Characterization of diarrheagenic Escherichia coli strains associated with diarrhea in children, Khouzestan, Iran

Abstract

Introduction: Diarrheagenic Escherichia coli (DEC) is a major etiologic agent among the pathogens that cause diarrhea in children.
 Methodology: To investigate the presence and pathotypes of DEC in children under five years of age, living in the province of Khouzestan, Iran. 208 diarrhea stool samples were screened by multiplex-PCR. The isolated DEC isolates were investigated for resistance to various antimicrobials including the production of extended-spectrum beta-lactamases (ESBLs) and phylogenetic groups were determined.
 Results: DEC isolates were identified in 54 (26%) diarrhea samples, and 4 (7%) cases contained two DEC pathotypes. DEC isolated included 35 (16.8%) enteroaggregative E. coli (EAEC), ten (4.8%) enteropathogenic E. coli (EPEC), six (2.9%) enteroinvasive E. coli (EIEC), six (2.9%) enterotoxigenic E. coli (ETEC) and one (0.48%) LEE-positive EAEC. Shiga-toxin producing E. coli (STEC) was not identified in any diarrheal samples. The most prevalent resistance was observed with ceftazidime (88%), followed by ceftizoxime (83%) and ceftriaxone (71%). The majority of isolates (> 75%) were sensitive to Imipenem, ciprofloxacin, and amikacin. More than 65% of the pathogenic isolates showed a multidrug-resistant phenotype. ESBL-producing strains was observed in 79.3% of all DEC isolates. Phylogenetic group B2 was the most predominant group with a frequency of 44.8%. A significant association was observed between the B2 phylogenetic group and the DEC isolates (P < 0.05).
 Conclusions: Overall, our findings highlight the importance of the role of DEC isolates in the etiology of diarrhea in children in Iran. The progressive increase in antimicrobial resistance among DEC isolates makes it imperative to implement policies to control the spread of resistant bacteria.

Gut Microbiota and Diarrhea: An Updated Review

“…After infection, E. coli adheres to the intestinal epithelial cells through the adherent fimbriae, and then produces toxins and exerts pathogenic effects (Mirhoseini et al, 2018;Liu et al, 2020). Generally, diarrheal E. coli exhibit multidrug resistance (Broujerdi et al, 2018), making it difficult to control the spread of pathogens.…”

An Integrated Perspective on Virulence-Associated Genes (VAGs), Antimicrobial Resistance (AMR), and Phylogenetic Clusters of Pathogenic and Non-pathogenic Avian Escherichia coli

“…Although astA has been reported in ExPEC (45), it appears to be more related to intestinal (commensal or diarrheagenic) strains (46)(47)(48). astA is a virulence gene also associated with the enteroaggregative E. coli (EAEC) isolates (49)(50)(51), although it is not restricted to this pathotype (52). The presence of this gene does not appear to contribute to disease by E. coli unless combined with other virulence traits (53).…”

Acute Infectious Gastroenteritis: The Causative Agents, Omics-Based Detection of Antigens and Novel Biomarkers

“…Interestingly, Enteropathogenic Escherichia coli cases are less frequently detected in Malaysia and its similar geographical/climatic areas, in comparison with a country such as Iran where it has been reported that acute gastroenteritis was greatly caused by this strain [ 77 ]. Most DEC are sensitive to ciprofloxacin and the empirical antibiotic of choice [ 78 , 79 ].…”

“…Children infected with Entamoeba histolytica were mostly presented with tenesmus [ 81 , 82 , 83 ], fever [ 81 , 82 ], vomiting [ 81 , 84 ], abdominal cramps [ 81 , 83 , 84 ], and bloody diarrhoea [ 8 , 82 , 83 ]. Through laboratory investigations, it was found that infection with Entamoeba histolytica results in leukocytosis [ 80 , 81 , 84 , 85 ], elevation of CRP [ 74 , 78 , 79 , 80 , 84 , 85 ], elevation of ESR [ 81 ], elevation of serum alkaline phosphatase, and serum transaminase levels [ 81 , 86 ]. Eating unwashed or raw vegetables [ 86 , 87 , 88 , 89 ] and poor water hygiene [ 82 , 90 , 91 ] were identified to increase the risk of Entamoeba histolytica infection.…”