Escherichia coli enterohemorrágica en el síndrome hemolítico urémico, en niños chilenos: evaluación de diferentes técnicas de diagnóstico de infección / Enterohemorrhagic escherichia coli in hemolytic uremic syndrome, in chilean children: evaluation of different technics of infection diagnosis

RESUMO

Enterohemorrhagic escherichia coli (EHEC), have been associated with pathogenesis of hemolytic uremic syndrome (HUS) worldwide. Our aim was to determine the association of EHEC ing¿fection and HUS in chilean children. During may 1991 and october 1993, 34 children HUS and 33 age matched controls (children with diarrhea that did not develop HUS) were enrolled in a case/control study. For each child a stool and serum sample were obtained at admission. Stools were processed for common enteropathogen and for EHEC identification. EHEC were identified in stools by gene probes for different virulence factors (EHEC plasmid-associated fimbria, Shiga-like toxin I, Shiga-like toxin II and eae adherence factor) and by detection of free fecal toxin by neutralization assay in Vero cells. Sera were processed for anti-cytotoxin antibodies also by an assay in Vero cells. Enteropathogens were isolated in 20.6 percent and 15.5 percent of HUS and control children respectively (p=NS). 91 percent of the HUS children and 73 percent of the control children were EHEC positive by one or more of the techniques used (p=0.05). Of the 3 detection methods used for EHEC, only free fecal cytotoxin was significantly more common in HUS children than controls (45.5 percent vs 9 percent p=0.007). Genotype patterns of HUS and controls strains were similar except for a trend towards a higher frequency of non-toxigenic strains in the control group. Serogroup 0157 was more common in HUS children than in controls (9 percent vs 0 percent p=0.036). In Chile as in other countries, EHEC infection is common and significantly associated with occurrence of HUS. Infection with EHEC strains 0157 seems to be important risk factor for HUS