Perspectives on Shiga-like Toxin Infections in Argentina ^†

Area of Science:

• Pediatrics
• Infectious Diseases
• Nephrology

Background:

• Argentina exhibits the highest global incidence of hemolytic uremic syndrome (HUS), a severe condition.
• HUS is the leading cause of acute renal failure and second-leading cause of chronic kidney disease in Argentine children.
• Seasonal outbreaks of Shiga-like toxin (SLT)-associated bloody diarrhea affect 30-39% of children under five during warmer months.

Purpose of the Study:

• To investigate the epidemiology and risk factors of hemolytic uremic syndrome (HUS) in Argentina.
• To determine the association between Shiga-like toxin (SLT)-producing *Escherichia coli* and HUS in children.
• To explore potential sources of SLT-producing *E. coli* infection, including household contacts and food products.

Main Methods:

• Retrospective analysis of HUS cases and incidence rates in Buenos Aires.
• Surveillance of bloody diarrhea and SLT-associated infections in children under five.
• Microbiological investigation of SLT-producing *E. coli* in HUS patients, household contacts, animals, and retail meat.

Main Results:

• The risk of HUS following SLT-associated bloody diarrhea is 4-5%, with 14% developing incomplete HUS.
• SLT-producing *E. coli* colonization is common in household contacts (39%) of HUS patients, with significant seroconversion rates (42%).
• While *E. coli* O157:H7 is implicated in a minority of cases (2-18%), other SLT-producing serotypes are recognized. Preliminary findings indicate the presence of SLT-producing *E. coli* in healthy animals and retail ground beef.

Conclusions:

• Shiga-like toxin-producing *E. coli* infections represent a significant risk factor for hemolytic uremic syndrome in Argentine children.
• Contaminated food products, particularly undercooked meat, and household transmission are likely important routes for SLT-producing *E. coli*.
• Further research into animal reservoirs and food safety practices is crucial for HUS prevention in Argentina.