In developing countries, acquired bacterial resistance to antimicrobial agents is common in isolates from healthy persons and from persons with community-acquired infections. Complex socioeconomic and behavioral factors associated with antibiotic resistance, particularly regarding diarrheal and respiratory pathogens, in developing tropical countries, include misuse of antibiotics by health professionals, unskilled practitioners, and laypersons; poor drug quality; unhygienic conditions accounting for spread of resistant bacteria; and inadequate surveillance.

Enteroaggregative Escherichia coli (EAEC) has been implicated in acute and persistent diarrhea, and most strains harbor a member of a partially-conserved plasmid family (called pAA). We studied EAEC isolated from Nigerian children aged <5 years to elucidate the roles of plasmid and chromosomal EAEC loci. We tested a total of 131 EAEC strains isolated from acute diarrhea case patients and control subjects for hybridization with 8 pAA plasmid-derived and 2 chromosomal gene probes, for several in vitro phenotypes and for resistance to antimicrobial agents. Using by multiple logistic regression, we found genes encoding the AAF/II fimbriae to be strongly associated with diarrhea in this population. EAEC strains appear to be of heterogeneous virulence, and data suggest that AAF/II may be a marker for pathogenic strains.

No abstract

Stool specimens from 113 adult outpatients with diarrhea in southwestern Nigeria and 63 controls were examined for bacterial and parasitic enteric pathogens. Enterohemorrhagic Escherichia coli (EHEC) (P < 0.02), enteroaggregative E. coli (EAEC) (P < 0.02), and Entamoeba histolytica (P < 0.0002) were significantly associated with diarrhea. Salmonella, Shigella, nontoxigenic Vibrio cholerae, other categories of diarrheagenic E. coli, as well as a variety of helminths were recovered more frequently from the stools of patients than from the stools of controls but did not show a significant association with disease. Multiple pathogens were recovered from 36.3% of specimens, and bloody diarrhea was commonly associated with E. histolytica and diarrheagenic E. coli infections. The majority of EHEC isolates were non-O157 strains that carried the stx 2 gene. Of the 23 EHEC-infected patients, 12 (52.2%) presented during the 10th week of the study. EHEC strains isolated within this cluster were more likely to hybridize with the enterohemolysin gene probe, to be nonmotile and sorbitol positive, and to fail to agglutinate O157 antisera. Pulsed-field gel electrophoresis demonstrated that the only strains with XbaI profiles that occurred more than once were isolated during the 10th and 11th weeks of the study, suggesting an outbreak. The study has demonstrated that E. histolytica, EHEC, and EAEC are important diarrheal pathogens within the study area and that sporadic and epidemic EHEC infections occur in developing as well as developed countries. Routine surveillance for diarrheagenic E. coli, even only at the tertiary-care level, would be useful in identifying outbreaks and assist in identifying environmental reservoirs and transmission routes.Diarrhea is an important cause of disease and death among children in developing countries (20). Adult visitors to tropical developing countries frequently experience traveler's diarrhea, caused by agents that are endemic in those countries but to which visitors have not had the opportunity to develop protective immunity (36). Adult residents of developing countries are less likely to have sporadic diarrhea, and when it occurs, it is unlikely to be life threatening. Therefore, diarrheal pathogens in adults residing in developing countries have been the subject of few investigations, and very little is known about the etiologic epidemiology of pathogens other than epidemic Vibrio cholerae and Shigella. Sporadic endemic diarrhea in adults, however, contributes to the loss of productivity in developing countries and increases the risk that pathogens will be passed to susceptible children or visitors. When such infections do occur, they are often treated empirically, even though very little is known about the etiologic agents in this population; and in many cases, they prompt self-medication with antibiotics, which are often available without prescription (33). We conducted a case-control study over an 11-week period to determine the causes of diarrhea among adults visiting the outpatient c...

IntroductionDiarrhoeagenic Escherichia coli (DEC) are major causes of diarrhoea in Nigeria. This study was conducted to determine the prevalence of diarrhoea caused by DEC within the Federal Capital Territory, Abuja, Nigeria.MethodsA total of 730 rectal swabs obtained from 201 children with diarrhoea and 529 healthy controls aged 0-24 months were cultured for the isolation of Escherichia coli. All E. coli isolates were investigated by PCR to determine their pathotype.ResultsA total of 61 DEC strains were recovered at a rate of 18.4% and 2.6% from children with diarrhoea and healthy controls respectively. The DEC strains recovered were Enteroaggregative Escherichia coli (34.4%), Shiga-toxin producing Escherichia coli (31.1%), Enterotoxigenic Escherichia coli(18.0%), typical enteropathogenic Escherichia coli (15.0%) and Enteroinvasive Escherichia coli (1.6%). Shiga-toxin producing Escherichia coli andEnteroinvasive Escherichia coli were recovered only from children suffering from diarrhoea and the overall prevalence of DEC strains was significantly higher among the children with diarrhoea (P < 0.0001). The number of DEC strains obtained during the dry season was significantly higher (P = 0.012) than the number obtained in the rainy season.ConclusionDiarrhoea caused by E. coli in the Nigerian children studied is associated with several diarrhoeagenic pathotypes and a significant proportion of the healthy children were found to harbour EAEC and ETEC strains. These asymptomatic carriers may be regarded as potential transmitters of infection to vulnerable children in the study area.