Falup-Pecurariu Oana, Lixandru Raluca Ileana, Cojocaru Emanuela, Csutak Katalin, Monescu Vlad, Muhsen Khitam, Falup-Pecurariu Cristian, Cohen Daniel
1Faculty of Medicine, Transilvania University, Brașov, Romania.
Department of Pediatrics, Children's Clinic Hospital, Brașov, Romania.
Gut Pathog. 2019 Sep 25;11:46. doi: 10.1186/s13099-019-0327-4. eCollection 2019.
Diarrheagenic () is an important cause of diarrheal diseases in both developing countries and industrialized countries. An outbreak of hemolytic uremic syndrome (HUS) in young children from southern Romania was reported in early 2016 and was attributed to Shiga toxin producing (STEC) O26 infection. The aim of this study was to determine the prevalence, demographic and clinical characteristics of STEC infections in children hospitalized with diarrhea in Brașov in the central region of Romania. We also described the occurrence of HUS among hospitalized children, close in time to the 2016 HUS outbreak in southern Romania.
A prospective study was conducted between March and December 2016 among 722 children aged 1-30 months hospitalized with acute diarrhea. Stool samples obtained from patients with diarrhea were tested for the presence of Shiga toxin type 1 (STX1) and type 2 (STX2) by an immunochromatographic assay, and other enteropathogens. Demographic and clinical information on cases of HUS diagnosed in the same hospital was obtained from medical records.
Overall 46/722 (6.4%) children (mean age 10.3 months, 32.6% females) hospitalized with diarrhea tested positive for STX1 or STX2; of these 79% were positive for both STX1 and STX2, 16% for STX2 only, and 5% for STX1 only. Bloody diarrhea, vomiting and fever were documented in 32.6%, 52.1% and 50.0%, respectively of patients with STEC infection. Eleven confirmed HUS cases (mean age 20 months, five females) were identified between 2014 and 2016 with prodromal diarrhea reported in 10 of them. Three of the 11 HUS patients required hemodialysis.
STEC prevalence among young children with diarrhea in Romania was high and the risk of HUS is emerging. The establishment of a systematic laboratory-based surveillance program including identification of the circulating STEC strains coupled with epidemiological investigation of HUS patients is warranted to determine the source and mode of transmission of STEC and prevent of STEC-associated diarrhea and HUS.
产志贺毒素大肠杆菌（STEC）是发展中国家和工业化国家腹泻病的重要病因。2016年初，罗马尼亚南部报告了一起幼儿溶血性尿毒症综合征（HUS）疫情，病因是产志贺毒素大肠杆菌O26感染。本研究的目的是确定罗马尼亚中部布拉索夫因腹泻住院儿童中STEC感染的患病率、人口统计学和临床特征。我们还描述了住院儿童中HUS的发生情况，时间上与2016年罗马尼亚南部的HUS疫情相近。
2016年3月至12月，对722名1至30个月因急性腹泻住院的儿童进行了一项前瞻性研究。通过免疫层析法检测腹泻患者粪便样本中1型志贺毒素（STX1）和2型志贺毒素（STX2）以及其他肠道病原体的存在情况。从病历中获取同一家医院诊断出的HUS病例的人口统计学和临床信息。
总体而言，722名因腹泻住院的儿童中有46名（6.4%）（平均年龄10.3个月，女性占32.6%）STX1或STX2检测呈阳性；其中79%的患者STX1和STX2均呈阳性，16%仅STX2呈阳性，5%仅STX1呈阳性。STEC感染患者中分别有32.6%、52.1%和50.0%出现血性腹泻、呕吐和发热症状。2014年至2016年期间共确诊11例HUS病例（平均年龄20个月，5名女性），其中10例有前驱腹泻症状。11例HUS患者中有3例需要进行血液透析。
罗马尼亚腹泻幼儿中STEC患病率较高，HUS风险正在显现。有必要建立一个基于实验室的系统监测项目，包括识别流行的STEC菌株以及对HUS患者进行流行病学调查，以确定STEC的来源和传播方式，预防STEC相关腹泻和HUS。
