Rivas M, Balbi L, Miliwebsky E S, García B, Tous M I, Leardini N A, Prieto M A, Chillemi G M, de Principi M E
Instituto Nacional de Enfermedades Infecciosas, ANLIS Dr. Carlos G. Malbrán, Ministerio de Salud y Acción Social, Buenos Aires. isturiz@mail-retina-ar
Medicina (B Aires). 1998;58(1):1-7.
Shiga toxin-producing Escherichia coli (STEC) has been associated with pathogenesis of hemolytic uremic syndrome (HUS) worldwide. The aim of the present study was to characterize the HUS cases reported in Mendoza and to determine their association with STEC infection. From July 1994 through June 1996 thirty-six patients with HUS were admitted to Hospital Pediátrico "Dr. HJ Notti" (Mean age 22.8 +/- 14.9 months, 44% females). The children developed HUS following an acute diarrheal illness in 94.4% of the cases. Bloody diarrhea was observed in 83.3% of them. Antimicrobial therapy had been administered to 69.4% of the patients. Most of the patients were well-nourished (88.9%), belong to middle-low socioeconomical condition (91.7%), from urban areas (72.2%) and they were mostly assisted during summer and the beginning of autumn. The acute stage of the disease occurred with presentation of pallor (100%), edema (25%), anuria (38.9%), oliguria (41.7%), hemolytic anemia (97.2%), thrombocytopenia (86.1%) and neurological involvement (41.7%). Twenty-five of them presented the full clinical syndrome. Peritoneal dialysis were performed in 50% and packed blood cell transfusion in 88.9%. The mean days of hospitalization was 15.1 +/- 9.2 [range 1-32]. A 91.7% of the patients recovered renal function, two developed chronic renal failure and one died. Cumulative evidence of STEC infection was found in 19 (86.4%) of 22 HUS patients. STEC O157:H7, biotype C was found in 8 (36.4%). The prevalent Stx type was Stx2 in STEC, free fecal Stx (STMF) and Stx-neutralizing antibodies (a-Stx). In Mendoza, as in the rest of Argentina E. coli O157:H7, biotype C, Stx2 producer is the most frequently detected pathogen in HUS cases.
产志贺毒素大肠杆菌（STEC）在全球范围内都与溶血尿毒综合征（HUS）的发病机制有关。本研究的目的是对门多萨报告的HUS病例进行特征描述，并确定它们与STEC感染的关联。从1994年7月到1996年6月，36例HUS患者被收治于“HJ Notti医生”儿科医院（平均年龄22.8±14.9个月，44%为女性）。94.4%的患儿在急性腹泻病后患上了HUS。其中83.3%出现了血性腹泻。69.4%的患者接受了抗菌治疗。大多数患者营养状况良好（88.9%），属于中低社会经济状况（91.7%），来自城市地区（72.2%），且大多在夏季和初秋期间就诊。疾病急性期表现为面色苍白（100%）、水肿（25%）、无尿（38.9%）、少尿（41.7%）、溶血性贫血（97.2%）、血小板减少（86.1%）和神经受累（41.7%）。其中25例表现出完整的临床综合征。50%的患者进行了腹膜透析，88.9%的患者进行了浓缩红细胞输血。平均住院天数为15.1±9.2天[范围1 - 32天]。91.7%的患者肾功能恢复，2例发展为慢性肾衰竭，1例死亡。在22例HUS患者中的19例（86.4%）发现了STEC感染的累积证据。在8例（36.4%）中发现了STEC O157:H7，生物型C。在STEC、游离粪便志贺毒素（STMF）和志贺毒素中和抗体（a - Stx）中，流行的志贺毒素类型是Stx2。在门多萨，与阿根廷其他地区一样，产志贺毒素2的生物型C大肠杆菌O157:H7是HUS病例中最常检测到的病原体。
