Fecal diagnostics in combination with serology: best test to establish STEC-HUS.
Fecal diagnostics in combination with serology: best test to establish STEC-HUS.
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DOI：
10.1007/s00467-016-3420-7
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发表时间：
2016-11
期刊：
影响因子：
--
通讯作者：
van de Kar NC
中科院分区：
文献类型：
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作者：
Wijnsma KL;van Bommel SA;van der Velden T;Volokhina E;Schreuder MF;van den Heuvel LP;van de Kar NC
在大多数儿科患者中，溶血性尿液综合征（HUS）是由产生志贺毒素的大肠杆菌（STEC）感染引起的（非典型的HUS）由于治疗和结果的差异STEC的脂多糖（LPS）持续数周，因此在诊断STEC中可能具有附加值。
在1990年至2014年之间在Radboud大学医学中心接受治疗的所有患者均在此回顾性单中心研究中均收集通过血清学测定（ELISA）检测。
有65名患者的数据可用于分析。 p <0.0001）当血清学抗体测定外，除了标准的粪便诊断测试外，还可以确认诊断性的STEC-HUS。
当与标准的粪便诊断测试结合使用以诊断STEC-HUS时，血清学抗O157 LPS分析显然做出了积极的贡献，应将其纳入临床实践中。
In the majority of pediatric patients, the hemolytic–uremic syndrome (HUS) is caused by an infection with Shiga toxin-producing Escherichia coli (STEC), mostly serotype O157. It is important to discriminate between HUS caused by STEC and complement-mediated HUS (atypical HUS) due to differences in treatment and outcome. As STEC and its toxins can only be detected in the patient’s stool for a short period of time after disease onset, the infectious agent may go undetected using only fecal diagnostic tests. Serum antibodies to lipopolysaccharide (LPS) of STEC persist for several weeks and may therefore be of added value in the diagnosis of STEC. All patients with clinical STEC-HUS who were treated at Radboud University Medical Center between 1990 and 2014 were included in this retrospective single-center study. Clinical and diagnostic microbiological data were collected. Immunoglobulin M (IgM) antibodies against LPS of STEC serotype O157 were detected by a serological assay (ELISA). Data from 65 patients weres available for analysis. Fecal diagnostic testing found evidence of an STEC infection in 34/63 patients (54 %). Serological evidence of STEC O157 was obtained in an additional 16 patients. This is an added value of 23 % (p < 0.0001) when the serological antibody assay is used in addition to standard fecal diagnostic tests to confirm the diagnosis STEC-HUS. This added value becomes especially apparent when the tests are performed more than 7 days after the initial manifestation of the gastrointestinal symptoms. The serological anti-O157 LPS assay clearly makes a positive contribution when used in combination with standard fecal diagnostic tests to diagnose STEC-HUS and should be incorporated in clinical practice.