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Italy, Haemolytic Uremic Syndrome: Cases reported from Apulia (Health Min., August 14 2013, edited)

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  • Italy, Haemolytic Uremic Syndrome: Cases reported from Apulia (Health Min., August 14 2013, edited)

    [Source: Italy Ministry of Health, full page in Italian: (LINK). Translated and edited.]


    Haemolytic Uremic Syndrome: Cases reported from Apulia

    (August 14 2013)

    The Haemolytic Uremic Syndrome Italian Registry System, in cooperation with the National Institute of Health (ISS, www.iss.it/seu) and with Italian Society for Paediatric Kidney Diseases (SINP), has been informed about several reported cases of HUS in patients resident in Apulia region or in people traveled there before the symptoms onset.

    Since August 1 till August 14 2013 eight children and one adult patients have been hospitalized after developing HUS.

    Most of HUS cases are secondary to a verocytotoxin producing Escherichia Coli infection (VTEC), with diarrhea, often with bloody stool, vomitus and abdominal pain.

    Preliminary laboratory investigations, performed by National Reference Laboratory for E.Coli at ISS, on two patients’ samples, revealed an infection with VTEC O26. Further investigation on the other cases are ongoing.

    Apulia Region Health Authorities are conducting epidemiological investigations, with Ministry of Health and National Institute of Health. These activities have not been able so far to ascertain with certainty a common source of infection.

    Regional Authorities are enhancing their epidemiological surveillance on local gastroenteritis activity, while the ISS sent an Alert message to all Italian paediatric kidney diseases Departments, through the SNIP, for early detection of other cases in the various Regions, possibly linked to the Apulia outbreak.

    For the same reason, ISS sent an Alert message to the European Centre for Disease Prevention and Control (ECDC).

    Health Authorities are recommending population in Apulia, or those that may have performed recent travel there, to seek medical advice at local hospital if bloody diarrhea should be developed, especially when very young children are involved.

    Further information on HUS with FAQs are available on the ISS website (in Italian): http://www.iss.it/seu/index.php?lang=1&anno=2013&tipo=16


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  • #2
    Re: Italy, Haemolytic Uremic Syndrome: Cases reported from Apulia (Health Min., August 14 2013, edited)

    [Source: ProMedMail.org, full page: (LINK). Edited.]


    Published Date: 2013-08-15 11:24:20 / Subject: PRO/AH/EDR> E. coli EHEC - Italy: (Puglia) O26 / Archive Number: 20130815.1881558

    E. COLI EHEC - ITALY: (PUGLIA) O26


    A ProMED-mail post http://www.promedmail.org / ProMED-mail is a program of the International Society for Infectious Diseases http://www.isid.org

    Date: Wed 14 Aug 2013

    Source: Italian Ministry of Health [in Italian, trans. submitter, edited]

    http://www.salute.gov.it/portale/news/p3_2_4_1_1.jsp?lingua=italiano&menu=salastampa&p=c omunicatistampa&id=4071

    http://www.iss.it/publ/index.php?lang=1&anno=2013&tipo=39


    The Hemolytic Uremic Syndrome [HUS] Italian Registry System, in cooperation with the National Institute of Health (Istituto Superiore di Sanita ISS], http://www.iss.it/seu) and the Italian Society for Pediatric Kidney Diseases (SINP), has been informed about several reported cases of HUS in patients resident in the region of Apulia [Puglia] or in people who traveled there before the onset of symptoms.

    Between 1 and 14 Aug 2013, 8 children and an adult patient were hospitalized after developing HUS. Most HUS cases are secondary to a Shiga toxin-producing _Escherichia coli_ infection (also called an enterohemorrhagic _E. coli_ or EHEC), with diarrhea, often with bloody stool, vomiting, and abdominal pain. Preliminary laboratory investigations performed by the National Reference Laboratory for _E. coli_ at ISS on 2 patients revealed an infection with EHEC O26. Further investigation on the other cases is ongoing.

    The Apulia Region Health Authorities are conducting epidemiological investigations with Ministry of Health and the ISS. These activities have not been able so far to ascertain with certainty a common source of infection. Regional authorities are enhancing their epidemiological surveillance on local gastroenteritis activity, while the ISS sent an alert message to all Italian pediatric kidney diseases departments, through the SNIP, for early detection of other cases in the various regions, possibly linked to the Apulia outbreak. For the same reason, ISS sent an alert message to the European Center for Disease Prevention and Control (ECDC).

    --
    communicated by:

    Giuseppe Michieli gimi69@libero.it


    [ProMED-mail thanks Giuseppe Michieli for this posting.

    In a 2-week period, 9 cases of hemolytic uremic syndrome have been diagnosed in Puglia in south eastern Italy. Usually, HUS occurs in no more than 5-10 per cent of cases, suggesting that as many as 200 cases of the infection could have occurred. ProMED-mail awaits more information regarding this Italian outbreak.

    In analyzing the genetic and phenotypic profiles of non-O157 groups, it has been found that they belong to their own lineages and have unique profiles of virulence traits different from O157 (1). The serogroups appearing to be most prominent are O26, O111, O128, and O103 (2), the former serotype being the implicated strain in this outbreak.

    If a laboratory is using sorbitol-MacConkey (sMAC) plates to identify VTEC by virtue of O157's inability to ferment sorbitol, the non-O157 strains will be missed. In a 3-year pediatric study from the University of Washington, USA (3), 1851 stool samples were processed for sorbitol fermentation as well as toxin production by EIA (enzyme immunoassay), and 28 strains of O157 were found along with O103 (4 strains), O118 (2 strains), O111 (2 strains), and 3 other strains.

    Clinically, the O157 infections had a higher frequency of bloody stools, fecal leukocytes, and abdominal pain with shorter symptom duration. Five (18 per cent) of O157 infections developed hemolytic uremic syndrome (HUS); none of the non-O157 strains did. Since toxin assay did not identify all O157 strains found on sMAC plates, the investigators did not advocate performing toxin assay alone. Non-O157 can produce HUS, as demonstrated by a cluster of O121 cases associated with a lake in Connecticut, USA (4).

    Since toxin assays are not uniformly performed in many areas, and most cases do not produce HUS, it is likely that cases due to non-O157 strains are being missed. How frequent this phenomenon will become over time is unclear.


    References
    ----------

    1. Schmidt H, Geitz C, Tarr PI, et al. Non-O157:H7 pathogenic Shiga-toxin producing _Escherichia coli_: phenotypic and genetic profiling of virulence traits and evidence for clonality. J Infect Dis 1999; 179(1): 115-23; available at http://www.journals.uchicago.edu/doi/full/10.1086/314537.

    2. Bettelheim KA. Role of non-O157 VTEC. Symp Ser Soc Appl Microbiol 2000; (29): 38S-50S; abstract available at http://www.ncbi.nlm.nih.gov/pubmed/10880178.

    3. Klein EJ, Stapp JR, Calusen CR, et al. Shiga toxin-producing _Escherichia coli_ in children with diarrhea: a prospective point-of-care study. J Pediatr 2002; 141(2): 172-7; available at http://www.ncbi.nlm.nih.gov/pubmed/12183710.

    4. McCarthy TA, Barrett NL, Hadler JL, et al: Hemolytic-uremic syndrome and _Escherichia coli_ O121 at a lake in Connecticut, 1999. Pediatrics 2001; 108(4): E59; available at http://pediatrics.aappublications.org/cgi/content/full/108/4/e59. - Mod.LL

    A HealthMap/ProMED-mail map can be accessed at http://healthmap.org/r/1BIF.]

    (?)


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    • #3
      Re: Italy, Haemolytic Uremic Syndrome: Cases reported from Apulia (Health Min., August 14 2013, edited)

      [Source: Corriere.it, full page in Italian: (LINK). Portion translated, edited.]


      HUS Alert in Apulia, 12 children affected so far

      Haemolytic uremic syndrome could damage kidneys and central nervous system. Epidemic feared.


      The most recent case was reported yesterday: a 15 year old boy from Brindisi has been diagnosed with HUS. This condition is a complication of an infection with a strain of toxin producing Escherichia Coli. With the latest case, a young boy scout, currently hospitalized at the infectious diseases department of the "Perrino" hospital, the cumulative number of paediatric HUS cases increases to 12, firstly reported on August 19.

      (?)


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      • #4
        Re: Italy, Haemolytic Uremic Syndrome: Cases reported from Apulia (Health Min., August 14 2013, edited)

        [Source: Il Fatto Quotidiano, full page in Italian: (LINK). Portion translated, edited.]


        Haemolytic Uremic Syndrome in Apulia: 16 cases in a month, outbreak feared.

        ‎21 August ‎2013 | Mary Tota


        The latest case is a 11 months old girl from Calimera, Lecce province. Yesterday another case, a 15 years old boy from Brindisi, developed the syndrome. Overall, there were 16 cases of haemolytic uremic syndrome reported from Apulia Region in less than two months. While from various hospitals and health centres more cases are being confirmed, concern is increasing. Medical experts are calling for calm to avoid an excessive alarm among population, but almost all are ackowledging that an outbreak is developing. In Italy, on average, in a year there are around forty cases of HUS. An alert was issued nationwide in Italy and all Apulia Region hospitals are coping with the event.

        (?)


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        • #5
          Re: Italy, Haemolytic Uremic Syndrome: Cases reported from Apulia (Health Min., August 14 2013, edited)

          [Source: ProMedMail.org, full page: (LINK). Extract.]


          Published Date: 2013-08-28 21:29:42 / Subject: PRO/AH/EDR> E. coli EHEC - Italy (02): (Puglia) O26 / Archive Number: 20130828.1909353

          E. COLI EHEC - ITALY (02): (PUGLIA), O26

          A ProMED-mail post http://www.promedmail.org / ProMED-mail is a program of the International Society for Infectious Diseases http://www.isid.org

          Date: Wed 21 Aug 2013 / Source: Corriere Del Mezzogiorno [in Italian, machine trans. edited] / http://corrieredelmezzogiorno.corriere.it/bari/notizie/cronaca/2013/21-agosto-2013/seu-casi-pugia-salgono-sedicil-ultimo-salento-climera-2222697609624.shtml


          Hemolytic uremic syndrome (HUS) cases in Pugia have risen to 16, and authorities say: "We do not exclude water[melon, ndm GM] from being the cause" for the cases all throughout the region.

          The last case occurred last Monday [19 Aug 2013] evening, in the lower Salento; the 1st, in San Marco in Lamis, in Foggiano. HUS is affecting Puglia from north to south, especially affecting children. The 16 cases have been recorded since 4 Jun 2013, 14 children aged 10 to 36 months, a 15-year-old boy, and an adult. Seven young patients have already recovered, 3 are on dialysis but not in danger of death.

          From information collected through statements by the parents, children affected by HUS had eaten fruit (watermelon in particular), dairy products, and salad. Perhaps the source was well water drawn for irrigation of cultivated fields, but [investigations] are still in progress.

          The origin and means of spread of the disease are still unclear; the only thing left is to follow a few basic rules: wash hands and utensils after contact with food, avoid consumption of undercooked meat (especially ground or carpaccio), and do not consume milk that is not pasteurized.

          [Byline: Francesca Mandese]

          --

          Communicated by: ProMED-mail promed@promedmail.org

          [As the number of cases of HUS increases, the source of the EHEC O26 remains unclear. Over all, there are usually 10-20 cases of infection for each case of HUS. ProMED awaits more information about this Italian outbreak. - Mod.LL

          A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1BIF.]

          (?)


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