High Disease Burden of Diarrhea Due to Enterotoxigenic Escherichia coli among Rural Egyptian Infants and Young Children

Abstract

The incidence of enterotoxigenic Escherichia coli diarrhea among Egyptian children was 1.5 episodes per child per year and accounted for 66% of all first episodes of diarrhea after birth. The incidence increased from 1.7 episodes per child per year in the first 6 months of life to 2.3 in the second 6 months and declined thereafter.Enterotoxigenic Escherichia coli (ETEC) has been recognized as the most common cause of infectious diarrhea in infants and young children in developing countries (14). Manifestations of ETEC infection run the spectrum from asymptomatic infection to severe dehydrating diarrheal illness. The virulence of ETEC is attributed to its ability to colonize the intestinal epithelium via fimbrial adhesive factors and express secretogenic enterotoxins of a heat-labile (LT) and/or a heatstable (ST) variety (10).The epidemiology of ETEC diarrhea was studied in a cohort of Egyptian children in two villages located in the Nile Delta. Children under the age of 24 months at the start of the study and all subsequent new-birth infants were monitored until the age of 36 months or the end of the study was reached. Surveillance for diarrhea was conducted by twice-weekly home visits in which fecal specimens were collected when loose stools were reported (9). For infants, a detailed dietary history (with reference to breastfeeding and the introduction of supplementary liquids and solids) was obtained at each visit. Standard methods were used to detect Salmonella, Shigella, Campylobacter, Vibrionaceae, rotavirus, and astrovirus (8,9,12). Rectal swabs were plated on McConkey's medium, and GM1-ganglioside enzyme-linked immunosorbent assays (11, 13) were used to evaluate five lactose-positive colonies for both LT and ST expression.Diarrheal episodes were defined as beginning on the first day of loose stools after at least three consecutive nondiarrheal days and were considered to have ended when followed by 3 days without diarrhea (9). An episode was classified as an ETEC episode when ETEC was detected at any time during the episode. Children were considered breastfed if they had received any breast milk. To analyze the "time to first episode" of all-cause diarrhea or ETEC diarrhea, Kaplan Meier (KM) curves were constructed for new-birth infants to obtain the distribution of the times to first episode (5). Since exclusively breastfed children usually have loose stools that may be misclassified as diarrhea and no pathogens were isolated in 73% of the diarrheal episodes in the first 3 months of life, the analysis of the time to first episode was restricted to episodes associated with pathogens (ETEC, Campylobacter, Shigella, Salmonella, rotavirus, or astrovirus). Poisson regression models using generalized estimating equations were fitted to adjust for confounding variables (6).In a cohort of 397 children with 211 new-birth infants, 3,477 episodes of diarrhea were detected over 3 years, resulting in an incidence of 5.5 episodes of diarrhea per child per year. Attack rates were highest during infancy (8.1 episodes p...

Enterotoxigenic Escherichia coli associated with childhood diarrhoea in Colombia, South America

“…ETEC is estimated to cause 200 million cases of diarrhoea yearly, leading to 150,000 deaths [35]. Several countries in the world report ETEC as the most common cause of diarrhoea among all E. coli intestinal pathotypes, among them Bangladesh, Egypt and Mexico [36][37][38]. In addition, ETEC is known to be the most frequent cause of traveller's diarrhoea [39][40][41].…”

Prevalence and genetic characteristics of Shigatoxigenic Escherichia coli from patients with diarrhoea in Maasailand, Kenya

“…Twofold serial dilutions of the culture filtrates were done in 96-well flat-bottom microtiter plates (Nunc, Roskilde, Denmark) (100 l per well; 12 wells per strain; dilutions from 1/2 to 1/2,048). A total of 20 l of the test filtrate containing 10 5 Vero cells in suspension were added to each well. The culture plates were incubated for 24 hours at 37C in a 5% CO 2 .…”

“…Globally diarrhoeal diseases account for almost a fifth of all deaths of children below five years of age, with an estimated 2.2 million deaths annually [2]. Epidemiological studies of diarrhoea have been reported from several African countries including South Africa [3], Gabon [4], Egypt [5] and Kenya [6]. A study conducted on travellers' diarrhoea that occurred in Europeans touring Mombasa, Kenya, reported an ETEC attack rate of 35% [7].…”

Prevalence and antibiotic resistance of bacterial pathogens isolated from childhood diarrhoea in four provinces of Kenya

“…Globally diarrhoeal diseases account for almost a fifth of all deaths of children below five years of age, with an estimated 2.2 million deaths annually [2]. Epidemiological studies of diarrhoea have been reported from several African countries including South Africa [3], Gabon [4], Egypt [5] and Kenya [6].…”