title: An epidemiologic surveillance of Shiga-like toxin-producing Escherichia coli infection in Argentinean children: risk factors and serum Shiga-like toxin 2 values.
abstract: OBJECTIVE
  Shiga-like toxin (Stx)-producing Escherichia coli (STEC) infection is an ongoing health issue that can lead to serious complications, including hemolytic uremic syndrome (HUS) and death. This study assessed demographic and epidemiologic information of STEC infection among Argentinean children.
  
  
  METHODS
  A prospective surveillance of 2435 screened children (age, 0.5-15 years) presenting with watery diarrhea and/or bloody diarrhea was undertaken to evaluate the clinical course of STEC infection.
  
  
  RESULTS
  Prevalence of STEC infection was 4.1% among subjects presenting with watery diarrhea for ≤ 5 days' duration, bloody diarrhea for ≤ 36 hours' duration, or both. Incidence of STEC infection was significantly higher in the subjects with bloody diarrhea. Ninety-three STEC+ children underwent further evaluation, of whom 8 (8.6%) developed HUS. White blood cells, particularly neutrophils, were abnormally elevated at screening in 5 of 8 HUS subjects. Quantifiable serum Stx-2 values were noted within 24 to 48 hours after the onset of bloody diarrhea in 3 HUS subjects using a validated chemiluminescence assay, with levels quickly dissipating by HUS onset.
  
  
  CONCLUSIONS
  Results suggest that young STEC-positive children with bloody diarrhea and exhibiting neutrophilic leukocytosis in the early course of their diarrhea are at risk for HUS progression. The observation of measurable concentrations of Stx-2 levels in the early post-bloody-diarrhea period and rapid dissipation at the time of HUS onset requires further evaluation.
authors.affiliation: Department of Medicine, Hospital de Niños Dr Ricardo Gutiérrez, Buenos Aires, Argentina. eduardoluislopez@fibertel.com.ar
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: López
authors.forename: Maria M
authors.initials: MM
authors.lastname: Contrini
authors.forename: Eduardo
authors.initials: E
authors.lastname: Glatstein
authors.forename: Silvia González
authors.initials: SG
authors.lastname: Ayala
authors.forename: Roberto
authors.initials: R
authors.lastname: Santoro
authors.forename: Gustavo
authors.initials: G
authors.lastname: Ezcurra
authors.forename: Eduardo
authors.initials: E
authors.lastname: Teplitz
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Matsumoto
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sato
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Sakai
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Katsuura
authors.forename: Satoru
authors.initials: S
authors.lastname: Hoshide
authors.forename: Takuya
authors.initials: T
authors.lastname: Morita
authors.forename: Ronald
authors.initials: R
authors.lastname: Harning
authors.forename: Sheldon
authors.initials: S
authors.lastname: Brookman
mesh_terms: D000293:Adolescent; D001118:Argentina / Q000453:epidemiology; D002648:Child; D003967:Diarrhea / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007223:Infant; D008297:Male; D016133:Polymerase Chain Reaction; D011159:Population Surveillance / Q000379:methods; D015995:Prevalence; D012307:Risk Factors; D022641:Shiga Toxin 2 / Q000096:biosynthesis* / Q000235:genetics; D022603:Shiga Toxins / Q000096:biosynthesis* / Q000235:genetics; D054323:Shiga-Toxigenic Escherichia coli / Q000302:isolation & purification* / Q000472:pathogenicity
chemical_list: D022641:Shiga Toxin 2; D022603:Shiga Toxins