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Hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli infection in Argentina: update of serotypes and genotypes and their relationship with severity of the disease

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Abstract

Background

Shiga toxin-producing Escherichia coli (STEC) infection is the most common cause of hemolytic uremic syndrome (HUS). Only few studies correlated serotypes and stx genotypes with disease severity. This study aimed to update STEC serotypes, stx genotypes, and virulence factors (eae and ehxA) in a cohort of patients with STEC-HUS and investigate whether they influence the severity of disease.

Methods

In this multicentric study, children hospitalized between 2005 and 2016 with STEC-HUS confirmed by the National Reference Laboratory were included. Serotypes (O157, O145, O121, and others), stx genotypes (stx1a, stx2a, stx2c, stx2d, and others), and virulence factors were analyzed, and their association with dialysis requirement (>10 days); severe neurological, cardiovascular, and/or bowel involvement; and death was assessed.

Results

The records of 280 patients were reviewed; 160 females, median age 21 months (IQR18m). STEC O157 was isolated in 206 (73.6%) patients, O145 in 47 (16.8%), O121 in 15 (5.4%), and other serotypes in 12 (4.2%). The stx2a/2c genotype was carried by 179 (63.9%) strains, stx2a by 94 (33.6%), stx1a/stx2a by five (1.8%), and stx1a only by two (0.7%). All strains except six harbored eae and ehxA genes. Fifty-nine (21.1%) patients had severe neurological involvement, 29 (10.4%) severe bowel injury, 14 (5%) cardiovascular involvement, 53 (18.9%) required > 10 days of dialysis, and 12 (4.3%) died. Neither serotypes nor stx genotypes detected were significantly linked to severity.

Conclusions

Serotype O157 and virulence stx2a/2c, eae, ehxA genotype are prevalent in Argentina, and no relationship was found between severity and serotypes and genotypes of STEC detected.

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Acknowledgements

We thank Eugenia Elorza and Fernanda Villarreal for their assistance in the statistical analysis.

Author information

Authors and Affiliations

  1. Pediatric Nephrology Unit, Pediatric Department, Hospital Interzonal Dr. José Penna Bahía Blanca, Las Lomas 217, (8000) Bahía Blanca, Buenos Aires, Argentina

    Laura F. Alconcher

  2. Nephrology Unit, Hospital General de Niños Pedro de Elizalde CABA, Buenos Aires, Argentina

    Alejandro Balestracci

  3. Pediatric Nephrology Division, Department of Pediatrics, Hospital Italiano Ciudad Autónoma de Buenos Aires (CABA), Buenos Aires, Argentina

    Paula A. Coccia

  4. Department of Nephrology, Hospital de Niños Sor María Ludovica La Plata, Buenos Aires, Argentina

    Angela del C. Suarez

  5. Pediatric Nephrology Division, Department of Pediatrics, Hospital Dr. Castro Rendon Neuquén, Neuquén, Argentina

    Flavia B. Ramírez

  6. Hospital Nacional de Pediatría JP Garrahan CABA, Buenos Aires, Argentina

    Marta L. Monteverde

  7. Department of Nephrology, Hospital de Niños San Justo, Buenos Aires, Argentina

    María Graciela Perez y Gutiérrez

  8. Pediatric Nephrology Division, Department of Pediatrics, Hospital Posadas, Buenos Aires, Argentina

    Paula M. Carlopio

  9. Department of Nephrology, Hospital Pediátrico Humberto J Notti Mendoza, Mendoza, Argentina

    Illiana Principi

  10. Dirección de Epidemiología de La Pampa - Hospital Lucio Molas, Santa Rosa, La Pampa, Argentina

    Patricia Estrella

  11. Department of Nephrology, Hospital del Niño Jesús, San Miguel de Tucumán, Tucumán, Argentina

    Susana Micelli

  12. Department of Pediatrics, Hospital Interzonal de Agudos Abrahan Piñeyro Junín, Buenos Aires, Argentina

    Daniela C. Leroy

  13. Hospital Infantil Municipal Córdoba, Córdoba, Argentina

    Nahir E. Quijada

  14. Hospital Provincial de Córdoba, Córdoba, Argentina

    Claudia Seminara

  15. Complejo Sanitario San Luis, San Luis, Argentina

    Marta I. Giordano

  16. Department of Nephrology, Hospital Juan Pablo II, Corrientes, Argentina

    Susana B. Hidalgo Solís

  17. Hospital Público Materno Infantil de Salta, Salta, Argentina

    Mariana Saurit

  18. Department of Nephrology, Hospital Provincial de Santa Fé, Santa Fé, Argentina

    Alejandra Caminitti

  19. Department of Nephrology, Hospital Materno Infantil Dr. Héctor Quintana Jujuy, San Salvador de Jujuy, Argentina

    Andrea Arias

  20. Department of Nephrology, Hospital Gutiérrez CABA, Buenos Aires, Argentina

    Miguel Liern

  21. Instituto Nacional de Enfermedades Infecciosas-ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires, Argentina

    Marta Rivas

Authors
  1. Laura F. Alconcher
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  2. Alejandro Balestracci
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  3. Paula A. Coccia
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  4. Angela del C. Suarez
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  5. Flavia B. Ramírez
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  6. Marta L. Monteverde
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  7. María Graciela Perez y Gutiérrez
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  8. Paula M. Carlopio
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  10. Patricia Estrella
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  11. Susana Micelli
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  14. Claudia Seminara
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  15. Marta I. Giordano
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  16. Susana B. Hidalgo Solís
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  17. Mariana Saurit
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  18. Alejandra Caminitti
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  19. Andrea Arias
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  20. Miguel Liern
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  21. Marta Rivas
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Corresponding author

Correspondence to Laura F. Alconcher.

Ethics declarations

This was a multicentric, observational, retrospective, and cross-sectional study. The Review Boards and Ethics Committees of the participating centers approved this study. The requirement to obtain informed consent was waived by the institutional review boards.

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The authors declare no competing interests.

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Alconcher, L.F., Balestracci, A., Coccia, P.A. et al. Hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli infection in Argentina: update of serotypes and genotypes and their relationship with severity of the disease. Pediatr Nephrol 36, 2811–2817 (2021). https://doi.org/10.1007/s00467-021-04988-y

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