Early findings in outbreak of haemolytic uraemic syndrome among young children caused by Shiga toxin-producing Escherichia coli, Romania, January to February 2016

Peron, Emilie; Zaharia, Alina; Zota, Lavinia; Severi, Ettore; Mårdh, Otilia; Usein, Codruta Romanita; Bălgrădean, Mihaela; Espinosa, Laura; Jansà, Josep M.; Scavia, Gaia; Rafilă, Alexandru; Serban, Amalia; Pistol, Adriana

doi:10.2807/1560-7917.es.2016.21.11.30170

Cited by 22 publications

(22 citation statements)

References 13 publications

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“…Hemolytic uremic syndrome (HUS) is described as a multisystemic disease 6,7 that affects mainly the kidney and is a major cause of morbidity and mortality in children under the age of 5 years old 1 . The kidney and brain are the main target organs affected in patients with HUS 2 .…”

Section: Discussionmentioning

confidence: 99%

“…Hemolytic uremic syndrome (HUS) is a hemorrhagic systemic microangiopathy, which primarily affects the kidney and is defined by the triad: acute renal failure, microangiopathic hemolytic anemia, and thrombocytopenia 1 . HUS often affects the central nervous system (CNS), neurological involvement representing a major cause of morbidity and mortality in children less than 5 years old 2 .…”

Section: Introductionmentioning

confidence: 99%

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Neurological complications in patients with typical hemolytic uremic syndrome

Costin¹,

BANULESCU²,

Atanasescu³

et al. 2020

Arch Balk Med Union

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neurological complications in patients with typical hemolytic uremic syndrome

Costin¹,

BANULESCU²,

Atanasescu³

et al. 2020

Arch Balk Med Union

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“…No stool samples were available for the initial cases whose serum samples were tested for antibodies to the lipopolysaccharide (LPS) of the major STEC serogroups (O157, O26, O103, O111, O145 and O55) by ELISA [11]. For later cases, culture enrichments of stool samples were tested by PCR to detect the presence of Shiga toxinencoding (stx1 and stx2) and intimin-encoding (eae) genes [13].…”

Section: Microbiological Investigation In Human Samplesmentioning

confidence: 99%

Multi‐country outbreak of Shiga toxin‐producing Escherichia coli infection associated with haemolytic uraemic syndrome

2016

EFSA Supporting Publications

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A multi-country outbreak of Shiga toxin-producing Escherichia coli (STEC) infection associated with haemolytic uraemic syndrome (HUS) and affecting mostly young children has been reported in the last two months in Romania. Italy reported one related HUS case through the Early Warning and Response System (EWRS) on 21 March 2016. Overall, 25 cases were identified as associated with this outbreak, of which 19 developed HUS and three died. Twelve cases had microbiological and/or serological evidence of STEC O26 infection; 13 additional cases met the probable case definition by developing HUS, testing positive for another STEC O serogroup (O157) or by testing positive by PCR for stx1 and/or stx2 and eae genes. Information collected from patients pointed towards a milk processing establishment (the Romanian operator) as a possible source of infection. The implicated milk processing establishment exported a particular type of cheese to four EU countries (Belgium, Germany, Italy and Spain) and one Italian importer further distributed this product to France and Germany. In Romania, one fresh cheese product made of cow's milk produced by the Romanian operator tested positive for E. coli O26 not possessing stx virulence genes. Other dairy products produced by the Romanian operator tested positive for E. coli virulence genes stx1, stx2 and eae. In Italy, a STEC O26 strain (positive for stx1, stx2 and eae) was isolated from a sample of the cheese that had been produced by the Romanian operator, imported from Romania and consumed by the Italian child that later developed HUS (stool samples negative for STEC but serum samples positive for the presence of antibodies against the LPS of E.coli O26). The PFGE analysis suggests the potential involvement of multiple strains from a common source or from multiple sources. Multi-strain STEC outbreaks have been reported in the past [1]. Therefore, it cannot be excluded that the cases belong to a single outbreak associated with a source contaminated by different strains. The epidemiological evidence linking some of the Romanian cases and the Italian case to the Romanian operator, in addition to the microbiological findings, are consistent with the hypothesis of a multi-strain outbreak. The last Romanian case associated with this outbreak had onset of symptoms on 14 March. The cheese consumed by the Italian case was imported in Italy from Romania on 1 March and had been produced on 18 February 2016 with an expiry date of 18 April 2016. A recall of the company products was undertaken in Romania as of 5 March and in Italy as of 15 March. Other Member States subsequently undertook recalls. According to information available at the time of conducting this assessment, the withdrawal of potentially contaminated dairy products following a recall has been limited in Member States, with the exception of Romania. It is therefore possible that affected products are still present in households, and detection of new cases cannot be excluded. In order to minimise the spread of the infection and...

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“…During the period December 2015eFebruary 2016, 15 cases of HUS were reported among children aged 5e38 months in southern Romania. 16 All the patients were hospitalized at the pediatric nephrology department of the "Marie Curie" Children's Hospital of Bucharest, Romania. Three patients died during this outbreak.…”

Section: Introductionmentioning

confidence: 99%