Atypical Enteropathogenic<i>Escherichia coli</i>Infection and Prolonged Diarrhea in Children

Nguyen, Rang N; Taylor, Louise S; Tauschek, Marija; Robins-Browne, Roy M.

doi:10.3201/eid1204.051112

Cited by 180 publications

(184 citation statements)

References 37 publications

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“…In the current study, as in many reports, the resistance rates of ampicillin, cotrimoxazole (trimethoprim-sulfamethoxazole) and tetracycline antibiotics were high and more than 39 % of the isolates showed resistance to these antibiotics (Putnam et al, 2004;Estrada-García et al, 2005;Nguyen et al, 2005). Resistance rates of EPEC to different antibiotics, however, differ noticeably between countries (Putnam et al, 2004;Estrada-García et al, 2005;Diniz-Santos et al, 2006;Nguyen et al, 2006;Pérez et al, 2010), which may reflect differences in the effectiveness of antimicrobial stewardship programs.…”

Section: Discussionsupporting

confidence: 64%

“…In the current study, among the 23 EPEC isolates tested, approximately 70 % were classified as atypical EPEC strains. Based on these data and the results of several recent studies, the prevalence of atypical EPEC seems to be on the rise (Afset et al, 2003;Nguyen et al, 2006;Albert et al, 2009). The role of atypical EPEC in childhood diarrhoea, however, still remains controversial (Moyo et al, 2007).…”

Section: Discussionmentioning

confidence: 75%

“…Nguyen et al (2006) found that atypical EPEC generally occurred in children ,2 years of age. Afset et al (2003) found that EPEC was significantly more common among children who were 12-23 months old than in those who were 12 months of age.…”

Section: Discussionmentioning

confidence: 96%

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Molecular analysis of typical and atypical enteropathogenic Escherichia coli (EPEC) isolated from children with diarrhoea

Nakhjavani

Emaneini

Hosseini

et al. 2013

Journal of Medical Microbiology

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Diarrhoea continues to be one of the most common causes of morbidity and mortality among infants and children in developing countries. To investigate the incidence, antimicrobial resistance and genetic relationships of enteropathogenic Escherichia coli (EPEC) in children with diarrhoea, a total of 612 stool specimens were collected in Tehran, Iran, and cultured to isolate strains of EPEC. The disc diffusion method was used to determine the susceptibility of the isolates according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. The presence of eae, stx and bfp-A genes was determined by PCR. The genetic relationships between EPEC isolates were determined by pulsed-field gel electrophoresis (PFGE). Out of the 412 strains of E. coli obtained from 612 diarrhoeal stool specimens, 23 (5.6 %) were identified as EPEC, of which seven (30.4 %) were classified as typical strains of EPEC and 16 (69.6 %) were classified as atypical. Out of the 23 EPEC isolates, 69.5 % were resistant to ampicillin, 39.1 % were resistant to tetracycline and cotrimoxazole, 30.4 % were resistant to cefpodoxime, ceftazidime, ceftriaxone and aztreonam, and 26.1 % were resistant to imipenem. The isolates were classified into 21 pulsotypes by PFGE profiles. The present study shows that typical and atypical EPEC isolates displayed considerable heterogeneity in PFGE profiles and EPEC infections were only sporadic in Tehran. Overall 69 % of isolates were resistant to at least one of the antibiotics tested. INTRODUCTIONEnteropathogenic Escherichia coli (EPEC) is one of the major causes of diarrhoea among children in developing countries (Hernandes et al., 2009;Moura et al., 2009). The pathogenesis of EPEC depends on the locus of enterocyte effacement (LEE), a chromosomal pathogenicity island. The LEE contains a number of different genes, including eae, which has an essential role in inducing a characteristic lesion formation in the intestinal epithelium, termed an attaching and effacing (A/E) lesion (Elliott et al., 1998;Vallance & Finlay 2000;Kaper et al., 2004). The eae gene encodes intimin, a 94 kDa outer-membrane protein that is responsible for the intimate adherence between bacterial and enterocyte membranes (Vallance & Finlay, 2000;Trabulsi et al., 2002). EPEC strains are classified as typical or atypical, according to the presence or absence of the E. coli adherence factor plasmid (EAF) that carries the bfpA gene, which encodes the bundle-forming pili (Hernandes et al., 2009). The most typical EPEC strains belong to the classic O : H serotypes and are eae-and bfpA-positive (Ochoa et al., 2008). The atypical EPEC isolates are eaepositive and bfpA-and stx (the gene encoding shiga-like toxin)-negative. EPEC are among the most important pathogens infecting children under 2 years of age in the developing world (Ochoa et al., 2008). Recent studies indicate that atypical EPEC is more prevalent than typical Abbreviations: EPEC, enteropathogenic Escherichia coli; LEE, locus of enterocyte effacement; PFGE, pulsed-field gel electrophore...

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 75%

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Molecular analysis of typical and atypical enteropathogenic Escherichia coli (EPEC) isolated from children with diarrhoea

Nakhjavani

Emaneini

Hosseini

et al. 2013

Journal of Medical Microbiology

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“…The aEPEC strains employed in the present study were isolated from diarrheal cases in independent epidemiological studies carried out in distinct periods in Brazil or Australia (31,33,37,47). The presence of several adhesin and toxin genes in these isolates has been reported before (16,45,47).…”

Section: Methodsmentioning

confidence: 94%

Fimbrial Adhesins Produced by Atypical Enteropathogenic Escherichia coli Strains

Hernandes

Velsko

Sampaio³

et al. 2011

Appl Environ Microbiol

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Atypical enteropathogenic Escherichia coli (aEPEC) has emerged as a significant cause of pediatric diarrhea worldwide; however, information regarding its adherence mechanisms to the human gut mucosa is lacking. In this study, we investigated the prevalence of several (fimA, ecpA, csgA, elfA, and hcpA) fimbrial genes in 71 aEPEC strains isolated from children with diarrhea (54 strains) and healthy individuals (17 strains) in Brazil and Australia by PCR. These genes are associated with adhesion and/or biofilm formation of pathogenic and commensal E. coli. Here, the most prevalent fimbrial genes found, in descending order, were hcpA (98.6%), ecpA (86%), fimA (76%), elfA (72%), and csgA (19.7%). Phenotypic expression of pili in aEPEC strains was assessed by several approaches. We were not able to detect the hemorrhagic coli pilus (HCP) or the E. coli lamininbinding fimbriae (ELF) in these strains by using immunofluorescence. Type 1 pili and curli were detected in 59% (by yeast agglutination) and 2.8% (by Congo red binding and immunofluorescence) of the strains, respectively. The E. coli common pilus (ECP) was evidenced in 36.6% of the strains on bacteria adhering to HeLa cells by immunofluorescence, suggesting that ECP could play an important role in cell adherence for some aEPEC strains. This study highlights the complex nature of the adherence mechanisms of aEPEC strains involving the coordinated function of fimbrial (e.g., ECP) and nonfimbrial (e.g., intimin) adhesins and indicates that these strains bear several pilus operons that could potentially be expressed in different niches favoring colonization and survival in and outside the host.

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“…31 This subset of EPEC has become a frequently detected pathogen, and recent investigations focused on its role in persistent diarrhea, probably caused by the lack of the bfp gene and subsequent delay in apoptosis of enterocytes. [32][33][34][35] Further research is necessary to demonstrate the relevance of these infections in the community, the burden of disease in children less than five years of age, and the potential role of antibiotics in medical management.…”

Section: Discussionmentioning

confidence: 99%

Diarrheagenic Escherichia coli in Children from Costa Rica

Pérez¹,

Gómez‐Duarte²,

Arias³

2010

The American Society of Tropical Medicine and Hygiene

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Abstract. More than 5,000 diarrheal cases per year receive medical care at the National Children's Hospital of Costa Rica, and nearly 5% of them require hospitalization. A total of 173 Escherichia coli strains isolated from children with diarrhea were characterized at the molecular, serologic, and phenotypic level. Multiplex and duplex polymerase chain reactions were used to detect the six categories of diarrheagenic E. coli . Thirty percent (n = 52) of the strains were positive, indicating a high prevalence among the pediatric population. Enteropathogenic E. coli and enteroinvasive E. coli pathotypes were the most prevalent (21% and 19%, respectively). Pathogenic strains were distributed among the four E. coli phylogenetic groups A, B1, B2, and D, with groups A and B1 the most commonly found. This study used molecular typing to evaluate the prevalence of diarrheagenic E. coli reported in Costa Rica and demonstrated the importance of these pathotypes in the pediatric population.

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Atypical EnteropathogenicEscherichia coliInfection and Prolonged Diarrhea in Children

Abstract: Infection of children with atypical EPEC is associated with prolonged diarrhea.

Cited by 180 publications

References 37 publications

Molecular analysis of typical and atypical enteropathogenic Escherichia coli (EPEC) isolated from children with diarrhoea

Molecular analysis of typical and atypical enteropathogenic Escherichia coli (EPEC) isolated from children with diarrhoea

Fimbrial Adhesins Produced by Atypical Enteropathogenic Escherichia coli Strains

Diarrheagenic Escherichia coli in Children from Costa Rica

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