Epidemic Diarrhea due to Enterotoxigenic Escherichia coli

Beatty, Mark E.; Adcock, Penny M.; Smith, Stephanie; Quinlan, Kyran; Kamimoto, Laurie; Rowe, Samantha; Scott, Karen P.; Conover, Craig; Varchmin, Thomas; Bopp, Cheryl A.; Greene, Katherine D.; Bibb, Bill; Slutsker, Laurence; Mintz, Eric D.

doi:10.1086/499246

Cited by 63 publications

(34 citation statements)

References 4 publications

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“…The largest ETEC outbreak reported in the United States was from the state of Illinois in 1998, where serotype O6:H16 (LT/ST) was isolated from several patients. Although only 120 cases were documented, it was estimated that 3,300 people may have become ill due to food prepared by a delicatessen that catered several events over the span of a few days (717). Further outbreaks were reported from a sushi restaurant in Nevada (710) and a buffet-style lunch in Illinois (718).…”

Section: Epidemiologymentioning

confidence: 99%

Recent Advances in Understanding Enteric Pathogenic Escherichia coli

et al. 2013

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SUMMARY Although Escherichia coli can be an innocuous resident of the gastrointestinal tract, it also has the pathogenic capacity to cause significant diarrheal and extraintestinal diseases. Pathogenic variants of E. coli (pathovars or pathotypes) cause much morbidity and mortality worldwide. Consequently, pathogenic E. coli is widely studied in humans, animals, food, and the environment. While there are many common features that these pathotypes employ to colonize the intestinal mucosa and cause disease, the course, onset, and complications vary significantly. Outbreaks are common in developed and developing countries, and they sometimes have fatal consequences. Many of these pathotypes are a major public health concern as they have low infectious doses and are transmitted through ubiquitous mediums, including food and water. The seriousness of pathogenic E. coli is exemplified by dedicated national and international surveillance programs that monitor and track outbreaks; unfortunately, this surveillance is often lacking in developing countries. While not all pathotypes carry the same public health profile, they all carry an enormous potential to cause disease and continue to present challenges to human health. This comprehensive review highlights recent advances in our understanding of the intestinal pathotypes of E. coli .

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Section: Epidemiologymentioning

confidence: 99%

Recent Advances in Understanding Enteric Pathogenic Escherichia coli

et al. 2013

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“…Collectively, these organisms are thought to account for hundreds of millions of cases of diarrheal illness and as many as 500,000 deaths annually in young children (43). Perennially the most common causes of diarrheal illness in travelers (27,38) and soldiers deployed to developing countries (7,25), ETEC strain have also emerged in several recent large-scale outbreaks in the United States (2,13).…”

mentioning

confidence: 99%

The EtpA Exoprotein of Enterotoxigenic Escherichia coli Promotes Intestinal Colonization and Is a Protective Antigen in an Experimental Model of Murine Infection

Roy

Hamilton²,

Allen³

et al. 2008

Infect Immun

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The enterotoxigenic Escherichia coli (ETEC) strains are major causes of morbidity and mortality due to diarrheal illness in developing countries. At present, there is no broadly protective vaccine for this diverse group of pathogens. The EtpA protein, identified in ETEC H10407 in a recent search for candidate immunogens, is a large glycosylated exoprotein secreted via two-partner secretion (TPS). Similar to structurally related molecules, EtpA functions in vitro as an adhesin. The studies reported here use a recently developed murine model of ETEC intestinal colonization to examine the immunogenicity and protective efficacy of EtpA. We report that mice repeatedly exposed to ETEC are protected from subsequent colonization and that they mount immune responses to both EtpA and its presumed two-partner secretion transporter (EtpB) during the course of experimental infection. Furthermore, isogenic etpA deletion mutants were impaired in the colonization of mice, and intranasal immunization of mice with recombinant EtpA conferred protection against ETEC H10407 in this model. Together, these data suggest that EtpA is required for optimal colonization of the intestine, findings paralleling those of previous in vitro studies demonstrating its role in adherence. EtpA and other TPS proteins may be viable targets for ETEC vaccine development.

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“…Enterotoxigenic Escherichia coli (ETEC) is an important cause of infant diarrhea in developing countries (5,18), a leading cause of traveler's diarrhea (1,14), and a re-emergent diarrheal pathogen in the United States (2,35). One of the ETEC putative colonization factors is Longus, a type IV pilus (T4P) composed of a 22-kDa major structural subunit designated LngA (11,13), which is estimated to be encoded or expressed by 10 to 35% of ETEC strains (12,15,20,21).…”

mentioning

confidence: 99%

Genetic Diversity of the Gene Cluster Encoding Longus, a Type IV Pilus of Enterotoxigenic Escherichia coli

et al. 2007

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Enterotoxigenic Escherichia coli (ETEC) strains produce a type IV pilus named Longus. We identified a 16-gene cluster involved in the biosynthesis of Longus that has 57 to 95% identity at the protein level to CFA/III, another type IV pilus of ETEC. Alleles of the Longus structural subunit gene lngA demonstrate a diversity of 12 to 19% at the protein level with strong positive selection for point replacements and horizontal transfer.Enterotoxigenic Escherichia coli (ETEC) is an important cause of infant diarrhea in developing countries (5, 18), a leading cause of traveler's diarrhea (1, 14), and a re-emergent diarrheal pathogen in the United States (2, 35). One of the ETEC putative colonization factors is Longus, a type IV pilus (T4P) composed of a 22-kDa major structural subunit designated LngA (11, 13), which is estimated to be encoded or expressed by 10 to 35% of ETEC strains (12,15,20,21). Antibodies reacting with LngA were found in stool from patients with ETEC infections (22). LngA shares homology with the major subunit of various T4Ps (9, 13), including the toxin-coregulated pilin of Vibrio cholerae (29) and the bundle-forming pilin of enteropathogenic E. coli (10). The highest homology (79%) is shared by LngA with CofA, the major subunit of another T4P of ETEC-CFA/III pili (13,16,27). Here we identify the genes involved in the assembly and regulation of Longus and describe their genetic and evolutionary variability.Three plasmid libraries were constructed by partial restriction endonuclease digestion of the Longus-encoding virulence plasmid from ETEC strain E9034A. Plasmids were screened by PCR with lngA-derived primers and then other lng-specific primers (the plasmids used in this study are listed in Table 1). The Longus gene cluster obtained from ETEC strain E9034A is 14 kb in length and contains 16 open reading frames. Fourteen genes share considerable homology, as well as cluster topology, with CFA/III genes and are thus designated, in homology with the cof cluster, lngR, lngS, lngT, lngA, lngB, lngC, lngD, lngE, lngF, lngG, lngH, lngI, lngJ, and lngP (Fig.

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Epidemic Diarrhea due to Enterotoxigenic Escherichia coli

Abstract: In the United States, where enterotoxigenic Escherichia coli is an emerging cause of foodborne disease, enterotoxigenic Escherichia coli should be suspected in outbreaks of gastroenteritis when common bacterial or viral enteric pathogens are not identified.

Cited by 63 publications

References 4 publications

Recent Advances in Understanding Enteric Pathogenic Escherichia coli

Recent Advances in Understanding Enteric Pathogenic Escherichia coli

The EtpA Exoprotein of Enterotoxigenic Escherichia coli Promotes Intestinal Colonization and Is a Protective Antigen in an Experimental Model of Murine Infection

Genetic Diversity of the Gene Cluster Encoding Longus, a Type IV Pilus of Enterotoxigenic Escherichia coli

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