Specific virulence factors associated with the pathogenesis of Escherichia coli strains causing neonatal meningitis (ECNM), such as the K1 capsular polysaccharide, the S fimbriae, and the Ibe10 protein, have been previously identified. However, some other yet unidentified factors are likely to be involved in the pathogenesis of ECNM. To identify specialized unique DNA regions associated with ECNM virulence, we used the representational difference analysis technique. The genomes of two strains belonging to nonpathogenic phylogenetic group A of the ECOR reference collection were subtracted from E. coli strain C5, isolated from a case of neonatal meningitis. Strain C5 belongs to the phylogenetic group B2 as do the majority of ECNM. We have isolated and mapped 64 DNA fragments which are specific for strain C5 and not found in nonpathogenic strains. Of these clones, 44 were clustered in six distinct regions on the chromosome. The sfa and ibe10 genes were located in regions 2 and 6, respectively. A group of genes (cnf1, hra, hly, and prs) known to be present in a pathogenicity island of the uropathogenic strain E. coli J96 colocalized with region 6. The occurrence of these DNA regions was tested in a set of meningitis-associated strains and in a control group composed of non-meningitisassociated strains belonging to the same B2 group. Regions 1, 3, and 4 were present in 91, 82, and 81%, respectively, of the meningitis strains and in 40, 13, and 47% of the control strains. Together, these data suggest that regions 1, 3, and 4 code for factors associated with the ability of E. coli to invade the meninges of neonates.Escherichia coli is responsible for a third of the cases of neonatal meningitis (NM), with an incidence of 0.1 per 1,000 live births (8). Case fatality rates are still very high and range from 25 to 40%. Furthermore, the occurrence of long-term neurologic sequelae in nonfatal cases is 33 to 50% of neonates with E. coli meningitis (8, 9, 32). Understanding the pathogenesis of this disease and characterizing these pathogenic strains are prerequisites to the development of new treatments.Few specific pathogenic determinants have been described for E. coli strains causing NM (ECNM). Both expression of the K1 capsular polysaccharide (17) and production of aerobactin (21) are believed to be important for bloodstream dissemination. On the other hand, S fimbrial adhesin (sfa) (11,17,23) and Ibe10 protein (13), involved in the adhesion and invasion of brain microvascular endothelial cells, likely promote the crossing of the blood-brain barrier.Phylogenetic approaches have helped to characterize the pathogenic strains. The E. coli species has been divided into four main phylogenetic groups designated A, B1, B2, and D (12, 28). Previous studies have shown that ECNM has a clonal structure (3,27) and that strains mostly belong to the B2 group (5). Considering that only 38% of ECNM have both sfa and ibe10, it is likely that other determinants remain to be identified (5). In favor of this hypothesis is the fact that 10 pa...