Prospective study of diarrhoeal disease in a cohort of rural Mexican children: incidence and isolated pathogens during the first two years of life

Abstract

SUMMARYColonization of the intestine by putative pathogens was followed longitudinally in a cohort of 56 infants born during one calendar year in a rural Mexican village with faecal cultures taken every fortnight and every time a child had diarrhoea. The frequency of isolation of pathogens during episodes of diarrhoea was compared with that of matched controls from the same cohort. Incidence of diarrhoea during the first year of life was 98%, diminishing to 93% during the second year. The incidence curves for each year were not significantly different (P > 041). Isolation of enteropathogenic Escherichia coli, enterotoxigenic Escherichia coli producing heat-stable (ST) and/or heat-labile (LT) enterotoxins and rotaviruses was significantly higher in infants with diarrhoea during the first 2 years of life. In the case of shigella, although no significant differences were found by semester of life, 13 of 16 children in which these strains were found had diarrhoea. Isolation of Salmonella spp., Campylobacter spp. and protozoa were not significantly different in the two groups during the period studied. Strains showing localized adherence to HEp-2 cells or the presence of colonization factor antigens I or E8775 were found with significantly higher frequency in children with diarrhoea. Eighty-two percent of ST' or LT' ETEC strains isolated produced one of the three known colonization factors.

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

“…In longitudinal studies with infants, both LT and ST phenotypes of ETEC were found to be associated with diarrhea (1,37). This has been shown to be the case also in hospital- (7,8) as well as community-based studies (1,37). However, in hospital-based studies (132), ETEC producing both LT and ST or ST alone were found to cause relatively more severe disease than that caused by LT-producing ETEC strains (Table 8).…”

Toxins and colonization factor antigens of enterotoxigenic Escherichia coli among residents of Jakarta, Indonesia.

“…19 This observation argues for the inclusion of CFAs into a multivalent vaccine formula. 20 Since the composition of CFAs expressed by ETECs varies from country to country, 21 we reasoned that identification of the toxinassociated CFAs of ETEC isolated from a diarrheal disease case-control study in Jakarta, Indonesia, would provide useful information for this geographical region. Knowledge from such a study may be useful for determining study sites for the evaluation of potential ETEC vaccines.…”

Antigen Detection in Enteropathogenic Escherichia coli Using Secretory Immunoglobulin A Antibodies Isolated from Human Breast Milk

“…One of the most striking clinical features of EPEC infections is the propensity of these enteropathogenic strains to cause disease in infants (6,10,19), with few reports of cases of EPEC associated with diarrhea in older children and adults (52). Infants are more likely to develop diarrhea during the first episode of colonization with EPEC than they are during subsequent encounters (11).…”