Risk of Diarrhea During the First Year of Life Associated With Initial and Subsequent Colonization by Specific Enteropathogens

Abstract

The incidence of colonization by enteropathogenic, enterotoxigenic, enteroinvasive, and enterohemorrhagic Escherichia coli (detected by DNA hybridization with specific radiolabeled probes), Salmonella sp., Shigella sp., Campylobacter jejuni, and rotavirus was related to the presence of diarrhea in a cohort of 75 rural infants followed longitudinally during the first year of life. The study was carried out between August 1985 and February 1987 in the village of Lugar Sobre la Tierra Blanca, in the state of Morelos, 180 km southwest of Mexico City. Intestinal colonization by specific enteropathogens was followed with fecal cultures taken every fortnight and every time a child had diarrhea. Pathogens isolated from cultures taken in the 48 hours prior to the initiation of the diarrheal episode were considered to be associated with the disease. Diarrhea was detected in 82% of the children with initial isolation of enterohemorrhagic E. coli and in 64% of the children with enteropathogenic E. coli or Shigella sp. The risk of diarrhea associated with the initial isolation of other pathogens was lower, at 41% for rotavirus and approximately 25% for enterotoxigenic E. coli, Salmonella sp., and C. jejuni. Initial colonization by the enteropathogens studied, whether or not they were associated with diarrhea, prevented disease, but not colonization by the same organism, when the children were reinfected during the first year of life. Enteropathogenic E. coli adherence factor, human or porcine heat-stable enterotoxins, fimbrial colonization factor antigens, and Shiga-like toxins I and II were important pathogenic characteristics related to the presence of diarrhea and to protection against subsequent infection by the same organisms.

Genotypic and Phenotypic Characterization of Enterotoxigenic Escherichia coli Strains Isolated from Peruvian Children

“…We identified a prevalence of ETEC of 5.3% in children with diarrhea between 2 and 24 months of age. This prevalence rate is lower than the rates reported from other studies performed in developing countries: 38% in children Ͻ2 years of age in Nicaragua (19), 33% in children Ͻ1 year of age in Mexico (6), and 18% in children Ͻ5 years of age in Argentina (32). These differences may be related to the age of the population and the type of study (passive versus active surveillance and a community-based versus hospital-based study).…”

Case-Control Study of Diarrheal Disease Etiology in a Remote Rural Area in Western Thailand

“…[10][11][12][13][14][15][16] Acquired immunity from frequent previous exposures, longterm convalescent shedding of the organism, or exposure to insufficient amounts of an organism to cause disease are the main explanations for asymptomatic carriers. 15,[17][18][19] Several studies have reported a high prevalence of Salmonella , Giardia , and Campylobacter in children without diarrhea in developing countries. 16,20,21 Recent data from Vietnam reported 23% of diarrheagenic E. coli in both diarrhea cases and controls.…”

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

“…Infants are more likely to develop diarrhea during the first episode of colonization with EPEC than they are during subsequent encounters (11). It is not known whether the low incidence of EPEC diarrhea in older children and adults is due to acquired immunity.…”