem-repeat analysis for serogroups O157, O26, O111, O91, O103, O121, O145 and O165, and pulsed-field gel electrophoresis (PFGE) for the other serogroups [4, 5]. Although serogroup O157 is currently the most dominant serotype in Japan, several reports have described nursery outbreaks by non-O157 EHEC [6–11]. EHEC infections often spread via secondary infection, probably due to EHEC’s low infectious dose.…”

Section: Introductionmentioning

confidence: 99%

Enterohaemorrhagic Escherichia coli O121:H19 acquired an extended-spectrum β-lactamase gene during the development of an outbreak in two nurseries

et al. 2019

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“…In our study, ten STEC infections were identified in the household contacts of STEC cases, probably indicating an exposure to the same source of infection or person-to-person transmission. The latter transmission route is common in childcare settings [13,37]. Further investigations into the carriage by, or infection of, household contacts are needed in order to allow a better evaluation of the role of person-to-person transmission within family settings and to elucidate further the sources of infection in young children and infants.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Shiga Toxin-Producing Escherichia coli Infections in Southern Italy after Implementation of Symptom-Based Surveillance of Bloody Diarrhea in the Pediatric Population

Loconsole

Giordano

Centrone

et al. 2020

IJERPH

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Shiga toxin-producing Escherichia coli (STEC) infections result in a significant public health impact because of the severity of the disease that, in young children especially, can lead to hemolytic–uremic syndrome (HUS). A rise in the number of HUS cases was observed in the Apulia region of Italy from 2013 to 2017, and so, in 2018, a symptom-based surveillance system for children with bloody diarrhea (BD) was initiated in order to detect and manage STEC infections. The objective of the study was to describe the epidemiology of STEC infections in children from June 2018 to August 2019. Children <15 years old with BD were hospitalized and tested for STEC. Real-time PCR for virulence genes (stx1, stx2, eae) and serogroup identification tests were performed on stool samples/rectal swabs of cases. STEC infection was detected in 87 (10.6%) BD cases. The median age of STEC cases was 2.7 years, and 60 (68.9%) were <4. Of these 87 cases, 12 (13.8%) came from households with diarrhea. The reporting rate was 14.2/100,000, with the highest incidence in cases from the province of Bari (24.2/100,000). Serogroups O26 and O111 were both detected in 22/87 (25.3%) cases. Co-infections occurred in 12.6% of cases (11/87). Twenty-nine STEC were positive for stx1, stx2, and eae. Five cases (5.7%) caused by O26 (n = 2), O111 (n = 2), and O45 (n = 1) developed into HUS. A risk-oriented approach based on the testing of children with BD during the summer may represent a potentially beneficial option to improve the sensitivity of STEC surveillance, not only in Italy but also in the context of Europe as a whole.

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A case of haemolytic uraemic syndrome (HUS) revealed an outbreak of Shiga toxin-2-producing Escherichia coli O26:H11 infection in a nursery, with long-lasting shedders and person-to-person transmission, Italy 2015

Cited by 20 publications

References 74 publications

Case-management protocol for bloody diarrhea as a model to reduce the clinical impact of Shiga toxin-producing Escherichia coli infections. Experience from Southern Italy

Case-management protocol for bloody diarrhea as a model to reduce the clinical impact of Shiga toxin-producing Escherichia coli infections. Experience from Southern Italy

Enterohaemorrhagic Escherichia coli O121:H19 acquired an extended-spectrum β-lactamase gene during the development of an outbreak in two nurseries

Epidemiology of Shiga Toxin-Producing Escherichia coli Infections in Southern Italy after Implementation of Symptom-Based Surveillance of Bloody Diarrhea in the Pediatric Population

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