Diarrheagenic Escherichia coli Infection in Baltimore, Maryland, and New Haven, Connecticut

Nataro, James P.; Mai, Volker; Johnson, Judith A.; Blackwelder, William C.; Heimer, Robert; Tirrell, S M; Edberg, Stephen C.; Braden, Christopher R.; Morris, J. Glenn; Hirshon, Jon Mark

doi:10.1086/505867

Cited by 188 publications

(128 citation statements)

References 15 publications

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“…Remarkably, these findings differ from previous reports by Nataro et al [8] and Ratchtrachenchia et al [38], which suggested that the prevalence of atypical EPEC is limited to industrialized countries and certain developing countries such as Brazil and Mexico. Even though the etiologic role of this sub-pathotype of EPEC in diarrhea has not been definitively established [34,19,18], this finding underscores the emergence of atypical EPEC worldwide [18,8]. We identified ETEC in all age groups except in the 37-48 months group, from which no ETEC strain was isolated.…”

Section: Discussionmentioning

confidence: 84%

“…EIEC elaborates the invasion plasmid antigen (ipaH), which is similar to Shigella species by means of genetic traits of virulence [16,17]. Numerous studies have reported that the epidemiologic features and prevalence of DEC pathogens as causative agents of diarrhea are known to vary from one region of the world to another and even between and within countries in the same geographical area [9,[18][19][20][21][22]. Diarrheal episodes in many developing countries affecting children younger than five years of age have been attributed to DEC such as ETEC, EPEC, and EAEC, which are considered to be the most important enteric pathogens responsible for 30% to 40% of all diarrheal episodes [23,24].…”

Section: Introductionmentioning

confidence: 99%

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Diarrheagenic Escherichia coli pathotypes isolated from children with diarrhea in the Federal Capital Territory Abuja, Nigeria

Ifeanyi

Ikeneche

Bassey

et al. 2015

J Infect Dev Ctries

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Introduction: Escherichia coli are frequently isolated from diarrheic children in the Federal Capital Territory Abuja, Nigeria, but their virulent properties are not routinely evaluated. Therefore, the etiology of childhood diarrheal disease attributable to diarrheagenic Escherichia coli (DEC) in Abuja, Nigeria remains unknown. Methodology: Stool specimens from 400 acute diarrheic children between 0 and 60 months of age were studied.E. coli strains isolated were evaluated by polymerase chain reaction (PCR) for nine virulence genes and HEp-2 cell adherence to detect and identify five distinct diarrheagenic E. coli categories. Results: Diarrheagenic E.coli was detected in 51 (12.8%) of the diarrheic children. The observed DEC pathotypes were enteropathogenic E. coli (EPEC) in 18 (4.5%) children, enterotoxigenic E. coli (ETEC) in 16 (4.0%), enteroaggrative E. coli (EAEC) in 8 (2.0%), enterohaemorrhagic E. coli (EHEC) in 6 (1.5%), and enteroinvasive E. coli (EIEC) in 3 (0.8%). Four (1.0 %) EPEC strains with only the eae+ gene that adhered diffusely to HEp-2 cell were identified as atypical EPEC. All the DEC categories except atypical EPEC were identified in children between 6 and 12 months of age. Conclusions: This study underscores the need for routine evaluation of diarrheic children for virulence properties of infectious DEC. Atypical EPEC are emerging among the DEC pathotypes isolated from childhood acute gastroenteritis in Abuja, Nigeria.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Diarrheagenic Escherichia coli pathotypes isolated from children with diarrhea in the Federal Capital Territory Abuja, Nigeria

Ifeanyi

Ikeneche

Bassey

et al. 2015

J Infect Dev Ctries

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“…These trends without statistical significance may relate to the study patient population, perhaps reflecting an age-related susceptibility to infection. The pathogenicity index, calculated as the percentage of case patients shedding EPEC divided by the percentage of control patients with positive test results for EPEC (Nataro et al, 2006), is remarkably variable in these studies, with no correlation with the children's age. However, these studies have different patient populations, recruitment methods, inclusion and exclusion criteria, and different definitions for their control subjects.…”

Section: Epidemiology Of Epec Infectionmentioning

confidence: 86%

New insights into the epidemiology of enteropathogenic Escherichia coli infection

Ochoa

Barletta

Contreras

et al. 2008

Transactions of the Royal Society of Tropical Medicine and Hygi

183

152

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Summary-Enteropathogenic Escherichia coli (EPEC) are among the most important pathogens infecting children worldwide and are one of the main causes of persistent diarrhea. EPEC were originally serogroup-defined E. coli associated with infantile diarrhea. As various mechanisms of pathogenesis have been discovered, EPEC classification has come to be based on the presence of specific genes. The eae (intimin) and bfpA (bundle-forming pilus) genes have both been used for identification of EPEC and for subdivision of this group of bacteria into typical and atypical strains. For many years typical EPEC have been considered to be the leading cause of infantile diarrhea in developing countries and were considered rare in industrialized countries. However, current data suggests that atypical EPEC are more prevalent than typical EPEC in both developing and developed countries. Moreover, the duration of diarrhea in patients infected with atypical EPEC is significantly longer than that caused by other pathogens. When comparing the isolation rates of EPEC among children with diarrhea and healthy controls without diarrhea, in general, there is a higher isolation rate in diarrhea, although not significantly higher in all studies. These inconsistencies probably are related to the study patient populations, reflecting a possible age-related susceptibility to infection.

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“…Case-controlled studies from the United States, 28 Palestine, 29 Denmark, 30 and Brazil 31 suggest an association with acute diarrhea, whereas those studies in Thailand 32 and Bangladesh 33 do not; however, all of these studies have been limited by the small numbers of NTS identified. As shown in our study and others, NTS are often isolated alongside other pathogenic organisms, a finding common for other enteropathogens.…”

Section: Discussionmentioning

confidence: 99%

Non-Typhoidal Salmonella Gastroenteritis at a Diarrheal Hospital in Dhaka, Bangladesh, 1996–2011

Leung¹,

Das²,

Malek³

et al. 2013

The American Journal of Tropical Medicine and Hygiene

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Abstract. Data on non-typhoidal Salmonella (NTS) infection in South Asia are limited. We used data gathered prospectively from 1996 to 2011 as part of a hospital surveillance system in Dhaka, Bangladesh, to identify diarrheal patients with NTS isolated from stool. NTS was isolated in 1.3% (468 of 37,439) of diarrheal patients; 47% of total cases of NTS were in children 5 years of age, although older adults ( 60 years) had the highest isolation rates. NTS isolation peaked in the monsoon months of July and August. Over the study period, rates of multidrug resistance decreased, whereas rates of decreased susceptibility to ciprofloxacin increased. Compared with control patients, NTS patients were older and wealthier; however, no differences in type of housing or exposure to animals were found. NTS patients had increased inflammatory cells in stool and required more fluid resuscitation.

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Diarrheagenic Escherichia coli Infection in Baltimore, Maryland, and New Haven, Connecticut

Abstract: Our data suggest that EAEC infection should be considered among persons with diarrhea that does not yield another known etiologic agent.

Cited by 188 publications

References 15 publications

Diarrheagenic Escherichia coli pathotypes isolated from children with diarrhea in the Federal Capital Territory Abuja, Nigeria

Diarrheagenic Escherichia coli pathotypes isolated from children with diarrhea in the Federal Capital Territory Abuja, Nigeria

New insights into the epidemiology of enteropathogenic Escherichia coli infection

Non-Typhoidal Salmonella Gastroenteritis at a Diarrheal Hospital in Dhaka, Bangladesh, 1996–2011

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