Skip to main content
NCBI home page
Journal of Clinical Microbiology logoLink to Journal of Clinical Microbiology
. 1995 Apr;33(4):973–977. doi: 10.1128/jcm.33.4.973-977.1995

Controlled study of Escherichia coli diarrheal infections in Bangladeshi children.

M J Albert 1, S M Faruque 1, A S Faruque 1, P K Neogi 1, M Ansaruzzaman 1, N A Bhuiyan 1, K Alam 1, M S Akbar 1
PMCID: PMC228078  PMID: 7790470

Abstract

Diarrheal diseases are highly prevalent in Bangladesh. However, the relative contribution of diarrheagenic Escherichia coli organisms--those that are enterotoxigenic (ETEC), enteropathogenic (EPEC), enteroinvasive, enterohemorrhagic, enteroaggregative, and diffuse adherent--to diarrhea in Bangladeshi populations is not known. With DNA probes specific for these diarrheagenic E. coli strains, we analyzed fecal E. coli from 451 children up to 5 years of age with acute diarrhea seeking treatment at a Dhaka hospital and from 602 matched control children without diarrhea from July 1991 to May 1992. Enteroinvasive E. coli was not isolated from any children; enterohemorrhagic E. coli was not isolated from any diarrheal children but was isolated from five control children; enteroaggregative and diffuse adherent E. coli strains were isolated with similar frequencies from children with and without diarrhea, thereby showing no association with diarrhea; ETEC was significantly associated with diarrhea in the diarrheal children as a whole and especially in the age groups of 0 to 24 months and 37 to 48 months (further analysis suggests an association with diarrhea for the heat-stable toxin only and for both heat-labile- and heat-stable-toxin-producing ETEC only); and EPEC was significantly associated with diarrhea in the diarrhea group as a whole and particularly in infants up to 1 year of age. Further analysis suggested that EPEC strains of only the traditional serogroups were significantly associated with diarrhea. ETEC and EPEC infections peaked during warm months. Our data thus suggest that EPEC and ETEC are important causes of acute diarrhea in children in this setting.

Full Text

The Full Text of this article is available as a PDF (179.9 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baqui A. H., Sack R. B., Black R. E., Haider K., Hossain A., Alim A. R., Yunus M., Chowdhury H. R., Siddique A. K. Enteropathogens associated with acute and persistent diarrhea in Bangladeshi children less than 5 years of age. J Infect Dis. 1992 Oct;166(4):792–796. doi: 10.1093/infdis/166.4.792. [DOI] [PubMed] [Google Scholar]
  2. Baudry B., Savarino S. J., Vial P., Kaper J. B., Levine M. M. A sensitive and specific DNA probe to identify enteroaggregative Escherichia coli, a recently discovered diarrheal pathogen. J Infect Dis. 1990 Jun;161(6):1249–1251. doi: 10.1093/infdis/161.6.1249. [DOI] [PubMed] [Google Scholar]
  3. Bhan M. K., Raj P., Levine M. M., Kaper J. B., Bhandari N., Srivastava R., Kumar R., Sazawal S. Enteroaggregative Escherichia coli associated with persistent diarrhea in a cohort of rural children in India. J Infect Dis. 1989 Jun;159(6):1061–1064. doi: 10.1093/infdis/159.6.1061. [DOI] [PubMed] [Google Scholar]
  4. Black R. E., Merson M. H., Rahman A. S., Yunus M., Alim A. R., Huq I., Yolken R. H., Curlin G. T. A two-year study of bacterial, viral, and parasitic agents associated with diarrhea in rural Bangladesh. J Infect Dis. 1980 Nov;142(5):660–664. doi: 10.1093/infdis/142.5.660. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bouzari S., Jafari A., Farhoudi-Moghaddam A. A., Shokouhi F., Parsi M. Adherence of non-enteropathogenic Escherichia coli to HeLa cells. J Med Microbiol. 1994 Feb;40(2):95–97. doi: 10.1099/00222615-40-2-95. [DOI] [PubMed] [Google Scholar]
  6. Brown J. E., Echeverria P., Taylor D. N., Seriwatana J., Vanapruks V., Lexomboon U., Neill R. N., Newland J. W. Determination by DNA hybridization of Shiga-like-toxin-producing Escherichia coli in children with diarrhea in Thailand. J Clin Microbiol. 1989 Feb;27(2):291–294. doi: 10.1128/jcm.27.2.291-294.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Cravioto A., Reyes R. E., Ortega R., Fernández G., Hernández R., López D. Prospective study of diarrhoeal disease in a cohort of rural Mexican children: incidence and isolated pathogens during the first two years of life. Epidemiol Infect. 1988 Aug;101(1):123–134. doi: 10.1017/s0950268800029289. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Echeverria P., Orskov F., Orskov I., Knutton S., Scheutz F., Brown J. E., Lexomboon U. Attaching and effacing enteropathogenic Escherichia coli as a cause of infantile diarrhea in Bangkok. J Infect Dis. 1991 Sep;164(3):550–554. doi: 10.1093/infdis/164.3.550. [DOI] [PubMed] [Google Scholar]
  9. Echeverria P., Serichantalerg O., Changchawalit S., Baudry B., Levine M. M., Orskov F., Orskov I. Tissue culture-adherent Escherichia coli in infantile diarrhea. J Infect Dis. 1992 Jan;165(1):141–143. doi: 10.1093/infdis/165.1.141. [DOI] [PubMed] [Google Scholar]
  10. Echeverria P., Taylor D. N., Lexsomboon U., Bhaibulaya M., Blacklow N. R., Tamura K., Sakazaki R. Case-control study of endemic diarrheal disease in Thai children. J Infect Dis. 1989 Mar;159(3):543–548. doi: 10.1093/infdis/159.3.543. [DOI] [PubMed] [Google Scholar]
  11. Echeverria P., Taylor D. N., Seriwatana J., Brown J. E., Lexomboon U. Examination of colonies and stool blots for detection of enteropathogens by DNA hybridization with eight DNA probes. J Clin Microbiol. 1989 Feb;27(2):331–334. doi: 10.1128/jcm.27.2.331-334.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Faruque A. S., Mahalanabis D., Islam A., Hoque S. S., Hasnat A. Common diarrhea pathogens and the risk of dehydration in young children with acute watery diarrhea: a case-control study. Am J Trop Med Hyg. 1993 Jul;49(1):93–100. doi: 10.4269/ajtmh.1993.49.93. [DOI] [PubMed] [Google Scholar]
  13. Faruque S. M., Haider K., Albert M. J., Ahmad Q. S., Alam A. N., Nahar S., Tzipori S. A comparative study of specific gene probes and standard bioassays to identify diarrhoeagenic Escherichia coli in paediatric patients with diarrhoea in Bangladesh. J Med Microbiol. 1992 Jan;36(1):37–40. doi: 10.1099/00222615-36-1-37. [DOI] [PubMed] [Google Scholar]
  14. Francis C. L., Jerse A. E., Kaper J. B., Falkow S. Characterization of interactions of enteropathogenic Escherichia coli O127:H6 with mammalian cells in vitro. J Infect Dis. 1991 Oct;164(4):693–703. doi: 10.1093/infdis/164.4.693. [DOI] [PubMed] [Google Scholar]
  15. Girón J. A., Donnenberg M. S., Martin W. C., Jarvis K. G., Kaper J. B. Distribution of the bundle-forming pilus structural gene (bfpA) among enteropathogenic Escherichia coli. J Infect Dis. 1993 Oct;168(4):1037–1041. doi: 10.1093/infdis/168.4.1037. [DOI] [PubMed] [Google Scholar]
  16. Gomes T. A., Blake P. A., Trabulsi L. R. Prevalence of Escherichia coli strains with localized, diffuse, and aggregative adherence to HeLa cells in infants with diarrhea and matched controls. J Clin Microbiol. 1989 Feb;27(2):266–269. doi: 10.1128/jcm.27.2.266-269.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Gomes T. A., Rassi V., MacDonald K. L., Ramos S. R., Trabulsi L. R., Vieira M. A., Guth B. E., Candeias J. A., Ivey C., Toledo M. R. Enteropathogens associated with acute diarrheal disease in urban infants in São Paulo, Brazil. J Infect Dis. 1991 Aug;164(2):331–337. doi: 10.1093/infdis/164.2.331. [DOI] [PubMed] [Google Scholar]
  18. Gomes T. A., Vieira M. A., Wachsmuth I. K., Blake P. A., Trabulsi L. R. Serotype-specific prevalence of Escherichia coli strains with EPEC adherence factor genes in infants with and without diarrhea in São Paulo, Brazil. J Infect Dis. 1989 Jul;160(1):131–135. doi: 10.1093/infdis/160.1.131. [DOI] [PubMed] [Google Scholar]
  19. Gunzburg S. T., Chang B. J., Elliott S. J., Burke V., Gracey M. Diffuse and enteroaggregative patterns of adherence of enteric Escherichia coli isolated from aboriginal children from the Kimberley region of Western Australia. J Infect Dis. 1993 Mar;167(3):755–758. doi: 10.1093/infdis/167.3.755. [DOI] [PubMed] [Google Scholar]
  20. Haider K., Faruque S. M., Shahid N. S., Albert M. J., Nahar S., Malek A., Tzipori S., Alam A. N. Enteroaggregative Escherichia coli infections in Bangladeshi children: clinical and microbiological features. J Diarrhoeal Dis Res. 1991 Dec;9(4):318–322. [PubMed] [Google Scholar]
  21. Jerse A. E., Gicquelais K. G., Kaper J. B. Plasmid and chromosomal elements involved in the pathogenesis of attaching and effacing Escherichia coli. Infect Immun. 1991 Nov;59(11):3869–3875. doi: 10.1128/iai.59.11.3869-3875.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Jerse A. E., Yu J., Tall B. D., Kaper J. B. A genetic locus of enteropathogenic Escherichia coli necessary for the production of attaching and effacing lesions on tissue culture cells. Proc Natl Acad Sci U S A. 1990 Oct;87(20):7839–7843. doi: 10.1073/pnas.87.20.7839. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Kim K. H., Suh I. S., Kim J. M., Kim C. W., Cho Y. J. Etiology of childhood diarrhea in Korea. J Clin Microbiol. 1989 Jun;27(6):1192–1196. doi: 10.1128/jcm.27.6.1192-1196.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Knutton S., Baldwin T., Williams P. H., McNeish A. S. Actin accumulation at sites of bacterial adhesion to tissue culture cells: basis of a new diagnostic test for enteropathogenic and enterohemorrhagic Escherichia coli. Infect Immun. 1989 Apr;57(4):1290–1298. doi: 10.1128/iai.57.4.1290-1298.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Levine M. M., Edelman R. Enteropathogenic Escherichia coli of classic serotypes associated with infant diarrhea: epidemiology and pathogenesis. Epidemiol Rev. 1984;6:31–51. doi: 10.1093/oxfordjournals.epirev.a036274. [DOI] [PubMed] [Google Scholar]
  26. Levine M. M., Ferreccio C., Prado V., Cayazzo M., Abrego P., Martinez J., Maggi L., Baldini M. M., Martin W., Maneval D. Epidemiologic studies of Escherichia coli diarrheal infections in a low socioeconomic level peri-urban community in Santiago, Chile. Am J Epidemiol. 1993 Nov 15;138(10):849–869. doi: 10.1093/oxfordjournals.aje.a116788. [DOI] [PubMed] [Google Scholar]
  27. Levine M. M., Prado V., Robins-Browne R., Lior H., Kaper J. B., Moseley S. L., Gicquelais K., Nataro J. P., Vial P., Tall B. Use of DNA probes and HEp-2 cell adherence assay to detect diarrheagenic Escherichia coli. J Infect Dis. 1988 Jul;158(1):224–228. doi: 10.1093/infdis/158.1.224. [DOI] [PubMed] [Google Scholar]
  28. Rahim Z., Kay B. A. Enrichment for Plesiomonas shigelloides from stools. J Clin Microbiol. 1988 Apr;26(4):789–790. doi: 10.1128/jcm.26.4.789-790.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Shariff M., Bhan M. K., Knutton S., Das B. K., Saini S., Kumar R. Evaluation of the fluorescence actin staining test for detection of enteropathogenic Escherichia coli. J Clin Microbiol. 1993 Feb;31(2):386–389. doi: 10.1128/jcm.31.2.386-389.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Snyder J. D., Merson M. H. The magnitude of the global problem of acute diarrhoeal disease: a review of active surveillance data. Bull World Health Organ. 1982;60(4):605–613. [PMC free article] [PubMed] [Google Scholar]
  31. Stoll B. J., Glass R. I., Huq M. I., Khan M. U., Holt J. E., Banu H. Surveillance of patients attending a diarrhoeal disease hospital in Bangladesh. Br Med J (Clin Res Ed) 1982 Oct 23;285(6349):1185–1188. doi: 10.1136/bmj.285.6349.1185. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Strockbine N. A., Faruque S. M., Kay B. A., Haider K., Alam K., Alam A. N., Tzipori S., Wachsmuth I. K. DNA probe analysis of diarrhoeagenic Escherichia coli: detection of EAF-positive isolates of traditional enteropathogenic E. coli serotypes among Bangladeshi paediatric diarrhoea patients. Mol Cell Probes. 1992 Apr;6(2):93–99. doi: 10.1016/0890-8508(92)90052-y. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Clinical Microbiology are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES