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An Epidemiologic Surveillance of Shiga-like Toxin-producing Escherichia coli Infection in Argentinean Children: Risk Factors and Serum Shiga-like Toxin 2 Values

López, Eduardo L. MD*; Contrini, Maria M. MD*; Glatstein, Eduardo MD; Ayala, Silvia González MD; Santoro, Roberto MD§; Ezcurra, Gustavo MD; Teplitz, Eduardo MD; Matsumoto, Yoichi PhD**; Sato, Hiroaki PhD**; Sakai, Kazuaki MSc**; Katsuura, Yasuhiro PhD**; Hoshide, Satoru MSc**; Morita, Takuya MSc††; Harning, Ronald PhD††; Brookman, Sheldon PhD††

The Pediatric Infectious Disease Journal: January 2012 - Volume 31 - Issue 1 - p 20–24
doi: 10.1097/INF.0b013e31822ea6cf
Original Studies

Background and Aims: 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.

From the *Department of Medicine, Hospital de Niños “Dr. Ricardo Gutiérrez,” Buenos Aires, Argentina; †Infectious Diseases Unit, Hospital de Niños “Santísima Trinidad,” Córdoba, Argentina; ‡Infectious Diseases Unit, Hospital de Niños “Sor María Ludovica,” La Plata, Argentina; §Outpatients Office Division, Hospital Interzonal Especializado Materno Infantil, Mar del Plata, Argentina; ¶Infectious Diseases Unit, Hospital “San Roque,” Paraná, Argentina; ∥Pediatric Department, Hospital Italiano Regional del Sur, Bahia Blanca, Argentina; **Teijin Pharma Limited, Tokyo, Japan; ††Teijin America, Inc., New York, NY.

Accepted for publication July 19, 2011.

Supported by the Program of Research and Development Promotion of Orphan Drugs, NIBIO (Japan) and a grant-in-aid from Teijin Pharma Limited.

The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Eduardo L. López, MD, Department of Medicine, Hospital de Niños “Dr. Ricardo Gutiérrez,” Guido 2676, Piso 10, Buenos Aires 1425, Argentina. E-mail:

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© 2012 Lippincott Williams & Wilkins, Inc.