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. 1993 Apr;31(4):851–856. doi: 10.1128/jcm.31.4.851-856.1993

Characterization of enterotoxigenic Escherichia coli isolated from U.S. troops deployed to the Middle East.

M K Wolf 1, D N Taylor 1, E C Boedeker 1, K C Hyams 1, D R Maneval 1, M M Levine 1, K Tamura 1, R A Wilson 1, P Echeverria 1
PMCID: PMC263576  PMID: 8463396

Abstract

Enterotoxigenic Escherichia coli (ETEC) was a common cause of traveler's diarrhea in U.S. soldiers in the Middle East in 1989 and 1990. To determine which bacterial components would be useful in a vaccine, potential protective antigens (toxin, colonization factor antigen [CFA], and serotype) from 189 ETEC isolates were examined. Nearly half of the isolates expressed both ETEC toxins, 39% had only heat-stable enterotoxin (ST), and 17% had heat-labile enterotoxin (LT). CFA/I was the least common colonization factor antigen (11%), CFA/II was common (34%), as was CFA/IV (31%), and 24% expressed none of these CFAs. Fifty-seven O:H serotypes were found. Serotype O6:H16 was the most common, occurring in 29% of the ETEC isolates, usually with LT-ST and CFA/II. Generally, CFA/II was associated with expression of both toxins, CFA/IV was associated with expression of ST, and none of the CFAs was routinely found with LT. We conclude that ETEC from soldiers in the Middle East expressed a variety of antigens and that an effective vaccine will require multiple protective antigens.

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Selected References

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  1. Binsztein N., Jouve M. J., Viboud G. I., López Moral L., Rivas M., Orskov I., Ahrén C., Svennerholm A. M. Colonization factors of enterotoxigenic Escherichia coli isolated from children with diarrhea in Argentina. J Clin Microbiol. 1991 Sep;29(9):1893–1898. doi: 10.1128/jcm.29.9.1893-1898.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Changchawalit S., Echeverria P., Taylor D. N., Leksomboon U., Tirapat C., Eampokalap B., Rowe B. Colonization factors associated with enterotoxigenic Escherichia coli isolated in Thailand. Infect Immun. 1984 Aug;45(2):525–527. doi: 10.1128/iai.45.2.525-527.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Clemens J. D., Sack D. A., Harris J. R., Chakraborty J., Neogy P. K., Stanton B., Huda N., Khan M. U., Kay B. A., Khan M. R. Cross-protection by B subunit-whole cell cholera vaccine against diarrhea associated with heat-labile toxin-producing enterotoxigenic Escherichia coli: results of a large-scale field trial. J Infect Dis. 1988 Aug;158(2):372–377. doi: 10.1093/infdis/158.2.372. [DOI] [PubMed] [Google Scholar]
  4. DuPont H. L., Formal S. B., Hornick R. B., Snyder M. J., Libonati J. P., Sheahan D. G., LaBrec E. H., Kalas J. P. Pathogenesis of Escherichia coli diarrhea. N Engl J Med. 1971 Jul 1;285(1):1–9. doi: 10.1056/NEJM197107012850101. [DOI] [PubMed] [Google Scholar]
  5. 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]
  6. Evans D. G., Evans D. J., Jr, Opekun A. R., Graham D. Y. Non-replicating oral whole cell vaccine protective against enterotoxigenic Escherichia coli (ETEC) diarrhea: stimulation of anti-CFA (CFA/I) and anti-enterotoxin (anti-LT) intestinal IgA and protection against challenge with ETEC belonging to heterologous serotypes. FEMS Microbiol Immunol. 1988 Dec;1(3):117–125. doi: 10.1111/j.1574-6968.1988.tb02363.x. [DOI] [PubMed] [Google Scholar]
  7. Evans D. G., Evans D. J., Jr, Tjoa W. S., DuPont H. L. Detection and characterization of colonization factor of enterotoxigenic Escherichia coli isolated from adults with diarrhea. Infect Immun. 1978 Feb;19(2):727–736. doi: 10.1128/iai.19.2.727-736.1978. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Gaastra W., de Graaf F. K. Host-specific fimbrial adhesins of noninvasive enterotoxigenic Escherichia coli strains. Microbiol Rev. 1982 Jun;46(2):129–161. doi: 10.1128/mr.46.2.129-161.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Haberberger R. L., Jr, Mikhail I. A., Burans J. P., Hyams K. C., Glenn J. C., Diniega B. M., Sorgen S., Mansour N., Blacklow N. R., Woody J. N. Travelers' diarrhea among United States military personnel during joint American-Egyptian armed forces exercises in Cairo, Egypt. Mil Med. 1991 Jan;156(1):27–30. [PubMed] [Google Scholar]
  10. Huilan S., Zhen L. G., Mathan M. M., Mathew M. M., Olarte J., Espejo R., Khin Maung U., Ghafoor M. A., Khan M. A., Sami Z. Etiology of acute diarrhoea among children in developing countries: a multicentre study in five countries. Bull World Health Organ. 1991;69(5):549–555. [PMC free article] [PubMed] [Google Scholar]
  11. Hyams K. C., Bourgeois A. L., Merrell B. R., Rozmajzl P., Escamilla J., Thornton S. A., Wasserman G. M., Burke A., Echeverria P., Green K. Y. Diarrheal disease during Operation Desert Shield. N Engl J Med. 1991 Nov 14;325(20):1423–1428. doi: 10.1056/NEJM199111143252006. [DOI] [PubMed] [Google Scholar]
  12. Klemm P. Fimbrial adhesions of Escherichia coli. Rev Infect Dis. 1985 May-Jun;7(3):321–340. doi: 10.1093/clinids/7.3.321. [DOI] [PubMed] [Google Scholar]
  13. Knutton S., McConnell M. M., Rowe B., McNeish A. S. Adhesion and ultrastructural properties of human enterotoxigenic Escherichia coli producing colonization factor antigens III and IV. Infect Immun. 1989 Nov;57(11):3364–3371. doi: 10.1128/iai.57.11.3364-3371.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Levine M. M. Escherichia coli that cause diarrhea: enterotoxigenic, enteropathogenic, enteroinvasive, enterohemorrhagic, and enteroadherent. J Infect Dis. 1987 Mar;155(3):377–389. doi: 10.1093/infdis/155.3.377. [DOI] [PubMed] [Google Scholar]
  15. Levine M. M., Ristaino P., Marley G., Smyth C., Knutton S., Boedeker E., Black R., Young C., Clements M. L., Cheney C. Coli surface antigens 1 and 3 of colonization factor antigen II-positive enterotoxigenic Escherichia coli: morphology, purification, and immune responses in humans. Infect Immun. 1984 May;44(2):409–420. doi: 10.1128/iai.44.2.409-420.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. McConnell M. M., Hibberd M. L., Penny M. E., Scotland S. M., Cheasty T., Rowe B. Surveys of human enterotoxigenic Escherichia coli from three different geographical areas for possible colonization factors. Epidemiol Infect. 1991 Jun;106(3):477–484. doi: 10.1017/s0950268800067522. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. McConnell M. M., Rowe B. Prevalence of the putative colonization factors CFA/III and PCFO159:H4 in enterotoxigenic Escherichia coli. J Infect Dis. 1989 Mar;159(3):582–586. doi: 10.1093/infdis/159.3.582. [DOI] [PubMed] [Google Scholar]
  18. McConnell M. M., Thomas L. V., Day N. P., Rowe B. Enzyme-linked immunosorbent assays for the detection of adhesion factor antigens of enterotoxigenic Escherichia coli. J Infect Dis. 1985 Dec;152(6):1120–1127. doi: 10.1093/infdis/152.6.1120. [DOI] [PubMed] [Google Scholar]
  19. McConnell M. M., Thomas L. V., Willshaw G. A., Smith H. R., Rowe B. Genetic control and properties of coli surface antigens of colonization factor antigen IV (PCF8775) of enterotoxigenic Escherichia coli. Infect Immun. 1988 Aug;56(8):1974–1980. doi: 10.1128/iai.56.8.1974-1980.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Peltola H., Siitonen A., Kyrönseppä H., Simula I., Mattila L., Oksanen P., Kataja M. J., Cadoz M. Prevention of travellers' diarrhoea by oral B-subunit/whole-cell cholera vaccine. Lancet. 1991 Nov 23;338(8778):1285–1289. doi: 10.1016/0140-6736(91)92590-x. [DOI] [PubMed] [Google Scholar]
  21. Rowe B., Taylor J., Bettelheim K. A. An investigation of traveller's diarrhoea. Lancet. 1970 Jan 3;1(7636):1–5. doi: 10.1016/s0140-6736(70)90520-9. [DOI] [PubMed] [Google Scholar]
  22. Scott D. A., Haberberger R. L., Thornton S. A., Hyams K. C. Norfloxacin for the prophylaxis of travelers' diarrhea in U.S. military personnel. Am J Trop Med Hyg. 1990 Feb;42(2):160–164. doi: 10.4269/ajtmh.1990.42.160. [DOI] [PubMed] [Google Scholar]
  23. Sen D., Ganguly U., Saha M. R., Bhattacharya S. K., Datta P., Datta D., Mukherjee A. K., Chakravarty R., Pal S. C. Studies on Escherichia coli as a cause of acute diarrhoea in Calcutta. J Med Microbiol. 1984 Feb;17(1):53–58. doi: 10.1099/00222615-17-1-53. [DOI] [PubMed] [Google Scholar]
  24. Sjöberg P. O., Lindahl M., Porath J., Wadström T. Purification and characterization of CS2, a sialic acid-specific haemagglutinin of enterotoxigenic Escherichia coli. Biochem J. 1988 Oct 1;255(1):105–111. doi: 10.1042/bj2550105. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Stoll B. J., Rowe B., Glass R. I., Gross R. J., Huq I. Changes in serotypes of enterotoxigenic Escherichia coli in Dhaka over time: usefulness of polyvalent antisera. J Clin Microbiol. 1983 Oct;18(4):935–937. doi: 10.1128/jcm.18.4.935-937.1983. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Svennerholm A. M., Vidal Y. L., Holmgren J., McConnell M. M., Rowe B. Role of PCF8775 antigen and its coli surface subcomponents for colonization, disease, and protective immunogenicity of enterotoxigenic Escherichia coli in rabbits. Infect Immun. 1988 Feb;56(2):523–528. doi: 10.1128/iai.56.2.523-528.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Taylor D. N., Sanchez J. L., Candler W., Thornton S., McQueen C., Echeverria P. Treatment of travelers' diarrhea: ciprofloxacin plus loperamide compared with ciprofloxacin alone. A placebo-controlled, randomized trial. Ann Intern Med. 1991 May 1;114(9):731–734. doi: 10.7326/0003-4819-114-9-731. [DOI] [PubMed] [Google Scholar]
  28. Thomas L. V., McConnell M. M., Rowe B., Field A. M. The possession of three novel coli surface antigens by enterotoxigenic Escherichia coli strains positive for the putative colonization factor PCF8775. J Gen Microbiol. 1985 Sep;131(9):2319–2326. doi: 10.1099/00221287-131-9-2319. [DOI] [PubMed] [Google Scholar]
  29. Thomas L. V., Rowe B. The occurrence of colonisation factors (CFA/I, CFA/II and E8775) in enterotoxigenic Escherichia coli from various countries in South East Asia. Med Microbiol Immunol. 1982;171(2):85–90. doi: 10.1007/BF02124915. [DOI] [PubMed] [Google Scholar]
  30. Wolf M. K., Andrews G. P., Tall B. D., McConnell M. M., Levine M. M., Boedeker E. C. Characterization of CS4 and CS6 antigenic components of PCF8775, a putative colonization factor complex from enterotoxigenic Escherichia coli E8775. Infect Immun. 1989 Jan;57(1):164–173. doi: 10.1128/iai.57.1.164-173.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]

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