Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy.
Pediatric Nephrology and Dialysis Unit, Pediatric Hospital "Giovanni XXIII", Via Giovanni Amendola, 207, 70126 Bari, Italy.
Int J Environ Res Public Health. 2020 Jul 16;17(14):5137. doi: 10.3390/ijerph17145137.
Shiga toxin-producing (STEC) infections result in a significant public health impact because of the severity of the disease that, in young children especially, can lead to hemolytic-uremic syndrome (HUS). A rise in the number of HUS cases was observed in the Apulia region of Italy from 2013 to 2017, and so, in 2018, a symptom-based surveillance system for children with bloody diarrhea (BD) was initiated in order to detect and manage STEC infections. The objective of the study was to describe the epidemiology of STEC infections in children from June 2018 to August 2019. Children <15 years old with BD were hospitalized and tested for STEC. Real-time PCR for virulence genes (, , ) and serogroup identification tests were performed on stool samples/rectal swabs of cases. STEC infection was detected in 87 (10.6%) BD cases. The median age of STEC cases was 2.7 years, and 60 (68.9%) were <4. Of these 87 cases, 12 (13.8%) came from households with diarrhea. The reporting rate was 14.2/100,000, with the highest incidence in cases from the province of Bari (24.2/100,000). Serogroups O26 and O111 were both detected in 22/87 (25.3%) cases. Co-infections occurred in 12.6% of cases (11/87). Twenty-nine STEC were positive for , , and . Five cases (5.7%) caused by O26 (n = 2), O111 (n = 2), and O45 (n = 1) developed into HUS. A risk-oriented approach based on the testing of children with BD during the summer may represent a potentially beneficial option to improve the sensitivity of STEC surveillance, not only in Italy but also in the context of Europe as a whole.
产志贺毒素（STEC）感染会对公共健康造成重大影响，因为这种疾病的严重程度，尤其是在幼儿中，可能导致溶血性尿毒综合征（HUS）。2013 年至 2017 年期间，意大利普利亚地区的 HUS 病例数量有所增加，因此，2018 年启动了一项针对有血便（BD）儿童的基于症状的监测系统，以发现和管理 STEC 感染。本研究的目的是描述 2018 年 6 月至 2019 年 8 月期间儿童中 STEC 感染的流行病学情况。因 BD 住院的<15 岁儿童接受 STEC 检测。对病例的粪便样本/直肠拭子进行实时 PCR 检测毒力基因（stx1、stx2 和 eae）和血清群鉴定试验。在 87 例 BD 病例中检测到 STEC 感染。STEC 病例的中位年龄为 2.7 岁，60 例（68.9%）<4 岁。在这 87 例病例中，有 12 例（13.8%）来自有腹泻的家庭。报告率为 14.2/100000，其中巴里省的发病率最高（24.2/100000）。在 22/87（25.3%）病例中均检测到血清群 O26 和 O111。12.6%的病例（11/87）发生合并感染。29 株 STEC 对 stx1、stx2 和 eae 均呈阳性。5 例（5.7%）由 O26（n=2）、O111（n=2）和 O45（n=1）引起的病例发展为 HUS。基于夏季对有 BD 儿童进行检测的风险导向方法可能是提高 STEC 监测敏感性的一种潜在有益选择，不仅在意大利，而且在整个欧洲范围内也是如此。
