Fecal diagnostics in combination with serology: best test to establish STEC-HUS

• Published in: Pediatric nephrology (Berlin, West) West), 2016-11, Vol.31 (11), p.2163-2170
• Main Authors: Wijnsma, Kioa L., van Bommel, Sheila A. M., van der Velden, Thea, Volokhina, Elena, Schreuder, Michiel F., van den Heuvel, Lambertus P., van de Kar, Nicole C. A. J.
• Format: Article
• Language: English
• Subjects: Acute kidney failure; Antibodies; Antibodies, Bacterial - blood; Child; Child, Preschool; Complications and side effects; Diagnosis; Diagnostic tests; Diarrhea; E coli; Eculizumab; Enzyme-Linked Immunosorbent Assay; Escherichia coli; Escherichia coli Infections - blood; Escherichia coli Infections - diagnosis; Escherichia coli Infections - microbiology; Escherichia coli O157 - immunology; Escherichia coli O157 - isolation & purification; Feces; Feces - microbiology; Female; Health aspects; Hemolytic-uremic syndrome; Hemolytic-Uremic Syndrome - blood; Hemolytic-Uremic Syndrome - diagnosis; Hemolytic-Uremic Syndrome - microbiology; Hospitals; Humans; Immunoglobulin M - blood; Immunoglobulins; Infant; Infections; Laboratories; Lipopolysaccharides - immunology; Male; Medicine; Medicine & Public Health; Nephrology; Original; Original Article; Pediatrics; Retrospective Studies; Risk factors; Serology; Serum Bactericidal Antibody Assay - methods; Time Factors; Urology
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-016-3420-7

Background In the majority of pediatric patients, the hemolytic–uremic syndrome (HUS) is caused by an infection with Shiga toxin-producing Escherichia coli (STEC), mostly serotype O157. It is important to discriminate between HUS caused by STEC and complement-mediated HUS (atypical HUS) due to differences in treatment and outcome. As STEC and its toxins can only be detected in the patient’s stool for a short period of time after disease onset, the infectious agent may go undetected using only fecal diagnostic tests. Serum antibodies to lipopolysaccharide (LPS) of STEC persist for several weeks and may therefore be of added value in the diagnosis of STEC. Methods All patients with clinical STEC-HUS who were treated at Radboud University Medical Center between 1990 and 2014 were included in this retrospective single-center study. Clinical and diagnostic microbiological data were collected. Immunoglobulin M (IgM) antibodies against LPS of STEC serotype O157 were detected by a serological assay (ELISA). Results Data from 65 patients weres available for analysis. Fecal diagnostic testing found evidence of an STEC infection in 34/63 patients (54 %). Serological evidence of STEC O157 was obtained in an additional 16 patients. This is an added value of 23 % ( p