Epidemiologia del síndrome urémco hemolítico en Argentina: diagnóstico del agente etiológico, reservorios y vías de transmissión / The epidemiology of hemolytic uremic syndrome in Argentina. Diagnosis of the etiologic agent, reservoirs and routes of transmission

ABSTRACT

Shiga toxin-producing Escherichia coli (STEC) cause sporadic cases and outbreaks of nonbloody and bloody diarrhea, and hemolytic uremic syndrome (HUS). E. coil O157:H7 is the most prevalent STEC serotype. However, other serotypes (O26:H11; O103:H2; O111:NM; O121:H19; O145:NM, among others) can cause a similar disease spectrum. Shiga toxins (Stx1, Stx2, and their variants), intimin, and enterohemolysin are the main virulence factors. Three different diagnostic criteria are used to determine the frequency of STEC infection: 1) isolation and characterization of STEC strains; 2) detection of specifically neutralizable free fecal Stx; and 3) Serological tests to detect Stx-antibodies. The surveillance of the STEC strains is performed using subtyping techniques: a) genotyping of Stx and eae by PCR-RFLP; b) phage typing of E. coil O157 strains; and c) pulsed-field gel electrophoresis. STEC O157 and non-O157 strains are recovered from clinic, animal, food and environmental samples, and E. coli O157:H7, a Stx2 and Stx2c producer, harboring eae and ehxA genes, is the most common serotype. During a prospective case-control study conducted to evaluate risk factors for sporadic STEC infection in Mendoza Province and Buenos Aires City and its surroundings during 2001-2002, exposures associated with risk included eating undercooked beef, contact with a child < 5 years with diarrhea and living in or visiting a place with farm animals. Both washing hands after handling raw beef, and eating fruits and vegetables were frequently protective. Strategies of prevention and control are necessary to decrease the incidence of STEC infections in Argentina.