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Fecal diagnostics in combination with serology: best test to establish STEC-HUS

Kioa L Wijnsma1, Sheila A M van Bommel2, Thea van der Velden3

  • 1Department of Pediatric Nephrology, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, P.O. Box 1901, 6500 HB, Nijmegen, Netherlands. Kioa.Wijnsma@radboudumc.nl.

Pediatric Nephrology (Berlin, Germany)
|June 1, 2016
PubMed

Insights

Diagnosing Shiga toxin-producing E. coli (STEC) hemolytic-uremic syndrome (HUS) is improved by a new antibody test. This serological assay detects STEC O157 antibodies, aiding diagnosis when stool tests are negative.

Area of Science:

  • Pediatric Nephrology
  • Infectious Diseases
  • Clinical Microbiology

Background:

  • Hemolytic-uremic syndrome (HUS) in children is often caused by Shiga toxin-producing E. coli (STEC), primarily serotype O157.
  • Distinguishing STEC-HUS from atypical HUS is crucial due to differing treatments and prognoses.
  • Standard fecal diagnostic tests for STEC may miss infections due to the short detection window of the pathogen and its toxins.

Purpose of the Study:

  • To evaluate the diagnostic added value of a serological assay detecting immunoglobulin M (IgM) antibodies against STEC O157 lipopolysaccharide (LPS).
  • To determine if this assay improves the detection rate of STEC-HUS, especially when standard fecal tests are inconclusive or performed late in the disease course.

Main Methods:

  • Retrospective analysis of clinical and microbiological data from 65 pediatric patients with STEC-HUS treated between 1990 and 2014.
  • Detection of IgM antibodies against STEC O157 LPS using an enzyme-linked immunosorbent assay (ELISA).
  • Comparison of diagnostic yield between fecal testing and the addition of the serological assay.

Main Results:

  • Fecal diagnostic tests confirmed STEC infection in 54% of patients.
  • The serological assay identified an additional 16 patients with STEC O157 infection, representing a 23% increase in diagnostic yield (p < 0.0001).
  • The added diagnostic value of the serological assay was most significant for samples collected more than 7 days after symptom onset.

Conclusions:

  • The anti-O157 LPS antibody assay significantly enhances the diagnosis of STEC-HUS when used alongside standard fecal tests.
  • This serological test provides crucial diagnostic information, particularly in later disease stages.
  • Incorporation of this assay into routine clinical practice is recommended for improved STEC-HUS diagnosis.
Abstract

Keywords:
Anti-O157 antibodiesDiagnosticsSTEC serotype O157STEC-HUSSerological LPS antibody detection

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