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Pediatric Nephrology
Published in: Pediatric Nephrology 9/2008

Open Access 01-09-2008 | Educational Review

Enterohaemorrhagic Escherichia coli and Shigella dysenteriae type 1-induced haemolytic uraemic syndrome

Author: C. Mark Taylor

Published in: Pediatric Nephrology | Issue 9/2008

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Abstract

Haemolytic uraemic syndrome (HUS) can be classified according to the aetiology of the different disorders from which it is composed. The most prevalent form is that induced by shigatoxin producing Escherichia coli (STEC) and, in some tropical regions, by Shigella dysenteriae type 1. STEC cause a zoonosis, are widely distributed in nature, enter the food chain in different ways, and show regional differences. Not all STEC are human pathogens. Enterohaemorrhagic E. coli usually cause attachment and effacing lesions in the intestine. This is not essential, but production of a shigatoxin (Stx) is. Because Stx are encoded by a bacteriophage, this property is transferable to naïve strains. Laboratory methods have improved by identifying STEC either via the toxin or its bacteriophage. Shigella dysenteriae type 1 produces shigatoxin, identical to Stx-1, but also has entero-invasive properties that enterohaemorrhagic Escherichia coli (EHEC) do not. Shigella patients risk bacteremia and benefit from early antibiotic treatment, unlike those with EHEC.
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Literature
1.
Besbas N, Karpman D, Landau D, Loirat C, Proesmans W, Remuzzi G, Rizzoni G, Taylor CM, Van de Kar N, Zimmerhackl LB (2006) A classification of hemolytic uremic syndrome and thrombotic thrombocytopenic purpura and related disorders. Kidney Int 70:423–431CrossRefPubMed
2.
Dolislager D, Tune B (1978) The hemolytic-uremic syndrome: spectrum of severity and significance of prodrome. Arch Pediatr Adolesc Med 132:55–58
3.
Karmali MA, Petric M, Lim C, Fleming PC, Arbus GC, Lior H (1985) The association between idiopathic hemolytic uremic syndrome and infection by verotoxin-producing Escherichia coli. J Infect Dis 151:775–782PubMedCrossRef
4.
Milford DV, Taylor CM, Gutridge B, Hall SM, Rowe B, Kleanthous H (1990) Haemolytic uraemic syndrome in the British Isles, 1985–8: association with verocytotoxin producing Escherichia coli. Part 1: Clinical and epidemiological aspects. Arch Dis Child 65:716–721PubMedPubMedCentralCrossRef
5.
Kleantous H, Smith HR, Scotland SM, Gross RJ, Rowe B, Taylor CM, Milford DV (1990) Haemolytic uraemic syndrome in the British Isles, 1985–8: association with verocytotoxin producing Escherichia coli. Part 2: microbiological aspects. Arch Dis Child 65:722–727CrossRef
6.
Griffin PM, Tauxe RV (1991) The epidemiology of infections caused by Escherichia coli O157:H7, other enterohemorrhagic E. coli and the associated hemolytic uremic syndrome. Epidemiol Rev 13:60–98PubMedCrossRef
7.
Banatvala N, Griffin PM, Greene KD, Barrett TJ, Bibb WF, Green JH, Wells JG, Hemolytic Uremic Syndrome Study Collaborators (2001) The United States national prospective hemolytic uremic syndrome study. J Infect Dis 183:1063–1070PubMedCrossRef
8.
Gerber A, Karch H, Allerberger F, Verweyen HM, Zimmerhackl LB (2002) Clinical course and the role of shiga toxin-producing Escherichia coli infection in the haemolytic-uraemic syndrome in pediatric patients,1997–2000, in Germany and Austria: a prospective study. J Infect Dis 186:493–500PubMedCrossRef
9.
Tozzi AE, Caprioli A, Minelli F, Gianviti A, De Petris L, Edefonti A, Montrini G, Ferretti A, De Palo T, Gaido M, Rizzoni G (2003) Shiga toxin-producing Escherichia coli infections associated with hemolytic uremic syndrome. Italy 1988–2000. Emerg Infect Dis 9:106–108PubMedPubMedCentralCrossRef
10.
Orth D, Wurzner R (2006) What makes an enterohemorrhagic Escherichia coli? Clin Infect Dis 43:1168–1169PubMedCrossRef
11.
Chiurchiu C, Firrincieli A, Santostefano M, Fusaroli M, Remuzzi G, Reggenenti P (2003) Adult nondiarrhea hemolytic uremic syndrome associated with shiga toxin Escherichia coli O157:H7 bacteremia and urinary tract infection. Am J Kidney Dis 41:E4PubMedCrossRef
12.
Frankel G, Phillips AD, Rosenshine I, Dougan G, Kaper JB, Knutton S (1998) Enteropathogenic and enterohaemorhagic Escherichia coli: more subversive elements. Mol Microbiol 30:911–921CrossRefPubMed
13.
Phillips AD, Navabpour S, Hicks S, Dougan G, Wallis T, Frankel G (2000) Enterohaemorrhagic Escherichia coli O157:H7 target Peyer’s patches in humans and cause attaching/effacing lesions in both human and bovine intestine. Gut 47:377–381PubMedPubMedCentralCrossRef
14.
Schuller S, Chong Y, Lewin J, Kenny B, Frankel G, Phillips AD (2007) Tir phosphorylation and Nck/N-WASP recruitment by enteropathogenic and enterohaemorrhagic Escherichia coli during ex vivo colonization of human intestinal mucosa is different to cell culture models. Cell Microbiol 9:1352–1364PubMedCrossRef
15.
Thorpe CM, Hurley BP, Acheson DW (2003) Shiga toxin interactions with the intestinal epithelium. Methods Mol Med 73:263–273PubMed
16.
Chart H, Jenkins C, Smith HR, Hedges D, Rowe B (1998) Haemolysin production by strains of verocytotxin-producing Escherichia coli. Microbiology 144:103–107PubMedCrossRef
17.
Gyles C, Johnson R, Gao A, Ziebell K, Pierard D, Aleksic S, Boerlin P (1998) Association of enterohemorrhagic Escherichia coli hemolysin with serotypes of shiga-like-toxin-producing Escherichia coli of human and bovine origins. App Environ Microbiol 64:4134–4141PubMedPubMedCentralCrossRef
18.
Aldick T, Bielaszewska M, Zhang W, Brockmeyer J, Schmidt H, Friedrich AW, Kim KS, Schmidt MA, Karch H (2007) Hemolysin from Shiga toxin-negative Escherichia coli O26 strains injures microvascular endothelium. Microbes Infect 9:282–290PubMedCrossRef
19.
Brooks JT, Sowers EG, Wells JG, Greene KD, Griffin PM, Hoekstra RM, Strockbine NA (2005) Non-O157 shiga toxin-producing Escherichia coli infections in the United States, 1983–2002. J Infect Dis 192:1422–1429PubMedCrossRef
20.
McCarthy TA, Barrett NL, Hadler JL, Salsbury B, Howard RT, Dingman DW, Brinkman CD, Bibb WF, Cartter ML (2001) Hemolytic uremic syndrome and Escherichia coli O121 at a lake in Connecticut, 1999. Pediatrics 108:E59PubMedCrossRef
21.
Misselwitz J, Karch H, Bielazewska M, Ulrike J, Ringelman F, Ronnefarth G, Patzer L (2003) Cluster of haemolytic uremic syndrome caused by shiga toxin-producing Escherichia coli O26:H11. Pediatr Infect Dis 22:349–354
22.
Elliott EJ, Robins-Browne RM, O’Loughlin EV, Bennet-Wood V, Bourke J, Henning P, Hogg GG, Knight J, Poewell H, Redmond D (2001) Nationwide study of haemolytic uraemic syndrome: clinical, microbiological and epidemiological features. Arch Dis Child 85:125–131PubMedPubMedCentralCrossRef
23.
Beutlin L, Bulte M, Weber A, Zimmermann S, Gleier K (2000) Investigation of human infections with verocytotxin-producing strains of Escherichia coli (VTEC) belonging to serogroup O118 with evidence of zoonotic transmission. Epidemiol Infect 125:47–54CrossRef
24.
Calderwood SB (1994) Toxin structure-function, receptors, cell biology. In: Karmali MA, Goglio AG (eds) Recent advances in verocytotxin-producing Escherichia coli infections. Elsevier Science, Netherlands, pp 119–122
25.
Zhang X, McDaniel AD, Wolf LE, Keusch GT, Waldor MK, Acheson DWK (2000) Quinolone antibiotics induce shiga toxin-encoding bacteriophages, toxin production, and death in mice. J Infect Dis 181:664–670PubMedCrossRef
26.
Safdar N, Said A, Gangnon RE, Maki DG (2002) Risk of hemolytic uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 enteritis. A meta-analysis. JAMA 288:996–100PubMedCrossRef
27.
Tschape H, Prager R, Strekel W, Fruth A, Tietze E, Böhme G (1995) Verotoxigenic Citrobacter freundii associated with severe gastroenteritis and cases of haemolytic uraemic syndrome in a nursery school: green butter as the infection source. Epidemiol Infect. 114:441–450PubMedPubMedCentralCrossRef
28.
Allison HE (2007) Stx-phages: drivers and mediators of the evolution of STEC and STEC-like pathogens. Future Microbiol 2:165–174PubMedCrossRef
29.
Lingwood CA (1999) Verotoxin/globosylceremide recognition: angiopathy, angiogenesis and antineoplasia. Biosci Rep 19:345–354PubMedCrossRef
30.
Schuller S, Heuschel R, Torrente F, Kaper JB, Phillips AD (2007) Shiga toxin binding to normal and inflamed human intestinal mucosa. Microbes Infect 9:35–39CrossRefPubMed
31.
Van Setten PA, Hinsberg VW, van der Velden TJ, van de Kar NC, Vermeer M, Mahan JD, Assman KJ, van den Heuvel LP, Monnens LA (1997) Effects of TNF alpha on verocytotoxin cytotoxicity in purified glomerular microvascular cells. Kidney Int 51:1245–1256PubMedCrossRef
32.
Williams JM, Boyd B, Nutikka A, Lingwood CA, Barnett Foster DE, Milford DV, Taylor CM (1999) A comparison of the effects of verocytotoxin-1 on primary human renal cells in culture. Toxicol Letters 105:47–57CrossRef
33.
Morigi M, Micheletti G, Figliuzzi M, Imberti B, Karmali MA, Remuzzi A, Remuzzi G, Zoja C (1995) Verotoxin-1 promotes leukocyte adhesion to cultured endothelial cells under physiological flow conditions. Blood 86:4553–4558PubMedCrossRef
34.
Morigi M, Galbusera M, Binda E, Imberti B, Gastoldi S, Remuzzi A, Zoja C, Remuzzi G (2001) Verotoxin-1–induced up-regulation of adhesive molecules renders microvascular endothelial cells thrombogenic at high shear stress. Blood 98:1828–1835PubMedCrossRef
35.
36.
Ludwig K, Karmali MA, Sarkim V, Bobrowski C, Petric M, Karch H, Muller-Wiefel DE (2001) Antibody response to Shiga toxins Stx2 and Stx1 in children with enteropathic hemolytic-uremic syndrome. J Clin Microbiol 39:2272–2229PubMedPubMedCentralCrossRef
37.
Friedrich AW, Bielaszewska M, Zhang WL, Pulz M, Kuczius T, Ammon A, Karch H (2002) Escherichia coli harbouring shiga toxin 2 gene variants: frequency and association with clinical symptoms. J Infect Dis 185:74–84PubMedCrossRef
38.
Bielaszewska M, Friedrich AW, Aldick T, Schurk-Bulgrin R, Karch H (2006) Shiga toxin activatable by intestinal mucus in Escherichia coli isolated from humans: predictor for a severe clinical outcome. Clin Infect Dis 43:1160–1167PubMedCrossRef
39.
Friedrich AW, Zhang W, Bielaszewska M, Melimann A, Kock R, Fruth A, Tschape H, Karch H (2007) Prevalence, virulence profiles, and clinical significance of Shiga toxin-negative variants of enterohemorrhagic Escherichia coli O157 infection in humans. Clin Infect Dis 45:39–45PubMedCrossRef
40.
Bielaszewska M, Kock R, Friedrich AW, von Eiff C, Zimmerhackl LB, Karch H, Mellmann A (2007) Shiga toxin mediated haemolytic uremic syndrome: time to change the diagnostic paradigm? PLos ONE 2(10):e1024PubMedPubMedCentralCrossRef
41.
Naylor SW, Low JC, Besser TE, Mahajan A, Gunn GJ, Pearce MC, McKendrick IJ, Smith DGE, Gally DL (2003) Lymphoid follicle-dense mucosa at the terminal rectum is the principal site of colonization of enterohemorrhagic Escherichia coli O157:H7 in the bovine host. Infect Immun 71:1505–1512PubMedPubMedCentralCrossRef
42.
Werber D, Behnke SC, Fruth A, Merie R, Menzier S, Glaser S, Kreienbrock L, Prager R, Tschape H, Roggentin P, Bockemuhl J, Ammon A (2007) Shiga toxin-producing Escherichia coli infection in Germany—different risk factors for different age groups. Am J Epidemiol 1665:425–434
43.
Ludwig K, Sarkim V, Bitzan M, Karmali MA, Bobrowski C, Ruder H, Laufs R, Sobbotka I, Petric M, Karch H, Muller-Wiefel DE (2002) Shiga toxin-producing Escherichia coli infection and antibodies against Stx2 and Stx1 in household contacts of children with enteropathic hemolytic-uremic syndrome. J Clin Microbiol 40:1773–1782PubMedPubMedCentralCrossRef
44.
Stephen R, Ragettli S, Unterman F (2000) Prevalence and characteristics of verotoxin-producing Escherichia coli (VTEC) in stool samples from asymptomatic human carriers working in the meat processing industry in Switzerland. J Appl Microbiol 88:335–341CrossRef
45.
Lynn R, O’Brien SJ, Taylor CM, Adak GK, Chart H, Cheasty T, Coia JE, Gillespie IA, Locking ME, Reilly WJ, Smith HR, Waters A, Willshaw G (2005) Childhood hemolytic uremic syndrome, United Kingdom and Ireland. Emerg Infect Dis 11:5990–5996CrossRef
46.
47.
Teel LD, Daly JA, Jerris RC, Maul D, Svanas G, O’Brien AD, Park CH (2007) Rapid detection of Shiga toxin-producing Escherichia coli by optical immunoassay. J Clin Microbiol. 45:3377–3380PubMedPubMedCentralCrossRef
48.
Bhimma R, Rollins NC, Coovadia HM, Adhikari M (1997) Post-dysenteric hemolytic uremic syndrome in children during an epidemic of Shigella dysentery in Kwazulu/Natal. Pediatr Nephrol 5:560–564CrossRef
49.
Bennish ML, Khan WA, Begum M, Bridges EA, Ahmed S, Saha D, Salam MA, Acheson D, Ryan ET (2006) Low risk of hemolytic uremic syndrome after early effective antimicrobial therapy for Shigella dysenteriae type 1 infection in Bangladesh. Clin Infect Dis 42:356–362PubMedCrossRef
50.
Taylor CM, Williams JM, Lote CJ, Howie AJ, Thewles A, Wood JA, Milford DV, Raafat F, Chant I, Rose PE (1999) A laboratory model of toxin-induced haemolytic uremic syndrome. Kidney Int 55:1367–1374PubMedCrossRef
51.
Guessous F, Marcinkiewicz M, Polanowska-Gabrowask R, Konkhum S, Heatherly D, Obrig T, Gear AR (2005) Shiga toxin 2 and lipopolysaccharide induce human microvascular endothelial cells to release chemokines and factors that stimulate platelet function. Infect Immun 73:8306–8316PubMedPubMedCentralCrossRef
52.
Koster F, Levin J, Walker L, Tung KS, Gilman RH, Rahaman MM, Majid MA, Islam S, Williams RC (1978) Hemolytic-uremic syndrome after shigellosis. Relation to endotoxemia and circulating immune complexes. N Engl J Med 298:927–933PubMedCrossRef
53.
Azim T, Oslam LN, Halder RC, Hamadani J, Khanum N, Sarker MS, Salam MA, Albert MJ (1995) Peripheral blood neutrophil responses in children with shigellosis. Clin Diagn Lab Immunol 2:616–622PubMedPubMedCentralCrossRef
54.
Butler T, Islam MR, Azad MAK, Jones PK (1987) Risk factors for development of hemolytic uremic syndrome during shigellosis. J Pediatr 110:894–897PubMedCrossRef
55.
Nathoo KJ, Porteous JE, Siziya S, Wellington M, Mason E (1998) Predictors of mortality in children hospitalized with dysentery in Harare, Zimbabwe. Cent Afr J Med 44:272–276PubMed
56.
Houdouin V, Doit C, Mariani P, Brahimi N, Loirat C, Bourrillon A, Bingen E (2004) A pediatric cluster of Shigella dysenteriae serotype 1 diarrhea with hemolytic uremic syndrome in 2 families from France. Clin Infect Dis 38:96–99CrossRef
Metadata
Title
Enterohaemorrhagic Escherichia coli and Shigella dysenteriae type 1-induced haemolytic uraemic syndrome
Author
C. Mark Taylor
Publication date
01-09-2008
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 9/2008
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-008-0820-3

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