The Pediatric infectious disease journal · 2026
Epidemiology of Bloody Diarrhea, Shiga Toxin-producing Escherichia coli and Hemolytic Uremic Syndrome in Children.
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Tamburini Giacomo, Daprai Laura, Gazzola Alessandra, Rossetti Daniele, Tomassini Elena, Dilio Giulia, Ria Thomas, Dato Letizia, Mancuso Maria Cristina, Luini Mario, Tel Francesca, Possenti Ilaria, Magistrali Chiara Francesca, Callegaro Anna Paola, Ardissino Gianluigi, ItalKid-HUS Network
Аннотация
BACKGROUND: Shiga Toxin-producing Escherichia coli -associated hemolytic uremic syndrome (STEC-HUS) remains a leading cause of acute kidney failure, worldwide. The disease often presents with acute bloody diarrhea and supportive care is the only therapeutic option; thus, early diagnosis and early management are of paramount importance.
AIM: Herein, we share the results of a proactive diagnostic approach to acute bloody diarrhea in children as shown by a surveillance activity devoted to the early diagnosis of STEC infection.
METHODS: Since 2010, in a well-defined area of Northern Italy (referral pediatric population of 2 million), children and teenagers (age <20) with acute bloody diarrhea had their stool screened for Shiga toxin (Stx) genes. Positive patients were hydrated and followed until recovery or the development of HUS.
RESULTS: Stool specimens from 7518 children with acute bloody diarrhea were tested, and 464 (6.2%) turned out to be positive for Stx genes. During the same period and in the same area, 178 STEC-HUS cases were diagnosed. The most common Stx encountered was the Stx2 (n: 217; 52.3%), followed by the combination of Stx1 and 2 (n: 111; 26.7%) while Stx1 was less commonly detected (n: 87; 21.0%). Acute bloody diarrhea, STEC infection and STEC-HUS were all more common in younger children <5 years except in the age group <1 year-old. The percentage of Stx+ acute bloody diarrheas doubles during the summer months, peaking as high as 10% in August and September.
CONCLUSIONS: The specific diagnostics for Stx genes can guide patients' management and help in identifying the source of the infection by revealing a significant proportion of children with STEC infection among patients with acute bloody diarrhea.
AIM: Herein, we share the results of a proactive diagnostic approach to acute bloody diarrhea in children as shown by a surveillance activity devoted to the early diagnosis of STEC infection.
METHODS: Since 2010, in a well-defined area of Northern Italy (referral pediatric population of 2 million), children and teenagers (age <20) with acute bloody diarrhea had their stool screened for Shiga toxin (Stx) genes. Positive patients were hydrated and followed until recovery or the development of HUS.
RESULTS: Stool specimens from 7518 children with acute bloody diarrhea were tested, and 464 (6.2%) turned out to be positive for Stx genes. During the same period and in the same area, 178 STEC-HUS cases were diagnosed. The most common Stx encountered was the Stx2 (n: 217; 52.3%), followed by the combination of Stx1 and 2 (n: 111; 26.7%) while Stx1 was less commonly detected (n: 87; 21.0%). Acute bloody diarrhea, STEC infection and STEC-HUS were all more common in younger children <5 years except in the age group <1 year-old. The percentage of Stx+ acute bloody diarrheas doubles during the summer months, peaking as high as 10% in August and September.
CONCLUSIONS: The specific diagnostics for Stx genes can guide patients' management and help in identifying the source of the infection by revealing a significant proportion of children with STEC infection among patients with acute bloody diarrhea.