- Publikační typ
- abstrakt z konference MeSH
Diarrhea-associated hemolytic uremic syndrome is characterized by hemolytic anemia, thrombocytopenia, and acute kidney injury secondary to enteric infection, typically Shiga toxin-producing Escherichia coli. Shiga toxin 2 is able to activate alternative complement pathways; therefore, the aim of the study was to analyze C3 as a predictor of clinical courses in patients with diarrhea-associated hemolytic uremic syndrome. We hypothesized that the patients with increased complement activation at admission suffered from a more severe course. We retrospectively analyzed data of 33 pediatric patients between 1999 and 2015 in the Czech Republic. We tested the association of a C3 concentration with biochemical parameters and the clinical data reflecting the severity of the disease. We found significant correlation between the initial C3 and the duration of renal replacement therapy (r = - 0.62, p = 0.0001) and the initial glomerular filtration rate (r = 0.36, p = 0.026). Patients with C3 < 0.825 g/L needed renal replacement therapy and also had significantly more renal complications (p = 0.015).Conclusion: Based on our study, decreased C3 concentrations can be used as one of the risk factors that can help predict the need for acute dialysis and a more severe course of disease in children with diarrhea-associated hemolytic uremic syndrome. What is Known: • Shiga toxin modulates the function of complement regulatory proteins and thus contributes to complement activation in patients with diarrhea-associated hemolytic uremic syndrome. • Risk factors that can predict the need for acute renal replacement therapy and poor outcome in patients with diarrhea-associated hemolytic uremic syndrome are mainly the combination of oligoanuria, dehydration, leukocytosis, high hematocrit > 23%, and neurological involvement. What is New: • A lowered concentration of C3 at the time of initial presentation of diarrhea-associated hemolytic uremic syndrome was associated with more severe renal failure and the need for renal replacement therapy along with the development of more extra renal complications. • Decreased C3 at admission can predict complicated course of diarrhea-associated hemolytic uremic syndrome.
- MeSH
- aktivace komplementu imunologie MeSH
- biologické markery krev MeSH
- dialýza ledvin statistika a číselné údaje MeSH
- dítě MeSH
- hemolyticko-uremický syndrom komplikace imunologie MeSH
- kojenec MeSH
- komplement C3 analýza MeSH
- ledviny patofyziologie MeSH
- lidé MeSH
- předškolní dítě MeSH
- prognóza MeSH
- průjem komplikace imunologie MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- ROC křivka MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: Enterohemorrhagic Escherichia coli (EHEC) O26:H11/H-, the most common non-O157 serotype causing hemolytic uremic syndrome worldwide, are evolutionarily highly dynamic with new pathogenic clones emerging rapidly. Here, we investigated the population structure of EHEC O26 isolated from patients in several European countries using whole genome sequencing, with emphasis on a detailed analysis of strains of the highly virulent new European clone (nEC) which has spread since 1990s. RESULTS: Genome-wide single nucleotide polymorphism (SNP)-based analysis of 32 EHEC O26 isolated in the Czech Republic, Germany, Austria and Italy demonstrated a split of the nEC (ST29C2 clonal group) into two distinct lineages, which we termed, based on their temporal emergence, as "early" nEC and "late" nEC. The evolutionary divergence of the early nEC and late nEC is marked by the presence of 59 and 70 lineage-specific SNPs (synapomorphic mutations) in the genomes of the respective lineages. In silico analyses of publicly available E. coli O26 genomic sequences identified the late nEC lineage worldwide. Using a PCR designed to target the late nEC synapomorphic mutation in the sen/ent gene, we identified the early nEC decline accompanied by the late nEC rise in Germany and the Czech Republic since 2004 and 2013, respectively. Most of the late nEC strains harbor one of two major types of Shiga toxin 2a (Stx2a)-encoding prophages. The type I stx2a-phage is virtually identical to stx2a-phage of EHEC O104:H4 outbreak strain, whereas the type II stx2a-phage is a hybrid of EHEC O104:H4 and EHEC O157:H7 stx2a-phages and carries a novel mutation in Stx2a. Strains harboring these two phage types do not differ by the amounts and biological activities of Stx2a produced. CONCLUSIONS: Using SNP-level analyses, we provide the evidence of the evolutionary split of EHEC O26:H11/H- nEC into two distinct lineages, and a recent replacement of the early nEC by the late nEC in Germany and the Czech Republic. PCR targeting the late nEC synapomorphic mutation in ent/sen enables the discrimination of early nEC strains and late nEC strains in clinical and environmental samples, thereby facilitating further investigations of their geographic distribution, prevalence, clinical significance and epidemiology.
- MeSH
- biologická evoluce * MeSH
- DNA bakterií MeSH
- enterohemoragická Escherichia coli klasifikace genetika izolace a purifikace MeSH
- fylogeneze MeSH
- genetická variace * MeSH
- genom bakteriální * MeSH
- genomika MeSH
- infekce vyvolané Escherichia coli diagnóza epidemiologie mikrobiologie MeSH
- lidé MeSH
- molekulární epidemiologie MeSH
- sekvenování celého genomu * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- dialýza ledvin využití MeSH
- dítě MeSH
- farmakoterapie MeSH
- feces mikrobiologie MeSH
- hemolyticko-uremický syndrom * diagnóza etiologie mikrobiologie terapie MeSH
- infekce vyvolané Escherichia coli přenos MeSH
- klinické laboratorní techniky MeSH
- lidé MeSH
- mikrobiologické techniky metody využití MeSH
- retrospektivní studie MeSH
- shiga toxin analýza škodlivé účinky MeSH
- shiga-toxigenní Escherichia coli MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
- Geografické názvy
- Česká republika MeSH
Shiga toxin-produkující Escherichia coli (STEC) jsou celosvětovými původci průjmového onemocnění a nejčastější příčinou vzniku hemolyticko-uremického syndromu (HUS) u dětí. Manifestace infekce STEC je různorodá. Zahrnuje průjmová onemocnění různé tíže, od nekomplikovaného průjmu přes hemoragickou kolitidu, až po rozvoj závažného systémového onemocnění – HUS, který patří mezi nejčastější příčiny akutního poškození ledvin zejména u malých dětí. Vzhledem k možné progresi průjmu v život ohrožující stav by měli být všichni lékaři ošetřující pacienty s průjmovým onemocněním obeznámeni s epidemiologií, patogenezí a klinickými příznaky infekce způsobené těmito bakteriemi. Článek pojednává o historii, epidemiologii, klinických aspektech a diagnostice infekcí STEC.
Shiga toxin-producing Escherichia coli (STEC) are an important cause of diarrhea and the major cause of typical form of hemolytic-uremic syndrome (HUS) worldwide. Manifestation of STEC infection can be diverse, from uncomplicated diarrhea through hemorrhagic colitis, to a serious systemic disease – HUS, that is the most common cause of acute kidney injury, especially in young children. Due to possible progression of diarrhea to life-threatening illness, all physicians treating patients with diarrhea should get familiar with the epidemiology, pathogenesis and clinical symptomes of infection caused by the organism. This article describes the history, epidemiology, pathogenesis, clinical aspects, and diagnostic methods of STEC infections.
- MeSH
- akutní poškození ledvin diagnóza komplikace MeSH
- dítě MeSH
- enterohemoragická Escherichia coli izolace a purifikace patogenita MeSH
- feces mikrobiologie MeSH
- hemolytické anemie diagnóza komplikace MeSH
- hemolyticko-uremický syndrom * diagnóza epidemiologie komplikace patofyziologie MeSH
- infekce vyvolané Escherichia coli diagnóza mikrobiologie MeSH
- lidé MeSH
- průjem etiologie komplikace mikrobiologie MeSH
- séroskupina MeSH
- shiga-toxigenní Escherichia coli * izolace a purifikace patogenita MeSH
- trombocytopenie diagnóza komplikace MeSH
- zdroje nemoci MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
