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Journal of Clinical Microbiology, February 2006, p. 313-317, Vol. 44, No. 2
0095-1137/06/$08.00+0     doi:10.1128/JCM.44.2.313-317.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Shiga Toxins Present in the Gut and in the Polymorphonuclear Leukocytes Circulating in the Blood of Children with Hemolytic-Uremic Syndrome{dagger}

Maurizio Brigotti,1* Alfredo Caprioli,2 Alberto E. Tozzi,3 Pier Luigi Tazzari,4 Francesca Ricci,4 Roberto Conte,4 Domenica Carnicelli,1 Maria Antonietta Procaccino,3 Fabio Minelli,2 Alfonso V. S. Ferretti,5 Fabio Paglialonga,6 Alberto Edefonti,6 and Gianfranco Rizzoni3

Dipartimento di Patologia Sperimentale, Università di Bologna, Bologna,1 Istituto Superiore di Sanità, Rome,2 Ospedale Pediatrico Bambino Gesù, Rome,3 Servizio di Immunoematologia e Trasfusionale, Ospedale S. Orsola-Malpighi, Bologna,4 Ospedale Santobono, Naples,5 Clinica Pediatrica De Marchi, Milan, Italy6

Received 8 September 2005/ Returned for modification 31 October 2005/ Accepted 7 November 2005

Hemolytic-uremic syndrome, the main cause of acute renal failure in early childhood, is caused primarily by intestinal infections from some Escherichia coli strains that produce Shiga toxins. The toxins released in the gut are targeted to renal endothelium after binding to polymorphonuclear leukocytes. The presence of Shiga toxins in the feces and the circulating neutrophils of 20 children with hemolytic uremic syndrome was evaluated by the Vero cell cytotoxicity assay and flow cytometric analysis, respectively. The latter showed the presence of Shiga toxins on the polymorphonuclear leukocytes of 13 patients, 5 of whom had no other microbiologic or serologic evidence of infection by Shiga toxin-producing Escherichia coli. A positive relationship was observed between the amounts of Shiga toxins released in the intestinal lumen and those released in the bloodstream. The toxins were detectable on the neutrophils for a median period of 5 days after they were no longer detectable in stools. This investigation confirms that the immunodetection of Shiga toxins on neutrophils is a valuable tool for laboratory diagnosis of Shiga toxin-producing Escherichia coli infection in hemolytic-uremic syndrome and provides clues for further studies on the role of neutrophils in the pathogenesis of this syndrome.

* Corresponding author. Mailing address: Dipartimento di Patologia Sperimentale, Via San Giacomo 14, 40126 Bologna, Italy. Phone: 39 051 2094716. Fax: 39 051 2094746. E-mail: brigotti{at}alma.unibo.it.

{dagger} This paper is dedicated to the memory of Gianfranco Rizzoni, who created the Study Group on HUS of the Italian Society for Pediatric Nephrology.

Journal of Clinical Microbiology, February 2006, p. 313-317, Vol. 44, No. 2
0095-1137/06/$08.00+0     doi:10.1128/JCM.44.2.313-317.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



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