A method fo detecting large numbers of isolates of enterotoxigenic Escherichia coli is described in which the genes encoding th enterotoxins are detected, rather than the toxins themselves. Radiolabeled fragments of DNA encoding the heat-labile (LT) or heat-stable (ST) toxins were used as hybridization probes for homologous DNA sequences in E. coli colonies grown and lysed in situ on nitrocellulose filters. The LT probe detected all of 31 E. coli strains producing ST and LT or only LT, while the ST probe detected 12 of 17 strains producing only ST and three of 26 strains producing ST and LT. These results suggest that the LTs produced by different isolates of E. coli are homologous and that human isolates of E. coli produce at least two heterologous STs detectable in the infant mouse assay. The hybridization method also detected the presence of enterotoxigenic E. coli in bacterial growth in directly spotted stools from patients with acute diarrhea.

A longitudinal study of diarrhea was carried out from May 1988 to April 1989 by household surveillance of 705 children less than 5 years old in rural Bangladesh. Stool samples were examined for enteric pathogens at the beginning of each diarrheal episode. For persistent episodes, stool examination was repeated on days 15-17 of the illness. For each case of persistent diarrhea, stool samples from age-matched acute diarrheal and healthy controls were examined. Compared with healthy controls, cases of diarrhea were associated with Shigella species (P = .07) and rotavirus (P less than .05). Diffusely adherent Escherichia coli (P less than .05) and cryptosporidia (P = .07) were the only enteropathogens associated with persistent diarrhea in comparison with acute diarrhea. No more than 15% of children had the same class of pathogen identified from stool on both days 1-3 and days 15-17, indicating that persistent infection was uncommon. However, a different enteropathogen was frequently found on days 15-17, suggesting that sequential infection may be a cause of persistent diarrhea.