Diarrhea remains one of the main sources of morbidity and mortality in the world, and a large proportion is caused by diarrheagenic Escherichia coli. In Mongolia, the epidemiology of diarrheagenic E. coli has not been well studied. A total of 238 E. coli strains from children with sporadic diarrhea and 278 E. coli strains from healthy children were examined by PCR for 10 virulence genes: enteropathogenic E. coli (EPEC) eae, tir, and bfpA; enterotoxigenic E. coli (ETEC) lt and st; enteroinvasive E. coli (EIEC) ipaH; enterohemorragic E. coli stx1 and stx2; and enteroaggregative E. coli (EAEC) aggR and astA. EAEC strains without AggR were identified by the HEp-2 cell adherence test. The detection of EAEC, ETEC, EPEC, and EIEC was significantly associated with diarrhea. The incidence of EAEC (15.1%), defined by either a molecular or a phenotypic assay, was higher in the diarrheal group than any other category (0 to 6.0%). The incidence of AggR-positive EAEC in the diarrheal group was significantly higher than in the control group (8.0 versus 1.4%; P ؍ 0.0004), while that of AggR-negative EAEC was not (7.1 versus 4.3%). Nineteen AggR-positive EAEC strains harbored other EAEC virulence genes-aggA, 2 (5.5%); aafA, 4 (11.1%); agg-3a, 5 (13.8%); aap, 8 (22.2%); aatA, 11 (30.5%); capU, 9 (25.0%); pet, 6 (16.6%); and set, 3 (8.3%)-and showed 15 genotypes. EAEC may be an important pathogen of sporadic diarrhea in Mongolian children. Genetic analysis showed the heterogeneity of EAEC but illustrated the importance of the AggR regulon (denoting typical EAEC) as a marker for virulent EAEC strains.Diarrhea continues to be one of the most common causes of morbidity and mortality among infants and children in developing countries (5, 18). Five distinct classes of diarrheagenic Escherichia coli (DEC) are recognized as being associated with diarrheal disease. They are enterotoxigenic E. coli (ETEC), enteroinvasive E. coli (EIEC), enteropathogenic E. coli (EPEC), enterohemorrhagic E. coli (EHEC), and enteroaggregative E. coli (EAEC); diffuse adhering E. coli (DAEC) may represent a sixth category, but this has not been clearly established (18). Each class of DEC is defined on the basis of distinct virulence characteristics, and tests for these characteristics have been developed to distinguish DEC classes from each other and from nonpathogenic E. coli strains of the normal flora (15, 34). The epidemiological significance of each E. coli category in childhood diarrhea varies with the geographical area. It has become clear that there are important regional differences in the prevalences of the different categories of DEC. The incidences of diarrheal illnesses caused by the different categories of DEC were examined mainly in Latin America, Africa, southern and Southeast Asia, and the Middle East (1,3,25,32,35,36,45). Study of the prevalences of DEC categories and their importance in childhood diarrhea has not been carried out in Mongolia. Therefore, to define the association of various categories of E. coli with diarrhea in Mongolia, w...