Síndrome urémico hemolítico: reporte de dos casos pediátricos con nexo epidemiológico / Hemolytic uremic syndrome: report of two pediatric clinical cases with epidemiologic link / Síndrome urémico hemolítico: reporte de casos pediátricos con nexo epidemiológico

Introducción: el síndrome hemolítico urémico (SHU) es en muchos países, de las causas más frecuentes de insuficiencia renal aguda. La mayoría de los casos ocurre luego de un episodio de gastroenteritis aguda (GEA) por Escherichia coli productora de toxina Shiga (STEC). En Uruguay a pesar de ser una enfermedad de notificación obligatoria, existe subregistro. Objetivo: describir dos casos clínicos de SHU asociados a GEA con nexo epidemiológico. Casos clínicos: se trata de dos varones de 4 y 5 años, sanos. En los días previos, ingesta de carne en el mismo local comercial. Consultaron por dolor abdominal, deposiciones líquidas y vómitos reiterados. El niño de 4 años presentaba fiebre y deposiciones líquidas con sangre. El niño de 5 años dolor abdominal. El estado de hidratación y las constantes vitales eran normales en ambos. Fueron admitidos a cuidados moderados. A las 48 horas y a los 5 días, respectivamente, agregan palidez cutáneo-mucosa intensa, edemas y oliguria. Estudios complementarios: anemia, plaquetopenia e insuficiencia renal. Ingresaron a cuidados intensivos y se realizó diálisis peritoneal. La investigación de STEC fue negativa y la evolución favorable. Conclusiones: en menores de 5 años el SHU asociado a GEA es la forma de enfermedad más frecuente. En Uruguay predominan las cepas STEC no-O157. En estos casos no se pudo identificar el agente. La existencia de un nexo epidemiológico alerta sobre la necesidad de extremar los cuidados en la preparación y cocción de la carne. Debido a la asociación con una enfermedad prevalente, es necesario tener presente esta complicación para poder sospecharla e iniciar el tratamiento en forma precoz y oportuna.

Introduction: hemolytic uremic syndrome (HUS) is one of the most frequent causes of acute renal failure in many countries. Most cases occur after an episode of acute gastroenteritis (GEA) due to the Shiga toxin producing Escherichia Soli (STEC). In Uruguay, despite being a disease that requires mandatory notification, it is under reported. Objective: to describe two clinical cases of HUS associated with GEA with an epidemiological link. Clinical cases: these are two healthy boys aged 4 and 5 years. In the previous days, they reported meat intake in the same commercial premises. They consulted for abdominal pain, liquid stools and repeated vomiting. The 4 year old boy had a fever and bloody stools. The 5 year old boy had abdominal pain. They both showed normal hydration levels and vital signs. They were admitted to moderate care. At 48 hours and 5 days, respectively, they showed intense skin and mucosal paleness, edema and oliguria. Complementary studies: anemia, thrombocytopenia and renal failure. They were admitted to intensive care and peritoneal dialysis was performed. The STEC's investigation was negative and the evolution favorable. Conclusions: in children under 5 years of age, HUS associated with GEA is the most frequent form of the disease. In Uruguay, non-O157 STEC strains predominate. In these cases, the agent could not be identified. The existence of an epidemiological link warns us about the need for extreme care in the preparation and cooking of meat. Due to the association with a prevalent disease, it is necessary to keep this complication in mind in order to suspect it and initiate early and timely treatment.

Introdução: a síndrome hemolítico urêmica (SHU) é uma das causas mais frequentes de insuficiência renal aguda em muitos países. A maioria dos casos ocorre após um episódio de gastroenterite aguda (GEA) devido à Escherichia Coli, a toxina produtora de Shiga (STEC). No Uruguai, apesar de ser uma doença de notificação compulsória, há subnotificação. Objetivo: descrever dois casos clínicos de SHU associada à AGE com vínculo epidemiológico. Casos clínicos: dois meninos saudáveis com idades entre 4 e 5 anos. Nos dias anteriores, eles reportaram consumo de carne nos mesmos estabe- lecimentos comerciais. Eles consultaram para dor abdominal, fezes líquidas e vômitos repetidos. O menino de 4 anos teve febre e fezes com sangue. O menino de 5 anos teve dores abdominais. O estado de hidratação e os sinais vitais foram normais em ambos meninos. Foram internados em cuidados moderados. Às 48 horas e 5 dias, respectivamente, apresentaram aliás palidez intensa da pele e mucosas, edema e oligúria. Realizaramse estudos complementares: anemia, trombocitopenia e insuficiência renal. Eles foram internados em terapia intensiva e realizouse diálise peritoneal. A investigação do STEC foi negativa e a evolução favorável. Conclusões: em crianças menores de 5 anos, a SHU associada à GEA é a forma mais frequente da doença. No Uruguai, predominam cepas STEC não-O157. Nesses casos, o agente não pôde ser identificado. A existência de um nexo epidemiológico alerta para a necessidade de extremo cuidado no preparo e cozimento da carne. Devido à associação com doença prevalente, é necessário considerar essa complicação para suspeitar e iniciar o tratamento precoce e oportunamente.

Vigilancia de síndrome urémico hemolítico / Surveillance of hemolytic uremic syndrome

Se presenta de manera breve la situación de Síndrome Urémico Hemolítico hasta la Semana Epidemiológica 15 de 2022, según datos de la notificación al Sistema Nacional de Vigilancia Epidemiológica, Incluye datos de notificación de agentes etiológicos 2021-2022.

Síndrome urémico hemolítico y yogur: entre la creencia popular y la evidencia científica / Hemolytic uremic syndrome and yoghurt: popular belief and scientific evidence

Algunos profesionales de la salud desaconsejan el consumo del yogur por el riesgo de provocar Síndrome Urémico Hemolítico, una enfermedad grave causada por cepas de E. coli productor de toxina Shiga (STEC por sus siglas en inglés). Estas bacterias pueden pasar del intestino del ganado vacuno a la carne o a la leche en condiciones inadecuadas de trabajo en frigoríficos o establecimientos productores de leche, respectivamente, siendo las hamburguesas insuficientemente cocidas el principal vector de la enfermedad y la leche cruda sin pasteurizar o los productos lácteos elaborados con ésta, otro factor de riesgo. En la industria láctea, el yogur se elabora con leche que es sometida a un doble tratamiento térmico. En la bibliografía moderna reportes de la presencia de STEC en yogures industriales, y los trabajos de revisión y meta-análisis no incluyen al yogur, pero sí a la leche sin pasteurizar, como vectores de trasmisión de STEC. En este contexto, y dada la evidencia científica disponible actualmente en relación a E. coli productor de toxina Shiga, el SUH y el yogur, parecería que estamos ante la presencia de una correlación espuria, la asociación de dos hechos que no tienen relación causal entre sí, más que a un hecho científico del cual uno (el yogur) es el responsable del otro (SUH).

Some health professionals discourage yogurt because of the risk of Hemolytic Uremic Syndrome (HUS), a serious disease caused by strains of Shiga toxin-producing E. coli (STEC). These bacteria can pass from the intestine of cattle to meat or milk under inadequate working conditions in slaughterhouses or milking plants. Undercooked hamburgers the main is vector of disease and unpasteurized raw milk or dairy products made with it, are another risk factors. In the dairy industry, yoghurt is made from milk that undergoes a double heat treatment. There are no reports of the presence of STEC in industrial yogurts in the modern bibliography, and reviews and meta-analysis do not point to yogurt as a risk factor for STEC, but rather unpasteurized milk. In this context, and given the scientific evidence currently available regarding STEC, HUS and yogurt, it would seem that we are in the presence of a spurious correlation, the association between two facts that have no causal relationship between them, rather than a scientific fact for which one (yogurt) may be responsible for the other (HUS).

Hemolytic uremic syndrome associated with streptococcus pneumoniae in pediatrics: a case series / Síndrome hemolítico-urêmica associada com streptococcus pneumoniae em pediatria: série de casos

ABSTRACT Objective: To describe a case series of four (4) patients with hemolytic uremic syndrome due to Streptococcus pneumoniae in a level four complexity institution in the city of Bogotá, D.C., Colombia. Cases description: We describe cases of four patients who presented respiratory symptoms and fever. All four patients were in regular conditions on hospital admission, after which they required intensive care and ventilatory support. Upon admission, three cases showed evidence of pleuropulmonary complication. Penicillin-sensitive Streptococcus pneumoniae was isolated in all cases. All patients presented anemia, severe thrombocytopenia, schistocytes on peripheral blood smear, and hyperazotemia. They required blood transfusion and renal replacement therapy during their hospitalization. The patients were diagnosed with hemolytic uremic syndrome due to S. pneumoniae. Three of the four patients had a progressive recovery of the renal function and were discharged after an average of 36 days of hospital stay. The remaining patient had two amputations in the extremities due to thrombotic vascular complications and was discharged after 99 days of hospital stay, requiring hemodialysis every other day. Comments: Hemolytic uremic syndrome due to Streptococcus pneumoniae is a rare but severe complication of invasive pneumococcal disease. Complicated pneumonia is the main condition associated with this entity. It is noteworthy the short period in which these cases were presented, considering the low annual incidence of the disease.

RESUMO Objetivo: Descrever uma série de casos de quatro pacientes com síndrome hemolítico-urêmica por pneumococo em uma instituição de referência em Bogotá, Colômbia. Descrição dos casos: Descrevemos os casos de quatro pacientes que apresentaram sintomas respiratórios e febre. Todos estavam em estado geral regular à admissão hospitalar e necessitaram de cuidados intensivos e suporte ventilatório. Na admissão, em três dos casos foi evidenciada a complicação pleuropulmonar. Isolamento de Streptococcus pneumoniae sensível à penicilina foi realizado em todos os casos. Os quatro pacientes precisaram de transfusão sanguínea e terapia de reposição renal durante a hospitalização. Nos testes laboratoriais, observou-se anemia, trombocitopenia grave, presença de esquizócitos em esfregaço de sangue periférico e hiperazotemia. Com esse quadro, o diagnóstico foi de síndrome hemolítico-urêmica associada à infecção por S. pneumoniae. Houve recuperação progressiva da função renal em três dos quatro pacientes, que tiveram alta após 36 dias de internação hospitalar, em média. Um paciente teve complicações vasculares trombóticas, resultando em duas amputações nas extremidades, e teve alta após 99 dias de internação, com necessidade de hemodiálise em dias alternados. Comentários: A síndrome hemolítico-urêmica por Streptococcus pneumoniae é uma complicação rara, mas grave, da doença invasiva pneumocócica. A pneumonia complicada é a principal condição associada a essa entidade. Destaca-se o curto período em que esses casos foram apresentados, levando em conta a baixa incidência anual de síndrome hemolítico-urêmica.

Síndrome hemolítico urémico asociado a Shigatoxina: ¿Cómo prevenirlo? / Shiga-toxin associated hemolytic uremic syndrome: how to prevent it?

Resumen: El síndrome hemolítico urémico (SHU) asociado a infección intestinal por bacterias productoras de Shigatoxina, que afecta principalmente a población infantil, puede causar morbilidad aguda grave, secuelas crónicas en varios órganos, y la muerte prematura en algunos de ellos. Dado su carácter zoonótico, adecuadas medidas de manejo agropecuario y correcta higiene de lo que consumimos es indispensable a la hora de prevenir la infección. Actualmente, una vez gatillado el SHU el manejo es médico y, principalmente, de soporte. En los últimos años diversas estrategias terapéuticas se han ido desarrollando para evitar que esta enfermedad ocurra, o, al menos, que pueda ser atenuada en sus consecuencias de morbi-mortalidad. El presente artículo describe acciones específicas a diferentes niveles de prevención de esta patología.

Abstract Hemolytic uremic syndrome (HUS) associated with intestinal infection by Shiga toxin-producing bacteria, which mainly affects children, can cause severe acute morbidity, chronic sequelae in seve ral organs, and premature death in some of them. Given its zoonotic nature, adequate measures of agricultural management and proper hygiene of what we consume are essential to prevent infection. Once the HUS is triggered, medical management is currently mainly supportive. In recent years, va rious therapeutic strategies have been developed to prevent this disease from occurring or, at least, to mitigate its morbidity and mortality consequences. This article describes specific actions at different levels of prevention of this pathology.

Tos convulsa, causa extraña de síndrome hemolítico urémico / Whooping cough, unusual cause of hemolytic uremic syndrome

La tos convulsa es una enfermedad infecto-contagiosa producida por Bordetella pertussis y Parapertussis. El principal reservorio son los adultos jóvenes. Los pacientes más susceptibles de presentar una forma grave de esta enfermedad son los lactantes menores de 6 meses. El síndrome urémico hemolítico es una complicación rara de la tos convulsa. La patogenia del mismo no ha sido aclarada, planteándose que el mismo es secundario al efecto de las toxinas producidas por Bordetella pertussis y por fenómenos inflamatorios. En la literatura internacional son escasos los reportes de síndrome urémico hemolítico asociado a tos convulsa y no se ha podido establecer cuáles son los factores de riesgo para el desarrollo del mismo. Se presenta el caso de una lactante que desarrolló insuficiencia renal aguda secundaria a un síndrome urémico hemolítico en el curso de una infección aguda por Bordetella pertussis que requirió terapia de sustitución de la función renal.

Whopping cough is an infectous disease caused by Bordetella pertussis and Parapertussis. The main reservoir of Bordetella are adolescents and adults. Infants younger than 6 months have increased risk for developing a severe illnes with a lethal evolution. Hemolytic uremic syndrome is an unusual complication of whopping cough. The pathogenic mechanisms have not been clarified. One of the hypothesis has established the role of Bordetella toxins and inflammatory mediators. There are few cases published of hemolytic uremic syndrome associated to whopping cough and risk factors for its development have not been established. In the present article we report the case of a breastfeeding who developed an acute renal failure secondary to a hemolytic uremic syndrome during the hospitalization in the Intensive Care Unit.

Síndrome urémico hemolítico con compromiso renal leve debido a una cepa de Escherichia coli productora de toxina Shiga [Shiga-toxin-producing Escherichia coli (STEC)] 0145 / Hemolytic uremic syndrome with mild renal involvement due to Shiga toxin-producing Escherichia coli (STEC) 0145 strain

El síndrome urémico hemolítico (SUH) es una afección caracterizada por la presencia de la tríada clásica: anemia hemolítica microangiopática, trombocitopenia y compromiso renal agudo. Los casos de SUH sin insuficiencia renal pueden confundirse con otras enfermedades hematológicas. Presentamos un caso de SUH pediátrico causado por una cepa de Escherichia coli productora de toxina Shiga Shiga-toxin-producing Escherichia coli (STEC) O145 con el genotipo stx2, ehxA, eae subtipo ?1. El niño no requirió diálisis durante la etapa aguda del SUH, evolucionó favorablemente y no tuvo recurrencias hasta el último control; además, mantuvo cifras normales de presión arterial y función renal normal. Esto puede deberse a varios factores: características de la cepa STEC infectante y susceptibilidad del hospedero al daño renal, entre otros. Este hallazgo destaca la participación regional de STEC no-O157 en enfermedades de la infancia y la importancia de realizar una vigilancia activa de todas las formas de SUH

Hemolytic uremic syndrome (HUS) is a disorder characterized by the presence of the classic triad: microangiopathic hemolytic anemia, thrombocytopenia and acute renal injury. HUS without acute renal failure can be confused with other hematologic diseases. An infantile HUS caused by a Shiga-toxin-producing Escherichia coli (STEC) O145 strain carrying genotype stx2, ehxA, eae subtype ?1 is herein reported. The infant did not require dialysis during the acute stage of HUS, evolved favorably, maintained normal blood pressure and normal renal function and had no recurrence until the last control. This could be due to several factors, such as the characteristics of infecting STEC strain and a reduction in host susceptibility to renal injury. This report highlights the regional participation of non-O157 STEC in childhood diseases and the importance of performing active surveillance for all forms of HUS

Escherichia coli O157:H7: local epidemiology and disease spectrum in Brazil

Escherichia coli O157: H7 is one of the most important foodborne pathogens nowadays, since it has been responsible for severe outbreaks worldwide. Event hough this food pathogen has been isolated in many countries, Brazilian foods were considered E. coli O157:H7-free until recently. However, the presence of E. coli O157:H7 has been reported in diverse foods produced in Brazil and an increasing number of isolation from cattle feces has been observed, demonstrating that this pathogen is present in different parts of Brazil, and severe foodborne outbreaks mayoccur in the near future if adequate control measures are not implemented

Clinical Implications of Pneumococcal Serotypes: Invasive Disease Potential, Clinical Presentations, and Antibiotic Resistance

Streptococcus pneumoniae can asymptomatically colonize the nasopharynx and cause a diverse range of illnesses. This clinical spectrum from colonization to invasive pneumococcal disease (IPD) appears to depend on the pneumococcal capsular serotype rather than the genetic background. According to a literature review, serotypes 1, 4, 5, 7F, 8, 12F, 14, 18C, and 19A are more likely to cause IPD. Although serotypes 1 and 19A are the predominant causes of invasive pneumococcal pneumonia, serotype 14 remains one of the most common etiologic agents of non-bacteremic pneumonia in adults, even after 7-valent pneumococcal conjugate vaccine (PCV7) introduction. Serotypes 1, 3, and 19A pneumococci are likely to cause empyema and hemolytic uremic syndrome. Serotype 1 pneumococcal meningitis is prevalent in the African meningitis belt, with a high fatality rate. In contrast to the capsule type, genotype is more closely associated with antibiotic resistance. CC320/271 strains expressing serotype 19A are multidrug-resistant (MDR) and prevalent worldwide in the era of PCV7. Several clones of MDR serotype 6C pneumococci emerged, and a MDR 6D clone (ST282) has been identified in Korea. Since the pneumococcal epidemiology of capsule types varies geographically and temporally, a nationwide serosurveillance system is vital to establishing appropriate vaccination strategies for each country.

Detección de microorganismos potencialmente patógenos en hogares de Mar del Plata / Detection of potentially pathogenic microorganisms in households of Mar del Plata / Detecção de microorganismos potencialmente patógenos em moradias de Mar del Plata

La cocina y el baño son los lugares del hogar más susceptibles de contaminación microbiana. Estos microbios se depositan sobre las superficies formando biofilms y pueden constituirse en potenciales fuentes causales de enfermedades. El objetivo del trabajo fue detectar la presencia y la concentración de carga microbiana en los elementos y utensilios de los sitios más críticos de viviendas de la ciudad de Mar del Plata. Se recolectaron 478 muestras de elementos y utensilios de cocinas y baños provenientes de 36 hogares de familias de características socioeconómicas similares a los casos de Síndrome Urémico Hemolítico ocurridos en la misma ciudad. En cocinas el 52% superó los parámetros establecidos para el estudio detectándose >100 UFC/muestra de aerobios mesófilos, >10 UFC/muestra de enterobacterias y presencia de Escherichia coliy Staphylococcus aureus. En baños el 37% excedió los criterios establecidos. Los elementos que superaron estos límites son los que habitualmente se encuentran húmedos. Se realizaron recomendaciones tendientes a asegurar una higiene adecuada en los sitios más críticos, trabajando en educación para la salud a nivel de los hogares de la comunidad teniendo en cuenta las recomendaciones que se deben cumplir al momento de la preparación de los alimentos.

The kitchen and bathroom are the places in the home most susceptible to microbial contamination. These germs are deposited on surfaces to form biofilms and may constitute grounds for potential disease sources. The aim of this study was to detect the presence and concentration of microbial load in the elements and utensils of the most critical housings in the city of Mar del Plata. Four hundred and seventy-eight samples of items and utensils collected from kitchens and bathrooms from 36 homes of families of similar socioeconomic characteristics to the cases of hemolytic uremic syndrome occurred in the same city. Fifty-two per cent of kitchens exceeded the parameters established for the study and >100UFC/sample of mesophilic aerobes, >10UFC/sample of Enterobacteriaceae and Escherichia coli and Staphylococcus aureus were detected. Thirty-seven per cent of baths exceeded the established criteria. The elements that are beyond these limits are usually found wet, becoming potential sources thereof. Recommendations were made to ensure proper hygiene in the most critical places. It is extremely important to work in health education at the household level of the community taking into account the recommendations that must be followed when preparing food.

A cozinha e o banheiro são os lugares da casa mais suscetíveis de contaminação microbiana. Estes micróbiomoras se depositam sobre as superficies formando biofilmes e podem se constituir em potenciais fontes causais de doengas. O objetivo do trabalho foi detectar a presenga e a concentragáo de carga microbiana nos elementos e utensilios dos lugares mais críticos de moradias da cidade de Mar del Plata. Foram coletadas 478 amostras de elementos e utensilios de cozinhas e banheiros provenientes de 36 moradias de familias de características socioeconómicas similares aos casos de Síndrome Hemolítico-Urêmica acontecidos na mesma cidade. Em cozinhas 52% superou os parâmetros estabelecidos para o estudo detectandose >100 UFC/amostra de aeróbios mesófilos, >10 UFC/amostra de Enterobactérias e presenga de Escherichia coli e Staphylococcus aureus. Em banheiros 37% excedeu os critérios estabelecidos. Os elementos que superaram estes limites sáo os que habitualmente se encontram úmidos. Foram realizadas recomendaçães tendentes a garantir uma higiene adequada nos lugares mais críticos, trabalhando em educação para a saúde em nivel das moradias da comunidade levando em consideração as recomendações que devem ser cumpridas na hora da preparação dos alimentos.

Viral-associated thrombotic microangiopathies

Thrombotic microangiopathies encompass a group of disorders characterized by microangiopathic he-molytic anemia, thrombocytopenia associated with hyaline thrombi [comprised primarily of platelet aggregates in the microcirculation], and varying degrees of end-organ failure. Many primary [genetic] and secondary etiological predisposing factors have been describednamely pregnancy, autoimmune disorders, cancer, drugs and antineoplastic therapy, bone marrow transplantation/solid organ transplantation, and infections. In the setting of infectious diseases, the association with Shiga or Shiga-like exotoxin of Escherichia coli 0157:H7 or Shigella dysenteriae type 1-induced typical hemolytic uremic syndrome is well known. Recently however, an increasing body of evidence suggests that viruses may also play an important role as trigger factors in the pathogenesis of thrombotic microangiopathies. This is a comprehensive review focusing on the current understanding of viral associated/induced endothelial stimulation and damage that ultimately leads to the development of this life-threatening multisystemic disorder

Modelo de contaminación cruzada por Escherichia coli verocitotoxigénica durante la elaboración de hamburguesas caseras y evaluación cuantitativa de riesgos / Quantitative risk model for verocytotoxigenic Escherichia coli cross-contamination during hamburger preparation

El objetivo del presente trabajo fue generar un modelo probabilístico para evaluar cuantitativamente el riesgo de contaminación cruzada de E. coli verocitotoxigénica (VTEC) durante el proceso de elaboración de hamburguesas caseras y su impacto en la salud pública. El modelo tuvo en cuenta un grupo de prácticas culinarias corrientes y a cada una de ellas se le asignó la probabilidad asociada de transferencia de VTEC entre los alimentos y los utensilios de cocina. Las distribuciones de probabilidad que mejor describieron cada paso del proceso fueron incorporadas en el programa @Risk® y se realizaron las simulaciones empleando el análisis Monte Carlo. La manipulación de alimentos crudos (en este caso, la carne picada) antes de la preparación de alimentos que no demandan cocción (como las guarniciones de vegetales frescos que suelen acompañarlas) (Odds ratio, OR = 6,57), así como el hábito del lavado de manos (OR = 12,02) y de las tablas que se utilizan durante la elaboración de estos platos (OR = 5,02), fueron los principales factores de riesgo de contaminación cruzada del patógeno entre la carne y las verduras. La información aportada por este modelo debería considerarse durante el diseño de estrategias de comunicación del riesgo del síndrome urémico hemolítico para acentuar la importancia que estos factores pueden tener en la transmisión de la enfermedad.

The objective of this study was to develop a quantitative risk model for verocytotoxigenic Escherichia coli (VTEC) cross-contamination during hamburger preparation at home. Published scientific information about the disease was considered for the elaboration of the model, which included a number of routines performed during food preparation in kitchens. The associated probabilities of bacterial transference between food items and kitchen utensils which best described each stage of the process were incorporated into the model by using @Risk® software. Handling raw meat before preparing ready-to-eat foods (Odds ratio, OR, 6.57), as well as hand (OR = 12.02) and cutting board (OR = 5.02) washing habits were the major risk factors of VTEC cross-contamination from meat to vegetables. The information provided by this model should be considered when designing public information campaigns on hemolytic uremic syndrome risk directed to food handlers, in order to stress the importance of the above mentioned factors in disease transmission.

Hábitos de consumo de hamburguesas y riesgo de exposición a Escherichia coli verotoxigénica (VTEC): modelo de simulación / Hamburger consumption patterns and exposure assessment for verocytotoxigenic Escherichia coli (VTEC): simulation model

El objetivo del trabajo fue evaluar cuantitativamente el riesgo para la salud pública debido a la infección por VTEC derivado del consumo de hamburguesas. Mediante un modelo de simulación, se analizaron procesos de distribución, almacenamiento y venta, así como hábitos de consumo. La prevalencia y concentración de VTEC fue incluida en el modelo sobre la base de información científica publicada acerca de la enfermedad. Las distribuciones de probabilidad que mejor describieron cada paso del proceso fueron incorporadas en el programa @RiskR, y se realizaron múltiples simulaciones empleando el análisis Monte Carlo. El riesgo estimado de padecer la infección por VTEC en los adultos fue de 4,45 x 10-4; mientras que en los niños, los riesgos de adquirir la infección, de padecer Síndrome Urémico Hemolítico (SUH) y de mortalidad fueron de 2,6 x 10-4, 1,38 x 10-5 y 4,54 x 10-7, respectivamente. El riesgo de adquirir la infección y sus secuelas estuvo correlacionado con la concentración bacteriana en la carne (r = 0,664). El consumo de hamburguesas de elaboración propia (r = -0,203) estuvo asociado con el riesgo de enfermar dadas las características del almacenamiento (r = -0,567), que forman parte de los hábitos de consumo de la población. La información generada debería considerarse durante el diseño de estrategias de gestión y comunicación del riesgo del SUH, con énfasis en la importancia que estos factores tienen en la trasmisión de la enfermedad.

A quantitative risk assessment was developed for verocytotoxigenic Escherichia coli (VTEC) associated with hamburger consumption. The assessment (simulation model) considers the distribution, storage and consumption patterns of hamburgers. The prevalence and concentration of VTEC were modelled at various stages along the agri-food beef production system using input derived from Argentinean data, whenever possible. The model predicted an infection risk of 4.45 x 10-4 per meal for adults. The risk values obtained for children were 2.6 x 10-4, 1.38 x 10-5 and 4.54 x10-7 for infection, Hemolytic Uremic Syndrome (HUS) and mortality, respectively. The risk of infection and HUS was positively correlated with bacterial concentration in meat (r = 0.664). There was a negative association between homemade hamburgers (r = -0.116) and the risk of illness; however this association has been considered due to differences between retail and domiciliary storage systems (r = -0.567) and not because of the intrinsic characteristics of the product. The most sensitive points of the production system were identified through the risk assessment, therefore, these can be utilized as a basis to apply different risk management policies in public health.

Síndrome hemolítico urémico / Hemolytic uremic syndrome

El síndrome hemolítico urémico incluye una triada clásica: anemia hemolítica microangiopática, trombocitopenia y disfunción renal aguda. Es preciso sospechar su diagnóstico en todo niño con historia de diarrea aguda sanguinolenta, para anticipar la evolución y las complicaciones que se asocian.

importance of Escherichia coli 0157:H7 in foodborn infection

Enterohemorrhagic Escherichia coli O157: H7 is one of the most important causes of bloody diarrhea. This bacterium is able to make bloody diarrhea or Hemorrhagic Colitis [HC] through verotoxin or shigatoxin production, and in acute forms it may lead to Hemolytic Uremic Syndrome [HUS] or Thrombotic Thrombocytopenic Purpurea [TTP]. Contamination with E. coli O157:H7 usually happens after consumption of animal products especially undercooked meats. The most important reservoir of this bacterium is beef and consumption of undercooked ground beef, especially in children younger than 10 years old, is the most common reason of food infection by this bacterium. Two important biochemical characteristics for detection of E. coli O157: H7 are lack of sorbitol fermentation and absence of glucuronidase. In order to control food infection with this bacterium, foods must be cooked thoroughly until reaching the temperature of at least 68.3°C, in the center