Disease Due to Enterotoxigenic Escherichia coli in Bangladeshi Adults: Clinical Aspects and a Controlled Trial of Tetracycline

Abstract

The clinical characteristics of disease due to enterotoxigenic Escherichia coli (ETEC) were determined in 88 adult males admitted to a hospital in Dacca, Bangladesh, with moderate to severe dehydration. Persons infected with ETEC strains producing both heat-labile toxin (LT) and heat-stable (ST) toxin had more dehydration and acidosis, longer duration of illness, and greater stool volume than persons infected with strains producing only ST. Tetracycline therapy, evaluated in 63 cases, resulted in slightly earlier termination of illness in patients with LT-ST strains but had no effect on illness in the patients with ST strains. In both groups of patients tetracycline shortened the duration of excretion of organisms. Because of its limited effectiveness and the generally excellent response of ETEC diarrhea to rehydration therapy alone, tetracycline is not warranted for use in treatment of ETEC diarrhea in adults in this population.

Enterotoxigenic Escherichia coli in Developing Countries: Epidemiology, Microbiology, Clinical Features, Treatment, and Prevention

“…These findings from Calcutta were soon confirmed by oral challenge of human volunteers (49,100) and by corroboration of studies in Dhaka, Bangladesh (61,113,117,149). ETEC were shown in these studies to be most frequently found in children; such findings have been subsequently corroborated in multiple studies in developing countries (23,24).…”

“…The incidence of ETEC infections in developing countries decreases after 5 years of age with a decrease of infections between the ages of 5 to 15 years (Table 6). The incidence increases again in those over 15 years of age and about 25% of ETEC illness is seen in adults (113,132). Limited epidemiological information is available for adults, and those available are mostly from India and Bangladesh.…”

“…Limited epidemiological information is available for adults, and those available are mostly from India and Bangladesh. It was in these settings that ETEC was first described extensively and was shown to be a cause of adult diarrhea resembling cholera in the severity of infection (113,149,154). It thus became obvious that adults with severe dehydrating cholera-like illness attributable to ETEC infections are not uncommon (132,214).…”

“…Initially the serogroups of ETEC were identified and found to be relatively few, and therefore it was thought that perhaps serotyping could be used to differentiate ETEC from other E. coli, including the enteropathogenic strains whose characteristic serotypes were known (124). Serotyping was found to be of limited use in Bangladesh (113,152,186) and when it became clear that a very large number of E. coli serotypes could be enterotoxigenic, this was abandoned.…”

The role of diarrhoeagenic Escherichia coli in acute diarrhoeal diseases in Bandar-Abbas, Iran

“…Enterotoxigenic Escherichia coli (ETEC) have been reported to be a major cause of diarrhoea in man throughout the world (Sack, 1975;Rowe et al, 1977), notably in developing countries (Merson et al, 1980). They have also been found to be the commonest cause of travellers' diarrhoea in all countries where surveys have been conducted (Merson et al, 1976;Echeverria et al, 1981 ;Ryder et al, 1981).…”