Abstract
Background
Prodromal symptoms are frequently reported in the atypical form of Hemolytic uremic syndrome (aHUS) suggesting implication of infectious triggers. Some pathogens may also play a role in the mechanisms of production of autoantibody directed against Factor H (FH), a complement regulator, leading to aHUS.
Methods
The presence of 15 gastrointestinal (GI) pathogens was investigated by using xTAG-based multiplex PCR techniques on stools collected at the acute phase in a cohort of Indian HUS children classified according to the presence or absence of anti-FH autoantibodies.
Results
Prevalence of pathogens in patients with anti-FH antibody (62.5%) was twice that in those without (31.5%). Different pathogens were detected, the most frequent being Clostridium difficile, Giardia intestinalis, Salmonella, Shigella, Rotavirus, Norovirus and Entamoeba histolytica. No stool was positive for Shigatoxin.
Conclusion
This study reveals a higher prevalence of GI pathogens in anti-FH positive than in negative patients. No single pathogen was implicated exclusively in one form of HUS. These pathogens may play a role in the disease initiation by inducing complement activation or an autoimmune response.
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Acknowledgements
We thank Sonia Burrel, David Boutolleau (Laboratoire de Virologie, Hôpital Pitié-Salpétrière, APHP), and Maxime Bidalot, Lucie Thery, Katia Balay, Pierre Pothier (CNR Virus Entériques, CHU Dijon) for technical assistance and, Philip Bastable (Pole de Recherche, CHU Dijon) for english reading. This work was supported by an "Indo-French Centre for the Promotion of Advanced Research" (IFCPAR) Grant (No. 4703-1). S.K.T., M.P., and A.G. were funded by a fellowship from IFCPAR.
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Togarsimalemath, S.K., Si-Mohammed, A., Puraswani, M. et al. Gastrointestinal pathogens in anti-FH antibody positive and negative Hemolytic Uremic Syndrome. Pediatr Res 84, 118–124 (2018). https://doi.org/10.1038/s41390-018-0009-9
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DOI: https://doi.org/10.1038/s41390-018-0009-9
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