Surveillance of Diarrheagenic Escherichia coli Strains Isolated from Diarrhea Cases from Children, Adults and Elderly at Northwest of Mexico

Abstract

Diarrheagenic Escherichia coli (DEC) strains are a main cause of gastrointestinal disease in developing countries. In this study we report the epidemiologic surveillance in a 4-year period (January 2011 to December 2014) of DEC strains causing acute diarrhea throughout the Sinaloa State, Mexico. DEC strains were isolated from outpatients of all ages with acute diarrhea (N = 1,037). Specific DEC pathotypes were identified by PCR-amplification of genes encoding virulence factors. The adhesion phenotype and antibiotic resistance were also investigated. DEC strains were detected in 23.3% (242/1037) of cases. The most frequently DEC strain isolated was EAEC [(12.2%), 126/242] followed by EPEC [(5.1%), 53/242], ETEC [(4.3%), 43/242] DAEC [(1.4%), 15/242], STEC [(0.3%), 3/242], and EIEC [(0.2%), 2/242]. EHEC strains were not detected. Overall DEC strains were more prevalent in children ≤2 years of age with EPEC strains the most common of DEC pathotypes. While ∼65% of EAEC strains were classified as typical variant based on the aggregative adherence to in vitro cultures of HEp-2 cells, a high proportion of EPEC strains was classified as atypical strains. EAEC, EPEC, ETEC, and DAEC strains were distributed in the north, central and south regions of Sinaloa state. Among all DEC strains, >90% were resistant to at least one commonly prescribed antibiotic. Strains were commonly resistant to first-line antibiotics such as tetracycline, ampicillin, and sulfamethoxazole-trimethoprim. Furthermore, more than 80% of DEC isolates were multi-drug resistant and EPEC and DAEC were the categories with major proportion of this feature. In conclusion, in nearly one out of four cases of acute diarrhea in Northwestern Mexico a multi-drug resistant DEC strain was isolated, in these cases EAEC was the most prevalent (52%) pathotype.

Molecular characterization of diarrheagenic Escherichia coli pathotypes: Association of virulent genes, serogroups, and antibiotic resistance among moderate‐to‐severe diarrhea patients

“…The incidence rates of diarrheagenic E. coli were observed up to 21% as the sole pathogen and approximately 6% as mixed infection with Rotavirus. Our study shows moderate DEC infection rates, similar to the reports from developing world . However, reports from other parts of India and neighboring countries showed 10‐35% variation in DEC incidence rates .…”

Molecular detection of diarrheogenic Escherichia coli in pediatric patients with acute diarrheal syndrome in Paraguay

“…La prevalencia encontrada fue relativamente baja con respecto a otros estudios realizados como el de Ochoa et al en Perú en el 2011 con un 31,5% (10), Hannaoui et al (11) en el 2010 con un 19%, Canizalez et al (12) en el 2016 con un 23%. Este resultado puede deberse al rango etario elegido en este estudio con respecto a los citados anteriormente.…”

“…Este resultado puede deberse al rango etario elegido en este estudio con respecto a los citados anteriormente. Se destaca la mayor presentación de ECD en niños de 1 a 3 años, que disminuye a partir de los 9 años, lo que coincide con los estudios de Canizalez et al (12), Dedeić-Ljubović et al (13) primeros seis meses de vida. Debería replantearse su rol como agente etiológico de diarrea, una vez descartada la presencia de cualquier otro tipo de patógeno entérico u otra causa no infecciosa.…”

“…La frecuencia disminuye con la edad y los adultos rara vez adquieren infecciones por EPEC, salvo condiciones excepcionales. (12,14) El tercer patotipo más frecuente encontrado en este estudio fue EAEC (22%), que en los demás estudios se encuentra como primero o segundo en cuanto a frecuencia entre ECD lo presentan como el de mayor frecuencia con 45%, 11% y 11% (12)(13)(14). Las infecciones por EAEC han sido identificadas en varias regiones del mundo con presentación en niños y adultos que viven en países de desarrollo así como en viajeros.…”

“…Las infecciones por EAEC han sido identificadas en varias regiones del mundo con presentación en niños y adultos que viven en países de desarrollo así como en viajeros. (12) EIEC con una frecuencia del 15% coincidiendo con otros estudios como cuarto o quinto patotipo en cuanto a frecuencia. EIEC causan diarrea acuosa y disentería en seres humanos.…”