Diarrhea Burden Due to Natural Infection with Enterotoxigenic Escherichia coli in a Birth Cohort in a Rural Egyptian Community

Abstract

c Enterotoxigenic Escherichia coli (ETEC) is commonly associated with diarrhea in Egyptian children. Children less than 3 years old in Abu Homos, Egypt, had approximately five diarrheal episodes per child every year, and at least one of these episodes was due to ETEC. The epidemiology of ETEC diarrhea among children living in a rural Egyptian community was further evaluated in this study. Between January 2004 and April 2007, 348 neonates were enrolled and followed for 2 years. Children were visited twice weekly, and a stool sample was obtained every 2 weeks regardless of symptomatology. A stool sample was obtained whenever a child had diarrhea. From the routine stool culture, five E. coli-like colonies were selected and screened for heat-labile and heat-stable toxins by GM1 enzyme-linked immunosorbent assay (ELISA) and further typed for colonization factor antigens by dot blot assay. Incidence of ETEC infection was estimated among children with diarrhea (symptomatic) and without diarrhea (asymptomatic). Incidence of diarrhea and ETEC-associated diarrhea was 7.8 and 1.48 per child-year, respectively. High risk of repeated ETEC diarrhea was associated with being over 6 months of age, warm season, male gender, and crowded sleeping conditions. Exclusive breast-feeding was protective for repeated ETEC infection. ETEC-associated diarrhea remains common among children living in the Nile Delta. The protective role of breast-feeding demonstrates the importance of promoting exclusive breast-feeding during, at least, the first 6 months of life.

Increased prevalence of pathogenic bacteria in the gut microbiota of infants at risk of developing celiac disease: The PROFICEL study

“…26 Moreover, in NOD-DQ8 mice the colonization with E. coli ENT CAI:5 isolated from one CD patient increased the sensitivity to gluten-induced immunopathology and suggested that this could be a contributing factor to the disease. 18 The ETEC type is a major cause of diarrhoea, 40 , 41 but it has also been detected in asymptomatic subjects acting as carriers, 42-44 who would presumably have an increased risk of developing gastrointestinal disorders.…”

Evaluation of the Immunogenicity and Protective Efficacy of an Enterotoxigenic Escherichia coli CFA/I Adhesin–Heat-Labile Toxin Chimera

“…In addition to adjuvant properties, those proteins also elicit anti-toxin responses that are important for protection, particularly against LT-producing (i.e. LT+ST and LT-only) ETEC strains (9,(25)(26)(27)(28). However, the toxicity associated with the native holotoxins by IN and orogastric administration, resulting in Bell's palsy and diarrhea, respectively, precludes their use as vaccine components via those routes.…”

Controlled Human Infection Models To Accelerate Vaccine Development

“…Enterotoxigenic Escherichia coli (ETEC) remains among the most common bacterial causes of diarrheaassociated morbidity and mortality (240)(241)(242)(243)(244)(245)(246). ETEC is often the first bacterial illness that children experience in endemic areas, with infants and young children experiencing two to five diarrhea episodes due to ETEC during their first three years of life (247)(248)(249). Recent studies in sub-Saharan Africa and South Asia conducted under the Global Enteric Multicenter Study (GEMS and GEM-1A) have reaffirmed the continuing importance of ETEC as one of the top four causes of moderate-to-severe diarrhea among children less than 5 years of age in both regions (243,250).…”