Bloody Diarrhea and Shiga Toxin–Producing Escherichia coli Hemolytic Uremic Syndrome in Children: Data from the ItalKid-HUS Network

Ardissino, Gianluigi; Vignati, Chiara; Masia, Carla; Capone, Valentina; Colombo, Raffaele; Tel, Francesca; Daprai, Laura; Testa, Sara; Dodaro, Antonella; Paglialonga, Fabio; Luini, M.; Brigotti, Maurizio; Picicco, Damiano; Baldioli, Carlo; Pagani, F.; Ceruti, Rossella; Tommasi, Paola; Possenti, Ilaria; Cresseri, Donata; Consonni, Dario; Montini, Giovanni; Arghittu, Milena

doi:10.1016/j.jpeds.2021.06.048

Cited by 21 publications

(8 citation statements)

References 24 publications

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“…12 Ardissino et al recommended that patients of bloody diarrhoea shall be screened for Shiga toxin gene and to detect renal complications as soon as feasible haemoglobinuria is suggested with the urine dipstick. 13 Mckee et al concluded in his study that at the time of presentation, D-dimer concentrations have insufficient sensitivity or specificity to distinguish between children with a Shiga toxin producing E .coli infection and those who had any other cause of bloody diarrhoea. D-dimer concentrations, on the other hand, might be able to separate infants with bloody diarrhoea with an infectious etiology from those with any other cause.…”

Section: Causes and Clinical Assessmentmentioning

confidence: 99%

Causes, clinical assessment and management of paediatric bloody diarrhoea

Alshaikh

Alshehri²,

Alsubaihi³

et al. 2022

Int J Community Med Public Health

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Despite being easily preventable and treatable, diarrhoea continues to be a serious public health problem in impoverished and emerging countries. It is a typical sign of gastrointestinal issues brought on by numerous pathogens, including bacteria, viruses, and protozoa. Particularly in developing nations it is of great concern as it is associated with considerable mortality and morbidity in children. Despite the decline in mortality rate, it is still the second leading cause of mortality among children under five years of age. Bloody diarrhoea is characterized by intestinal inflammation, particularly of the colon, stomach pain, and severe diarrhoea with blood or mucus in the faeces. It is also referred as dysentery. Among the bacteria and parasites that cause dysentery include Entamoeba histolytica, Shigella, Campylobacter, Salmonella, Schistosoma mansoni, and Campylobacter. The most common cause of this disease is Shigella. The purpose of this research is to review the available information about causes, clinical assessment and management of paediatric bloody diarrhoea. Stool culture is a standard diagnostic measure. Digestive issues and nutritional inadequacies are more frequent in children with bloody diarrhoea. Bloody diarrhoea often lasts longer and is more problematic than watery diarrhoea. It has a high percentage of case fatalities and adversely impacts a child's growth. Rehydration therapy shall be started immediately to prevent dehydration associated complications and fatalities. Treatment with fluoroquinolones as first-line medications, beta-lactams and cephalosporins as second-line medications is recommended. Further clinical research is however needed to define the clinical efficacy of available treatment and management strategies.

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Section: Causes and Clinical Assessmentmentioning

confidence: 99%

Causes, clinical assessment and management of paediatric bloody diarrhoea

Alshaikh

Alshehri²,

Alsubaihi³

et al. 2022

Int J Community Med Public Health

View full text Add to dashboard Cite

show abstract

“…In detail, a 50 μL fecal or rectal swab can be inoculated in MacConkey broth and incubated at 37 °C for 18–24 h. Then, DNA is extracted from the bacteria. After quantification, the genes of Stx1, Stx2, E. coli attaching and effacing gene ( eae ), enterohemorrhagic E. coli (EHEC) hemolysin ( hly ), and invasion plasmin antigen H (ipaH) gene could be identified [ 33 , 35 ]. The genes for Stx2 ( stx2 ) and intimin ( eae ) are found in STEC serotype O157 strains, which are associated with severe disease [ 36 , 37 ].…”

Section: Stec-hus Diagnosismentioning

confidence: 99%

“…EHEC hemolysin, which is an important virulence factor of EHEC, utilizes outer membrane vesicles to target mitochondria, causes the apoptosis of endothelial cells and epithelial cells, and ultimately mediates microvascular endothelial injury [ 38 ]. A PCR targeting the ipaH-gene could help with further distinguishing the presence of Shigella and enteroinvasive E. coli infection, which can also cause bloody diarrhea [ 35 , 39 ].…”

Section: Stec-hus Diagnosismentioning

confidence: 99%

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Diagnosis and Treatment for Shiga Toxin-Producing Escherichia coli Associated Hemolytic Uremic Syndrome

Liu

Thaker

Wang

et al. 2022

Toxins

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Shiga toxin-producing Escherichia coli (STEC)-associated hemolytic uremic syndrome (STEC-HUS) is a clinical syndrome involving hemolytic anemia (with fragmented red blood cells), low levels of platelets in the blood (thrombocytopenia), and acute kidney injury (AKI). It is the major infectious cause of AKI in children. In severe cases, neurological complications and even death may occur. Treating STEC-HUS is challenging, as patients often already have organ injuries when they seek medical treatment. Early diagnosis is of great significance for improving prognosis and reducing mortality and sequelae. In this review, we first briefly summarize the diagnostics for STEC-HUS, including history taking, clinical manifestations, fecal and serological detection methods for STEC, and complement activation monitoring. We also summarize preventive and therapeutic strategies for STEC-HUS, such as vaccines, volume expansion, renal replacement therapy (RRT), antibiotics, plasma exchange, antibodies and inhibitors that interfere with receptor binding, and the intracellular trafficking of the Shiga toxin.

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“…There are no data supporting treating these infections because they often resolve quickly, and there is no evidence that antibiotics shorten illness duration or lessen severity. Low-risk STEC almost never cause HUS [52]. Therefore, this particular outcome cannot be used to guide treatment approaches for these pathogens.…”

Section: Hospital-associated Infectionsmentioning

confidence: 99%

Why antibiotics should not be used to treat Shiga toxin-producing Escherichia coli infections

Tarr

Freedman

2021

Current Opinion in Gastroenterology

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Purpose of reviewThere has been much debate about treating Shiga toxin-producing Escherichia coli (STEC) infections with antibiotics. No data convincingly demonstrate that antibiotics are better than no antibiotic treatment at all, and many studies suggest antibiotics increase the risk of developing the hemolytic uremic syndrome (HUS). This topic is timely, because emerging technology enables rapid identification of STEC-infected patients, and we anticipate questions about management will increase. This review is designed to familiarize readers with the series of observations that underlie our recommendations. Recent findingsThe long debate over antibiotics in STEC infections appears resolved by gradually accruing information that show that antibiotics do not benefit infected patients. In fact, they are associated with an increased likelihood of developing HUS. A meta-analysis published in 2016 demonstrated that low risk of bias studies find a clear association between antibiotic use and development of HUS. Subsequent publications do not refute these findings.

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Bloody Diarrhea and Shiga Toxin–Producing Escherichia coli Hemolytic Uremic Syndrome in Children: Data from the ItalKid-HUS Network

Cited by 21 publications

References 24 publications

Causes, clinical assessment and management of paediatric bloody diarrhoea

Causes, clinical assessment and management of paediatric bloody diarrhoea

Diagnosis and Treatment for Shiga Toxin-Producing Escherichia coli Associated Hemolytic Uremic Syndrome

Why antibiotics should not be used to treat Shiga toxin-producing Escherichia coli infections

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