Frequency of enterovirulentEscherichia coli in diarrhoeal disease in The Netherlands

Rademaker, Carin M. A.; Fluit, Ad C.; Jansze, M.; Jansen, Wim; Glerum, J. H.; Verhoef, J.

doi:10.1007/bf01967581

Cited by 8 publications

(5 citation statements)

References 28 publications

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“…This is a high prevalence compared to most other reports (Forestier et al, 1996;Bokete et al, 1997;Tompkins et al, 1999;Svenungsson et al, 2000;Keskimäki et al, 2001;Knutton et al, 2001;Vieira et al, 2001). Typical EPEC (bfpA þ ) was uncommon, a finding that is consistent with other reports of low prevalence of typical EPEC in Europe (Rademaker et al, 1993;Morelli et al, 1994;Forestier et al, 1996;Giammanco et al, 1996;Scotland et al, 1996;Svenungsson et al, 2000;Keskimäki et al, 2001;Knutton et al, 2001;Paciorek, 2002) and North America (Bokete et al, 1997;Caeiro et al, 1999). Atypical EPEC, which constituted all but one isolate in this study, seemed to be widely spread among children with diarrhoea in Norway.…”

Section: Epecsupporting

confidence: 86%

“…The eae gene, which is located in the 'locus of enterocyte effacement' (LEE) pathogenicity island, and the bfpA gene, located on a plasmid called the EPEC adherence factor (EAF), have both been used for identification of EPEC and for subdivision of this group of bacteria into typical and atypical strains (Nataro & Kaper, 1998 Recently, after the introduction of new molecular diagnostic methods, EPEC has again been reported from several developed countries (Scotland et al, 1991;Rademaker et al, 1993;Morelli et al, 1994;Forestier et al, 1996; Giammanco et al, 1996;Bokete et al, 1997;Pelayo et al, 1999;Tompkins et al, 1999;Svenungsson et al, 2000; Keskimäki et al, 2001;Knutton et al, 2001). The aim of the present study was to investigate the relative contribution of EPEC among other identifiable causes of infectious diarrhoea in Norwegian children.…”

Section: Introductionmentioning

confidence: 99%

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High prevalence of atypical enteropathogenic Escherichia coli (EPEC) in Norwegian children with diarrhoea

Afset

Bergh

Bevanger

2003

Journal of Medical Microbiology

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The aim of the present study was to investigate the relative contribution of enteropathogenic Escherichia coli (EPEC) as a cause of infectious diarrhoea in Norwegian children. Data from faecal specimens from children ,2 years old with diarrhoea during the year 2001 were analysed. E. coli isolates with the attaching and effacing genotype (eae þ ) were examined for the presence of the bundle-forming pilus (bfpA) and Shiga toxin genes by PCR, and for genetic relatedness by PFGE. During the 1-year period, 598 specimens from 440 patients ,2 years old were analysed. Potential enteric pathogens were identified in 124 patients (28·2 %). EPEC was the most frequently identified agent (44 patients), followed by rotavirus (41 patients), Campylobacter jejuni (17 patients) and adenovirus (17 patients). All other agents were detected in five patients or less. Only one of the eae þ E. coli isolates was classified as typical EPEC (bfpA þ ). Among the 43 isolates that were classified as atypical EPEC (bfpA À ), eight strains belonged to EPEC serogroups, whereas the majority of strains (n ¼ 35) were not agglutinated by EPEC antisera. None of the EPEC isolates were genetically related. This study demonstrates that atypical EPEC of non-EPEC serogroups is highly prevalent among Norwegian children with diarrhoea. INTRODUCTIONInfectious diarrhoea is one of the world's leading causes of morbidity and mortality, resulting in about two million deaths per year (World Health Organization, 2002). The majority of cases of serious diarrhoea occur among children in developing countries (World Health Organization, 1995). In contrast to third-world countries, paediatric infectious diarrhoea is rarely fatal in industrialized countries. It does, however, frequently cause visits to physicians, as well as lost work-time for parents, and therefore gives rise to considerable medical expense (Avendaño et al., 1993).After the discovery of enteropathogenic Escherichia coli (EPEC) as a cause of childhood diarrhoea in 1945, EPEC was diagnosed frequently as a cause of paediatric diarrhoea in developed countries over the next three decades (Levine & Edelman, 1984). Then, for unknown reasons, the incidence of EPEC declined in this part of the world (Nataro & Kaper, 1998).For many years, diagnosis of EPEC was based on O : H serotype identification (Levine & Edelman, 1984). During the last two decades, the pathogenic mechanism of EPEC infection has been clarified (Nataro & Kaper, 1998); this has resulted in a change in diagnostic methods from serogrouping to phenotypic and genotypic methods.The central mechanism of EPEC pathogenesis is a lesion called 'attaching and effacing' (A/E), which is characterized by intimate adherence of bacteria to the intestinal epithelium (Vallance & Finlay, 2000). The eae gene, which is located in the 'locus of enterocyte effacement' (LEE) pathogenicity island, and the bfpA gene, located on a plasmid called the EPEC adherence factor (EAF), have both been used for identification of EPEC and for subdivision of this group of bacteria i...

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Section: Epecsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

High prevalence of atypical enteropathogenic Escherichia coli (EPEC) in Norwegian children with diarrhoea

Afset

Bergh

Bevanger

2003

Journal of Medical Microbiology

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“…The presence of the gene encoding bundle-forming pilus, a recognized EPEC virulence factor (23), was neither alone nor in combination with the eae gene associated with diarrhea (data not shown). Recent studies have applied a definition of EPEC where the serotype of the infecting strains is not taken into account (25,27). Had we defined EPEC by the presence of the eae gene in stx-negative strains, we would not have identified EPEC as a diarrheagenic pathogen.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have focused on either bacterial or viral etiologies of diarrhea (7,27,38). The present study, comprising examinations for bacteria, virus, and parasites, was conducted to clarify the most common infectious etiologies of diarrhea in Danish children less than 5 years of age.…”

mentioning

confidence: 99%

Etiology of Diarrhea in Young Children in Denmark: a Case-Control Study

Neimann²,

et al. 2005

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Infectious gastroenteritis is one of the most common diseases in young children. To clarify the infectious etiology of diarrhea in Danish children less than 5 years of age, we conducted a 2-year prospective case-control study. Stools from 424 children with diarrhea and 870 asymptomatic age-matched controls were examined, and their parents were interviewed concerning symptoms. Rotavirus, adenovirus, and astrovirus were detected by enzyme-linked immunosorbent assay, and norovirus and sapovirus were detected by PCR. Salmonella, thermotolerant Campylobacter, Yersinia, Shigella, and Vibrio spp. were detected by standard methods. Shiga toxinproducing (STEC), attaching-and-effacing (A/EEC), enteropathogenic (EPEC), enterotoxigenic, enteroinvasive, and enteroaggregative Escherichia coli were detected by using colony hybridization with virulence gene probes and serotyping. Parasites were detected by microscopy. Overall, a potential pathogen was found in 54% of cases. More cases than controls were infected with rotavirus, Salmonella, norovirus, adenovirus, Campylobacter, sapovirus, STEC, classical EPEC, Yersinia, and Cryptosporidium strains, whereas A/EEC, although common, was not associated with illness. The single most important cause of diarrhea was rotavirus, which points toward the need for a childhood vaccine for this pathogen, but norovirus, adenovirus, and sapovirus were also major etiologies. Salmonella sp. was the most common bacterial pathogen, followed by Campylobacter, STEC, Yersinia, and classical EPEC strains. A/EEC not belonging to the classical EPEC serotypes was not associated with diarrhea, underscoring the importance of serotyping for the definition of EPEC.Infectious gastroenteritis is one of the most common diseases in humans, with particularly high morbidity in children younger than 5 years of age (3). In industrialized countries, such as Denmark, the associated mortality is low, but the social burden and economic costs due to care of ill children and parents' absence from work are substantial because of the high incidence. Rotavirus is known to be the most common cause of severe acute, watery diarrhea in children under 5 years of age in industrialized and developing parts of the world (14, 43). In recent decades other new etiologies of diarrhea have been recognized, including noro-and sapovirus, Shiga toxin-producing Escherichia coli (STEC), and enteroaggregative E. coli (EAggEC). Furthermore, the incidence of food-borne Campylobacter and Salmonella infections has increased in many industrialized countries.Several case-control or cohort studies of enteropathogens associated with childhood diarrhea have been conducted in developing countries, but only a few analytical studies covering a broad range of newly discovered diarrheal agents have been undertaken in Europe (5,8,25,35). Many studies have focused on either bacterial or viral etiologies of diarrhea (7,27,38). The present study, comprising examinations for bacteria, virus, and parasites, was conducted to clarify the most common infectious etiol...

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“…The exact prevalence and significance of (new) EPEC and A/EEC strains of non‐EPEC serotypes as aetiological agents of childhood diarrhoea in the industrialised world is not well‐established and seems to vary in different countries, depending on classification and choice of diagnostic procedures [11,22,24–26]. For example, A/EEC strains were found frequently among Norwegian children with diarrhoea [27], albeit without the use of a control group; however no significant differences were observed in a subsequent case‐control study, although an association between eae ‐positive E. coli and prolonged diarrhoea was revealed [28].…”

Section: Introductionmentioning

confidence: 99%

Attaching and effacing Escherichia coli isolates from Danish children: clinical significance and microbiological characteristics

Jensen

Ethelberg

Olesen

et al. 2007

Clinical Microbiology and Infection

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This study describes the prevalence, clinical manifestations and microbiological characteristics of attaching and effacing Escherichia coli isolates, i.e., enteropathogenic E. coli (EPEC) belonging to the classical EPEC serotypes, non-EPEC attaching and effacing E. coli (A/EEC) and verocytotoxin-producing E. coli (VTEC), isolated in a case-control study of Danish children aged <5 years. Among 424 children with diarrhoea and 866 healthy controls, EPEC and VTEC were more prevalent in cases (2.4% and 2.6%, respectively) than in controls (0.7% and 0.7%, respectively). There was a high frequency of A/EEC isolates (n = 121), but these were equally prevalent in cases (11.3%) and controls (12.5%), and comprised a heterogeneous distribution of O:H serotypes. The intimin (eae) subtypes in A/EEC isolates showed an even distribution; the eae-gamma subtype predominated in classical EPEC cases. The virulence genes encoding the bundle-forming pilus (bfpA) and enteroaggregative heat-stable enterotoxin (astA) were rare among all isolates, and seemed to be of limited pathogenic importance in this population. Virulence characterisation of A/EEC isolates did not reveal any significant differences between cases and controls. Colonisation of children with A/EEC was associated with contact with sheep or goats (OR 2.2). The role of A/EEC, not being VTEC or belonging to the classical EPEC serotypes, requires further clarification, but serotyping is useful in discriminating between EPEC and A/EEC strains.

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Frequency of enterovirulentEscherichia coli in diarrhoeal disease in The Netherlands

Cited by 8 publications

References 28 publications

High prevalence of atypical enteropathogenic Escherichia coli (EPEC) in Norwegian children with diarrhoea

High prevalence of atypical enteropathogenic Escherichia coli (EPEC) in Norwegian children with diarrhoea

Etiology of Diarrhea in Young Children in Denmark: a Case-Control Study

Attaching and effacing Escherichia coli isolates from Danish children: clinical significance and microbiological characteristics

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