Surveillance of Shiga toxin-producing Escherichia coli associated bloody diarrhea in Argentina

• Published in: Revista argentina de microbiología 2023-10, Vol.55 (4), p.345-354
• Main Authors: Rivas, Marta, Pichel, Mariana, Colonna, Mariana, Casanello, Adrián López, Alconcher, Laura F., Galavotti, Jimena, Principi, Iliana, Araujo, Sofía Pérez, Ramírez, Flavia B., González, Gladys, Pianciola, Luis A., Mazzeo, Melina, Suarez, Ángela, Oderiz, Sebastián, Ghezzi, Lidia F.R., Arrigo, Diego J., Paladini, José H., Baroni, María R., Pérez, Susana, Tamborini, Ana, Chinen, Isabel, Miliwebsky, Elizabeth S., Goldbaum, Fernando, Muñoz, Luciana, Spatz, Linus, Sanguineti, Santiago, Lucarelli, Lucas Iván, Fennen, Lara Parada, Valles, Patricia, Poidomani, Ana María, Huerga, María, Fioravanti, Leonardo, De Rose, Emanuel, Crivaro, Eugenia, Pallaoro, Nerina, Prado, Analía, Coccia, Paula A., Ferraris, Verónica, Aro, Carolina, Castañeira, Mariana, Llach, Andrea Rodríguez, Casabona, Luis Marcelo
• Format: Article
• Language: English
• Subjects: Argentina; Bloody diarrhea; Children; Diarrea sanguinolenta; diarrhea; females; hemolytic uremic syndrome; monitoring; Niños; patients; polymerase chain reaction; prospective studies; risk; serotypes; Shiga toxin; Shiga toxin-producing Escherichia coli; STEC; summer; Surveillance; Vigilancia
• ISSN: 0325-7541
• DOI: 10.1016/j.ram.2023.03.003

•A prospective study on STEC-bloody diarrhea was performed in Argentina between October 2018 and June 2019.•Twenty-nine (4.1%) of 714 bloody diarrhea patients aged 1–9 years were STEC-positive.•Four (13.8%) bloody diarrhea cases progressed to HUS 3–9 days after diarrhea onset.•The most common serotypes among BD and HUS cases were O157:H7 and O145:H28.•The prevalent genotypes among BD and HUS cases were stx2a-only or -associated. In Argentina, hemolytic uremic syndrome (HUS) caused by Shiga toxin-producing Escherichia coli (STEC-HUS) infection is endemic, and reliable data about prevalence and risk factors have been available since 2000. However, information about STEC-associated bloody diarrhea (BD) is limited. A prospective study was performed during the period October 2018–June 2019 in seven tertiary-hospitals and 18 referral units from different regions, aiming to determine (i) the frequency of STEC-positive BD cases in 714 children aged 1–9 years of age and (ii) the rate of progression of bloody diarrhea to HUS. The number and regional distribution of STEC-HUS cases in the same hospitals and during the same period were also assessed. Twenty-nine (4.1%) of the BD patients were STEC-positive, as determined by the Shiga Toxin Quik Chek (STQC) test and/or the multiplex polymerase chain reaction (mPCR) assay. The highest frequencies were found in the Southern region (Neuquén, 8.7%; Bahía Blanca, 7.9%), in children between 12 and 23 month of age (8.8%), during summertime. Four (13.8%) cases progressed to HUS, three to nine days after diarrhea onset. Twenty-seven STEC-HUS in children under 5 years of age (77.8%) were enrolled, 51.9% were female; 44% were Stx-positive by STQC and all by mPCR. The most common serotypes were O157:H7 and O145:H28 and the prevalent genotypes, both among BD and HUS cases, were stx2a-only or -associated. Considering the endemic behavior of HUS and its high incidence, these data show that the rate of STEC-positive cases is low among BD patients. However, the early recognition of STEC-positive cases is important for patient monitoring and initiation of supportive treatment. En Argentina, el síndrome urémico hemolítico asociado a Escherichia coli productor de toxina Shiga (STEC-SUH) es endémico y, desde 2000, de notificación obligatoria. Sin embargo, la información sobre diarrea sanguinolenta (DS) asociada a STEC (DS-STEC) es limitada. Se realizó un estudio prospectivo desde octubre de 2018 hasta junio de 2019 en siete hospitales de te