RESUMEN

BACKGROUND: Shiga toxin (Stx)-producing Escherichia coli (STEC) infection is associated with hemolytic uremic syndrome (HUS), the main cause of acute renal failure in early childhood. Stx is essential in the pathogenesis of HUS, which has been mostly related to Stx2-producing isolates. Very limited data exist on the immune response to STEC in the Brazilian population. In this study, the prevalence of immunoglobulin G (IgG) antibodies to Stx2 was investigated in sera of children diagnosed with HUS and of healthy children in the city of São Paulo, Brazil. METHODS: IgG-antibody reactivity to Stx2 was determined by immunoblotting (WB) and enzyme-linked immunosorbent assay (ELISA) in sera from 13 children with HUS aged 8 months to 6 years and 54 healthy urban children aged 5 months to 7 years. RESULTS: A positive immune response to the A and B subunits of Stx2 was observed in 46.1% HUS patients and in 16.6% healthy individuals by WB. All HUS patients and 62.9% healthy children showed IgG antibodies to the Stx2 A subunit. The frequency of antibodies to both subunits or only to the A subunit of Stx2 was significantly higher in HUS patients than controls (p<0.05). Also, the mean OD value obtained by ELISA was higher in that group. Considering children's age, the frequency of reactivity to either the A subunit or both subunits of Stx2 was considerably higher in HUS children up to three years old compared to controls in the same age range. Moreover, in almost 37% of healthy children, no immune response to Stx2 was detected independently of the child's age. CONCLUSIONS: The seroepidemiolgy of anti-Stx2 antibodies was described for the first time in healthy children and children with HUS in Brazil. The percentage of individuals showing antibodies against Stx2 was higher among HUS patients than controls, and in spite of the low number of notified HUS cases, STEC strains are circulating in our settings. In addition, the results obtained also corroborated previous data on the increased sensitivity and specificity of WB compared to toxin-based enzyme immunoassays.

Asunto(s)

RESUMEN

Enterohemorrhagic Escherichia coli (EHEC) strains can cause hemolytic uremic syndrome (HUS), a leading cause of childhood renal failure. The adhesin intimin and the secreted proteins A (EspA) and B (EspB) contribute to the occurrence of EHEC attaching and effacing lesions. In this study, immunoblot assays were performed to determine immunoglobulin G (IgG) antibodies reactive with these proteins in sera from 13 children diagnosed with HUS and in sera from 54 healthy Brazilian children. In general, high frequencies of serum IgG antibodies reactive with EspA, EspB and the conserved region of intimin were observed in both HUS patients and controls with no statistically significant differences. However, a marked difference in immune response to these proteins was observed in HUS patients compared to controls in infants less than two years of age. In addition, IgG against the variable region of intimin γ was more frequently detected in HUS patients than in children with no signs of infection (p<0.05) regardless of age, suggesting that the detection of antibodies directed to the variable region of intimin γ can be useful in serodiagnostic tests of EHEC-infected patients. The immune response against intimin and structural proteins encoded by the locus of enterocyte effacement pathogenicity island in patients with HUS has previously not been described in Brazil. The results presented here may contribute to the development of diagnostic tools and complement information concerning EHEC epidemiology in our setting.

Asunto(s)

RESUMEN

The hemolytic uremic syndrome (HUS) caused by Shiga toxin-producing Escherichia coli (STEC) is one of the most frequent causes of pediatric acute renal failure. The aim of this study was to report the clinic and microbiologic features associated with 13 post-diarrheal HUS cases identified in pediatric intensive care units in the city of São Paulo, Brazil, from January 2001 to August 2005. Epidemiologic, clinic, and laboratorial information, along with fecal and serum samples, were collected for identifying the genetic sequences of Stx and for studying antibodies directed against LPS O26, O111 and O157. STEC was isolated from three patients, and serotypes O26:H11, O157:H7 and O165:H- were identified. In nine patients, high levels of IgM against LPS O111 (n=2) and O157 (n=7) were detected. Dialysis was required in 76.9% of the patients; arterial hypertension was present in 61.5%, neurological complications were observed in 30.7%, and only one patient died. During a 5-year follow-up period, one patient developed chronic kidney disease. The combined use of microbiologic and serologic techniques provided evidence of STEC infection in 92.3% of the HUS cases studied, and the importance of O157 STEC as agents of HUS in São Paulo has not been previously highlighted.