Center for HUS Prevention Control and Management, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano.
Laboratory of Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano.
J Pediatr. 2021 Oct;237:34-40.e1. doi: 10.1016/j.jpeds.2021.06.048. Epub 2021 Jun 29.
To analyze the results of an enhanced laboratory-surveillance protocol for bloody diarrhea aimed at identifying children with Shiga toxin-producing Escherichia coli (STEC) infection early in the course of the disease toward the early identification and management of patients with hemolytic uremic syndrome (HUS).
The study (2010-2019) involved a referral population of 2.3 million children. Stool samples of patients with bloody diarrhea were screened for Shiga toxin (Stx) genes. Positive patients were rehydrated and monitored for hemoglobinuria until diarrhea resolved or STEC-HUS was diagnosed.
A total of 4767 children were screened; 214 (4.5%) were positive for either Stx1 (29.0%) or Stx2 (45.3%) or both Stx1+2 (25.7%); 34 patients (15.9%) developed STEC-HUS (0.71% of bloody diarrheas). Hemoglobinuria was present in all patients with HUS. Patients with Stx2 alone showed a greater risk of STEC-HUS (23.7% vs 12.7%) and none of the patients with Stx1 alone developed HUS. During the same period of time, 95 other patients were diagnosed STEC-HUS but were not captured by the screening program (26 had nonbloody diarrhea, 11 came from areas not covered by the screening program, and 58 had not been referred to the screening program, although they did meet the inclusion criteria). At HUS presentation, serum creatinine of patients identified by screening was significantly lower compared with that of the remaining patients (median 0.9 vs 1.51 mg/dL).
Nearly 1% of children with bloody diarrhea developed STEC-HUS, and its diagnosis was anticipated by the screening program for Stx. The screening of bloody diarrhea for Stx is recommended, and monitoring patients carrying Stx2 with urine dipstick for hemoglobinuria is suggested to identify the renal complication as early as possible.
分析强化实验室监测方案对血性腹泻的结果，以便在疾病早期识别产志贺毒素大肠杆菌（STEC）感染的儿童，并尽早识别和管理溶血尿毒综合征（HUS）患者。
本研究（2010-2019 年）涉及 230 万儿童的转诊人群。对血性腹泻患者的粪便样本进行志贺毒素（Stx）基因筛查。阳性患者接受补液治疗，并在腹泻缓解或诊断为 STEC-HUS 之前监测血红蛋白尿。
共筛查 4767 名儿童，214 名（4.5%）Stx1（29.0%）或 Stx2（45.3%）或两者均阳性（25.7%）；34 名患者（15.9%）发生 STEC-HUS（血性腹泻的 0.71%）。所有 HUS 患者均存在血红蛋白尿。仅携带 Stx2 的患者发生 STEC-HUS 的风险更高（23.7% vs 12.7%），而仅携带 Stx1 的患者无一例发生 HUS。在同一时期，还有 95 名患者被诊断为 STEC-HUS，但未被筛查方案捕获（26 名患者有非血性腹泻，11 名患者来自筛查方案未覆盖的地区，58 名患者未被转诊至筛查方案，尽管他们符合纳入标准）。在 HUS 发病时，筛查组患者的血清肌酐明显低于其余患者（中位数 0.9 vs 1.51 mg/dL）。
近 1%的血性腹泻儿童发生 STEC-HUS，Stx 筛查方案可预测其诊断。建议对血性腹泻进行 Stx 筛查，并建议对携带 Stx2 的患者进行尿液干化学法检测血红蛋白尿，以便尽早识别肾脏并发症。
