Shiga-Toxin Producing Escherichia coli and the Hemolytic Uremic Syndrome: What Have We Learned in the Past 25 Years?
Shiga-Toxin Producing Escherichia coli and the Hemolytic Uremic Syndrome: What Have We Learned in the Past 25 Years?
复制标题
DOI：
10.1007/978-0-387-79838-7_1
复制
发表时间：
2009-01-01
期刊：
影响因子：
--
通讯作者：
Tarr, Phillip I.
中科院分区：
文献类型：
--
作者：
Ahn, Christina K.;Holt, Nicholas J.;Tarr, Phillip I.
属于O157: H7血清型并产生志贺毒素的大肠杆菌是重要的和具有挑战性的人类病原体。这种微生物可以引起相当严重的人类肠道疾病，包括腹泻和血性腹泻。最值得注意的是，大肠杆菌O157: H7是全世界溶血性尿毒症综合征（HUS）的主要病因。溶血性尿毒综合征包括非免疫性溶血性贫血、血小板减少症和急性肾功能衰竭，对儿童的影响尤为严重。大肠杆菌O157: H7感染和溶血性尿毒综合症都相对罕见。根据2007年疾病控制中心（CDC）的估计（McNabb, Jajosky et al. 2007），在整个美国，每年培养证实的大肠杆菌O157: H7感染病例只有约2600例。根据这些数据，我们估计每年大约有400例溶血性尿毒综合征病例，其中一半或更多的病例发生在10岁以下的儿童中。HUS是一种血栓性疾病（Upadhyaya, Barwick et al. 1980; inner, Howie et al. 1997; Tsai, Chandler et al. 2001），这些血栓继发的缺血性肾损伤很可能导致急性肾功能衰竭（Bellomo, Kellum et al. 2007）。也有可能血栓性损伤在疾病早期就开始了，远在氮质血症发生之前。这是一个挑战，因为针对感染细菌的干预措施可能是徒劳的，但如果及时发现患者，就有机会在血栓形成时维持肾脏灌注。由于大肠杆菌O157: H7感染的罕见性、严重后果及其在流行病学中的重要性，在发病点附近进行良好的社区微生物学诊断，并利用综合征谱分析准确、迅速地识别受感染患者至关重要。
Escherichia coli that belong to the serotype O157: H7 and produce Shiga toxins are important and challenging human pathogens. This organism can cause quite severe human enteric illnesses, including diarrhea and bloody diarrhea. Most notably, E. coli O157: H7 is the predominant cause of the hemolytic uremic syndrome (HUS) worldwide. HUS consists of nonimmune hemolytic anemia, thrombocytopenia, and acute renal failure, and disproportionately affects children. Both E. coli O157: H7 infections and HUS are relatively rare. According to 2007 estimates from the Centers for Disease Control (CDC)(McNabb, Jajosky et al. 2007), there are only c. 2600 cases of culture-proven E. coli O157: H7 infection annually in the entire United States. Based on these data, we estimate that there are about 400 cases of HUS per year, and half or more of the cases of HUS are in children less than 10 years of age. HUS is a thrombotic illness (Upadhyaya, Barwick et al. 1980; Inward, Howie et al. 1997; Tsai, Chandler et al. 2001), and it is quite likely that ischemic renal injury secondary to these thrombi leads to acute renal failure (Bellomo, Kellum et al. 2007). It is also probable that the thrombotic injury begins early in the illness, well before azotemia ensues. This is a challenge because interventions that target the infecting bacteria are probably futile, but if patients are identified in a timely manner, there is an opportunity to maintain renal perfusion as thrombi evolve. Because of the rarity of E. coli O157: H7 infections, their serious consequences and their epidemiological importance, it is critical to have good community-based microbiology diagnosis close to point of presentation, and to utilize syndrome profiling to identify infected patients accurately and expeditiously.