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. 1971 Apr;50(4):881–889. doi: 10.1172/JCI106560

Acute undifferentiated human diarrhea in the tropics

I. Alterations in intestinal microflora

S L Gorbach 1,2, J G Banwell 1,2, B D Chatterjee 1,2, B Jacobs 1,2, R B Sack 1,2
PMCID: PMC292003  PMID: 4926260

Abstract

The microflora of the small and large intestine was determined in 17 adults with acute undifferentiated diarrhea in Calcutta, India. On the basis of bacteriologic findings, the patients could be divided into two groups: those with a predominant flora of Escherichia coli (eight patients) and those with a mixed coliform flora (nine patients). In the former group, E. coli were distributed throughout the small and large bowel. Broth filtrates of these isolates contained an enterotoxin which caused fluid accumulation in the rabbit intestinal loop model. Toxigenic E. coli were cleared rapidly from the small bowel during the acute period; some patients only had the “hot” strains in their fecal effluent. During convalescence, the serotypes of E. coli changed and the new strains did not elaborate enterotoxin. Only one of the eight patients had a serotype previously associated with diarrhea. Acute undifferentiated diarrhea in the remaining cases was apparently caused by untypable E. coli or by typable strains not generally considered pathogenic.

Small bowel and fecal cultures from the mixed flora group revealed a heterogeneous mixture of Gram-negative enteric bacilli and a distinct pattern could not be discerned. Further study will be needed to elucidate the cause of diarrhea in these cases.

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Selected References

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

  1. Banwell J. G., Gorbach S. L., Pierce N. F., Mitra R., Mondal A. Acute undifferentiated human diarrhea in the tropics. II. Alterations in intestinal fluid and electrolyte movements. J Clin Invest. 1971 Apr;50(4):890–900. doi: 10.1172/JCI106561. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Banwell J. G., Pierce N. F., Mitra R. C., Brigham K. L., Caranasos G. J., Keimowitz R. I., Fedson D. S., Thomas J., Gorbach S. L., Sack R. B. Intestinal fluid and electrolyte transport in human cholera. J Clin Invest. 1970 Jan;49(1):183–195. doi: 10.1172/JCI106217. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Burrows W., Musteikis G. M. Cholera infection and toxin in the rabbit ileal loop. J Infect Dis. 1966 Apr;116(2):183–190. doi: 10.1093/infdis/116.2.183. [DOI] [PubMed] [Google Scholar]
  4. CRAMBLETT H. G., SIEWERS C. M. THE ETIOLOGY OF GASTROENTERITIS IN INFANTS AND CHILDREN, WITH EMPHASIS ON THE OCCURRENCE OF SIMULTANEOUS MIXED VIRAL-BACTERIAL INFECTIONS. Pediatrics. 1965 Jun;35:885–898. [PubMed] [Google Scholar]
  5. Cohen R., Kalser M. H., Arteaga I., Yawn E., Frazier D., Leite C. A., Ahearn D. G., Roth F. Microbial intestinal flora in acute diarrheal disease. JAMA. 1967 Sep 11;201(11):835–840. [PubMed] [Google Scholar]
  6. DE S. N., CHATTERJE D. N. An experimental study of the mechanism of action of Vibriod cholerae on the intestinal mucous membrane. J Pathol Bacteriol. 1953 Oct;66(2):559–562. doi: 10.1002/path.1700660228. [DOI] [PubMed] [Google Scholar]
  7. FERGUSON W. W., JUNE R. C. Experiments on feeding adult volunteers with Escherichia coli 111, B4, a coliform organism associated with infant diarrhea. Am J Hyg. 1952 Mar;55(2):155–169. doi: 10.1093/oxfordjournals.aje.a119510. [DOI] [PubMed] [Google Scholar]
  8. Finkelstein R. A., Atthasampunna P., Chulasamaya M., Charunmethee P. Pathogenesis of experimental cholera: biologic ativities of purified procholeragen A. J Immunol. 1966 Mar;96(3):440–449. [PubMed] [Google Scholar]
  9. GANGAROSA E. F., BEISEL W. R., BENYAJATI C., SPRINZ H., PIYARATN P. The nature of the gastrointestinal lesion in asiatic cholera and its relation to pathogenesis: a biopsy study. Am J Trop Med Hyg. 1960 Mar;9:125–135. doi: 10.4269/ajtmh.1960.9.125. [DOI] [PubMed] [Google Scholar]
  10. GORDON J. E. ACUTE DIARRHEAL DISEASE. Am J Med Sci. 1964 Sep;248:345–365. [PubMed] [Google Scholar]
  11. GUARDIOLA-ROTGER A., DEGONZALEZ E. F., KAUDER E., MUNOZ A., LOPEZ V. A., GADEA D. E., FUNKENBUSCH M. J. STUDIES ON DIARRHEAL DISEASES. THE MULTIPLICITY OF INFECTIOUS AGENTS IN THE INTESTINAL FLORA OF PUERTO RICAN CHILDREN WITH GASTROENTERITIS. J Pediatr. 1964 Jul;65:81–91. doi: 10.1016/s0022-3476(64)80556-4. [DOI] [PubMed] [Google Scholar]
  12. Gorbach S. L., Banwell J. G., Jacobs B., Chatterjee B. D., Mitra R., Brigham K. L., Neogy K. N. Intestinal microflora in Asiatic cholera. I. "Rice-water" stool. J Infect Dis. 1970 Jan;121(1):32–37. doi: 10.1093/infdis/121.1.32. [DOI] [PubMed] [Google Scholar]
  13. Gorbach S. L., Banwell J. G., Jacobs B., Chatterjee B. D., Mitra R., Brigham K. L., Neogy K. N. Intestinal microflora in Asiatic cholera. II. The small bowel. J Infect Dis. 1970 Jan;121(1):38–45. doi: 10.1093/infdis/121.1.38. [DOI] [PubMed] [Google Scholar]
  14. Gorbach S. L., Neale G., Levitan R., Hepner G. W. Alterations in human intestinal microflora during experimental diarrhoea. Gut. 1970 Jan;11(1):1–6. doi: 10.1136/gut.11.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Gorbach S. L., Plaut A. G., Nahas L., Weinstein L., Spanknebel G., Levitan R. Studies of intestinal microflora. II. Microorganisms of the small intestine and their relations to oral and fecal flora. Gastroenterology. 1967 Dec;53(6):856–867. [PubMed] [Google Scholar]
  16. Gyles C. L., Barnum D. A. A heat-labile enterotoxin from strains of Eschericha coli enteropathogenic for pigs. J Infect Dis. 1969 Oct;120(4):419–426. doi: 10.1093/infdis/120.4.419. [DOI] [PubMed] [Google Scholar]
  17. JUNE R. C., FERGUSON W. W., WORFEL M. T. Experiments in feeding adult volunteers with Escherichia coli 55, B5, a coliform organism associated with infant diarrhea. Am J Hyg. 1953 Mar;57(2):222–236. doi: 10.1093/oxfordjournals.aje.a119570. [DOI] [PubMed] [Google Scholar]
  18. KEAN B. H. THE DIARRHEA OF TRAVELERS TO MEXICO. SUMMARY OF FIVE-YEAR STUDY. Ann Intern Med. 1963 Nov;59:605–614. doi: 10.7326/0003-4819-59-5-605. [DOI] [PubMed] [Google Scholar]
  19. KOYA G., KOSAKAI N., FUKASAWA Y. Supplementary studies on the multiplication of Escherichia coli O-111 B4 in the intestinal tract of adult volunteers and its relation to manifestation of coli enteritis. Jpn J Med Sci Biol. 1954 Dec;7(6):655–661. doi: 10.7883/yoken1952.7.655. [DOI] [PubMed] [Google Scholar]
  20. Kohler E. M. Enterotoxic activity of filtrates of escherichia coli in young pigs. Am J Vet Res. 1968 Dec;29(12):2263–2274. [PubMed] [Google Scholar]
  21. LOESCHE W. J., SOCRANSKY S. S., GIBBONS R. J. BACTEROIDES ORALIS, PROPOSED NEW SPECIES ISOLATED FROM THE ORAL CAVITY OF MAN. J Bacteriol. 1964 Nov;88:1329–1337. doi: 10.1128/jb.88.5.1329-1337.1964. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. MATA L. J., ALBERTAZZI C., NEGREROS A., FERNANDEZ R. PREVALENCE OF SHIGELLA, SALMONELLA, AND ENTEROPATHOGENIC ESCHERICHIA COLI IN SIX MAYAN VILLAGES. Am J Public Health Nations Health. 1965 Sep;55:1396–1402. doi: 10.2105/ajph.55.9.1396. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Moore W. E., Cato E. P., Holdeman L. V. Anaerobic bacteria of the gastrointestinal flora and their occurrence in clinical infections. J Infect Dis. 1969 Jun;119(6):641–649. doi: 10.1093/infdis/119.6.641. [DOI] [PubMed] [Google Scholar]
  24. NETER E. Enteritis due to enteropathogenic Escherichia coli; present-day status and unsolved problems. J Pediatr. 1959 Aug;55(2):223–239. doi: 10.1016/s0022-3476(59)80091-3. [DOI] [PubMed] [Google Scholar]
  25. OLARTE J., FERGUSON W. W., HENDERSON N. D., TORREGROSA L. Klebsiella strains isolated from diarrheal infants. Human volunteer studies. Am J Dis Child. 1961 Jun;101:763–770. doi: 10.1001/archpedi.1961.04020070077011. [DOI] [PubMed] [Google Scholar]
  26. 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]
  27. SABIN A. B. CAUSE AND CONTROL OF FATAL, INFANTILE DIARRHEAL DISEASES. Am J Trop Med Hyg. 1963 Jul;12:556–566. doi: 10.4269/ajtmh.1963.12.556. [DOI] [PubMed] [Google Scholar]
  28. Smith H. W., Halls S. Observations by the ligated intestinal segment and oral inoculation methods on Escherichia coli infections in pigs, calves, lambs and rabbits. J Pathol Bacteriol. 1967 Apr;93(2):499–529. doi: 10.1002/path.1700930211. [DOI] [PubMed] [Google Scholar]
  29. TAYLOR J., MALTBY M. P., PAYNE J. M. Factors influencing the response of ligated rabbit-gut segments to injected Escherichia coli. J Pathol Bacteriol. 1958 Oct;76(2):491–499. doi: 10.1002/path.1700760218. [DOI] [PubMed] [Google Scholar]
  30. TAYLOR J., WILKINS M. P., PAYNE J. M. Relation of rabbit gut reaction to enteropathogenic Escherichia coli. Br J Exp Pathol. 1961 Feb;42:43–52. [PMC free article] [PubMed] [Google Scholar]
  31. THOMSON S. The numbers of pathogenic bacilli in faeces in intestinal diseases. J Hyg (Lond) 1955 Jun;53(2):217–224. doi: 10.1017/s0022172400000681. [DOI] [PMC free article] [PubMed] [Google Scholar]

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