Escherichia coli enteropatógeno clásico (EPEC) asociado a casos de diarrea en niños usuarios del Hospital Pereira Rossell
Aspectos clínicos y características de las cepas involucradas
Palabras clave:
DIARREA INFANTIL, ENFERMEDAD AGUDA, HECES, INFECCIONES POR ESCHERICHIA COLI, ESCHERICHIA COLI
Resumen
Introducción: la enfermedad diarreica aguda (EDA) es responsable de 12.000 muertes por día en niños de Asia, África y Latinoamérica. Escherichia coli enteropatógeno clásico (EPEC) es un virotipo diarreogénico importante y se asocia a episodios de EDA en niños menores de 5 años que viven en estas regiones.
Objetivos: conocer las manifestaciones clínicas de los casos de diarrea por EPEC en niños usuarios de un servicio de Salud Pública y establecer las características de las cepas involucradas.
Material y método: se estudiaron 95 niños con EDA. A cada uno se le realizó historia clínica y estudio copromicrobiológico. Las cepas EPEC se detectaron por reacción en cadena de la polimerasa (PCR) para eae y se caracterizaron completamente incluyendo la determinación de las variantes genéticas del gen eae y bfp.
Resultados: se aislaron 26 cepas EPEC, 15 correspondieron a cepas "típicas" y 11 a cultivos "atípicos". La variante más frecuente de bfp fue b y se demostraron 9 variantes de eae. La mayoría de los niños infectados con EPEC presentó diarrea acuosa asociada a vómitos, y fiebre en 50% de los casos. En 20% se demostró la presencia de sangre y leucocitos fecales.
Conclusiones: como ocurre en otras zonas, las cepas EPEC "típicas" aparecen como enteropatógenos frecuentes en este grupo de niños. Los cultivos "atípicos" también jugarían un papel destacado como agentes de diarrea. Las características clínicas no difieren de las comunicadas en niños de países desarrollados con diarrea por EPEC y no hubo diferencias con los otros agentes.
Citas
(1) Galiana A, Ferrari AM, Nairac A, Peluffo L, Bello O. Diarrea aguda infantil. In: Atención pediátrica. Pautas de diagnóstico, tratamiento y prevención. 5 ed. Montevideo: Oficina del Libro-AEM, 2000: 67-72.
(2) Bern C, Martines J, de Zoysa I, Glass RI. The magnitude of the global problem of diarrhoeal disease: a ten-year update. Bull World Health Organ 1992; 70: 705-14.
(3) Koga, M, Yuki N, Takahashi M, Saito K, Hirata K. Are Campylobacter curvus and Campylobacter upsaliensis antecedent infectious agents in Guillain-Barre and Fisher’s syndrome? J Neurol Sci 1999; 163: 53-7.
(4) Gadea M, Varela G, Bernadá M, Sirok A, Mota M, Sabelli R, et al. Primer aislamiento en Uruguay de Escherichia coli productora de toxina Shiga del serotipo O157:H7 en una niña con síndrome urémico hemolítico. Rev Méd Urug 2004; 20: 79-81.
(5) World Health Organization. The treatment of diarrhoea: a manual for physicians and other senior health workers (WHO/CDR/95.3). Ginebra: WHO, 1995.
(6) Food and Agriculture Association /World Health Organization. Evaluation of health and nutritional properties of probiotics in food including powder milk with live lactic acid bacteria. (Córdoba (Argentina), 1-4 oct. 2001). Ginebra: FAO/WHO, 2001. 34 p.
(7) Nataro JP, Kaper JB. Diarrheagenic Escherichia coli. Clin Microbiol Rev 1998; 11: 142-201.
(8) Knutton S, Lloyd DR, McNeish AS. Adhesion of enteropathogenic Escherichia coli to human intestinal enterocytes and cultured human intestinal mucosa. Infect Immun 1987; 55: 69-77.
(9) McDaniel TK, Kaper JB. A cloned pathogenicity island from enteropathogenic Escherichia coli confers the attaching and effacing phenotype on E. coli K-12. Mol Microbiol 1997; 23: 399-407.
(10) Kaper J B. Defining EPEC. Rev Microbiol 1996; 27: 130-3.
(11) Brinkley C, Burland V, Keller R, Rose DJ, Boutin AT, Klink SA, et al. Nucleotide sequence analysis of the enteropathogenic Escherichia coli adherence factor plasmid pMAR7. Infect Immun 2006; 74: 5408-13.
(12) Elliott S J, Wainwright LA, McDaniel TK, Jarvis KG, Deng YK, Lai LC, et al. The complete sequence of the locus of enterocyte effacement (LEE) from enteropathogenic Escherichia coli E2348/69. Mol Microbiol 1998; 28:1-4.
(13) Girard F, Batisson I, Frankel GM, Harel JM, Fairbrother JM. Interaction of enteropathogenic and shiga toxin-producing Escherichia coli and porcine intestinal mucosa: role of intimin and tir in adherence. Infect Immun 2005; 73: 6005-16.
(14) Girón JA, Ho AS, Schoolnik GK. Characterization of fimbriae produced by enteropathogenic Escherichia coli. J Bacteriol 1993; 175: 7391-403.
(15) Stone KD, Zhang HZ, Carlson LK, Donnenberg MS. A cluster of fourteen genes from enteropathogenic Escherichia coli is sufficient for the biogenesis of a type IV pilus. Mol Microbiol 1996; 20: 325-37
(16) Tobe T, Hayashi T, Han C, Schoolnik GK, Ohtsubo E, Sasakawa C. Complete DNA sequence and structural analysis of the enteropathogenic Escherichia coli adherence factor plasmid. Infect Immun 1999; 67: 5455-62.
(17) Blank TE, Zhong H, Bell AL, Whittam TS, Donnenberg MS. Molecular variation among type IV pilin (bfpA) genes from diverse enteropathogenic Escherichia coli strains. Infect Immun 2000; 68: 7028-38.
(18) Trabulsi LR, Keller R, Tardelli Gomes TA. Typical and atypical enteropathogenic Escherichia coli. Emerg Infect Dis 2002; 8: 508-13.
(19) Yatsuyanagi J, Saito S, Miyajima Y, Amano K, Enomoto K. Characterization of atypical enteropathogenic Escherichia coli strains harboring the astA gene that were associated with a waterborne outbreak of diarrhea in Japan. J Clin Microbiol 2003; 41: 2033-9.
(20) Alikhani MY, Mirsalehian A, Aslani MM. Detection of typical and atypical enteropathogenic Escherichia coli (EPEC) in Iranian children with and without diarrhoea. J Med Microbiol 2006; 55: 1159-63.
(21) World Health Organization Programme for control of diarrheal diseases. Manual for laboratory investigations of acute enteric infections. Ginebra: WHO, 1987.
(22) Evaluación del crecimiento del niño. In: Cusminsky M. Organización Panamericana de la Salud. Manual de crecimiento y desarrollo del niño. 2 ed. (Serie Paltex, 8). Washinton: OPS, 1993: 23-52.
(23) Torres ME, Pírez MC, Schelotto F, Varela G, Parodi V, Allende F, et al. Etiology of children’s diarrhea in Montevideo, Uruguay: associated pathogens and unusual isolates. J Clin Microbiol 2001; 39: 2134-9.
(24) Aranda KR, Fagundes-Neto U, Scaletsky IC. Evaluation of multiplex PCRs for diagnosis of infection with diarrheagenic Escherichia coli and Shigella spp. J Clin Microbiol 2004; 42: 5849-53.
(25) Nguyen TV, Le Van P, Huy C, Nguyen Gia K, Weintraub A. Detection and characterization of diarrheagenic Escherichia coli from young children in Hanoi, Vietnam. J Clin Microbiol 2005; 43: 755-60.
(26) Ewing WH. The genus Escherichia coli. In: Edwards and Ewing’s identification of enterobacteriaceae. 4 ed. New York: Elsevier, 1985: 93-134.
(27) Clinical and Laboratory Standars Institute/NCCLS. Performance standards for antimicrobial susceptibility testing: 15º informational suppl. (Document M100-S15). Pennsylvania: CLSI, 2005.
(28) Blanco M, Blanco JE, Dahbi G, Mora A, Alonso MP, Varela G, et al. Typing of intimin (eae) genes from enteropathogenic Escherichia coli (EPEC) isolated from children with diarrhoea in Montevideo, Uruguay: identification of two novel intimin variants (muB and xiR/beta2B). J Med Microbiol 2006; 55: 1165-74
(29) Tompkins DS, Hudson MJ, Smith HR, Eglin RP, Wheeler JG, Brett MM, et al. A study of infectious intestinal disease in England: microbiological findings in cases and controls. Commun Dis Public Health 1999; 2:108-13.
(30) Olesen B, Neimann J, Böttiger B, Ethelberg N, Schiellerup P, Jensen C, et al. Etiology of diarrhea in young children in Denmark: a case-control study. J Clin Microbiol 2005; 43: 3636-41.
(31) Miller JR, Barrett L, Kotloff K, Guerrant RL. A rapid diagnostic test for infectious and inflammatory enteritis. Arch Intern Med 1994; 154: 2660-4.
(32) Cheng A, Mac Donald JR, Thielman NM. Infectious diarrhea in developed and developing countries. J Clin Gastoenterol 2005; 39: 757-72.
(33) Scaletsky IC, Fabbricotti SH, Silva SO, Morais MB, Fagundes-Neto U. HEp-2-adherent Escherichia coli strains associated with acute infantile diarrhea, Sao Paulo, Brazil. Emerg Infect Dis 2002; 8: 855-8.
(34) Rodrigues J, Thomazini CM, Morelli A, de Batista G. Reduced eiological role for enteropathogenic Escherichia coli in cases of diarrhea in brazilian infants. J Clin Microbiol 2004; 42: 398-400.
(35) Yatsuyanagi J, Saito S, Sato H, Miyajima H, Amano K, Enomoto K. Characterization of enteropathogenic and enteroaggregative Escherichia coli isolated from diarrheal outbreak. J Clin Microbiol 2002; 40:294-7.
(36) Scotland SM, Smith HR, Cheasty T, Said B, Willshaw GA, Stokes N, et al. Use of gene probes and adhesion tests to characterize E. coli belonging to enteropathogenic serogroups isolated in United Kingdom. J Med Microbiol 1996; 44: 438-43.
(37) Hartland E, Batchelor M, Delahay RM, Hale C, Matthews S, Dougan G, et al. Binding of intimin from enteropathogenic Escherichia coli to tir and to host cells. Mol Microbiol 1999; 32: 151-8.
(38) Carvalho H, Teel LD, Kokai-Kun JF, O’Brien AD. Antibody against the carboxyl terminus of intimin a reduces enteropathogenic Escherichia coli adherence to tissue culture cells and subsequent induction of actin polymerization. Infect Immun 2005; 73: 2541-6.
(39) Blank TE, Zhong H, Bell AL, Whittam TS, Donnenberg JK. Molecular variation among type IV pilin (bfpA) genes from diverse enteropathogenic Escherichia coli strains. Infect Immun 2000; 68: 7028-38.
(40) Loureiro I, Frankel G, Adu-Bobie J, Dougan G, Trabulsi LR, Carneiro-Sampaio MM. Human colostrum contains IgA antibodies reactive to enteropathogenic Escherichia coli virulence-associated proteins: intimin, BfpA, EspA, and EspB. J Pediatr Gastroenterol Nutr 1998; 27: 166-71.
(2) Bern C, Martines J, de Zoysa I, Glass RI. The magnitude of the global problem of diarrhoeal disease: a ten-year update. Bull World Health Organ 1992; 70: 705-14.
(3) Koga, M, Yuki N, Takahashi M, Saito K, Hirata K. Are Campylobacter curvus and Campylobacter upsaliensis antecedent infectious agents in Guillain-Barre and Fisher’s syndrome? J Neurol Sci 1999; 163: 53-7.
(4) Gadea M, Varela G, Bernadá M, Sirok A, Mota M, Sabelli R, et al. Primer aislamiento en Uruguay de Escherichia coli productora de toxina Shiga del serotipo O157:H7 en una niña con síndrome urémico hemolítico. Rev Méd Urug 2004; 20: 79-81.
(5) World Health Organization. The treatment of diarrhoea: a manual for physicians and other senior health workers (WHO/CDR/95.3). Ginebra: WHO, 1995.
(6) Food and Agriculture Association /World Health Organization. Evaluation of health and nutritional properties of probiotics in food including powder milk with live lactic acid bacteria. (Córdoba (Argentina), 1-4 oct. 2001). Ginebra: FAO/WHO, 2001. 34 p.
(7) Nataro JP, Kaper JB. Diarrheagenic Escherichia coli. Clin Microbiol Rev 1998; 11: 142-201.
(8) Knutton S, Lloyd DR, McNeish AS. Adhesion of enteropathogenic Escherichia coli to human intestinal enterocytes and cultured human intestinal mucosa. Infect Immun 1987; 55: 69-77.
(9) McDaniel TK, Kaper JB. A cloned pathogenicity island from enteropathogenic Escherichia coli confers the attaching and effacing phenotype on E. coli K-12. Mol Microbiol 1997; 23: 399-407.
(10) Kaper J B. Defining EPEC. Rev Microbiol 1996; 27: 130-3.
(11) Brinkley C, Burland V, Keller R, Rose DJ, Boutin AT, Klink SA, et al. Nucleotide sequence analysis of the enteropathogenic Escherichia coli adherence factor plasmid pMAR7. Infect Immun 2006; 74: 5408-13.
(12) Elliott S J, Wainwright LA, McDaniel TK, Jarvis KG, Deng YK, Lai LC, et al. The complete sequence of the locus of enterocyte effacement (LEE) from enteropathogenic Escherichia coli E2348/69. Mol Microbiol 1998; 28:1-4.
(13) Girard F, Batisson I, Frankel GM, Harel JM, Fairbrother JM. Interaction of enteropathogenic and shiga toxin-producing Escherichia coli and porcine intestinal mucosa: role of intimin and tir in adherence. Infect Immun 2005; 73: 6005-16.
(14) Girón JA, Ho AS, Schoolnik GK. Characterization of fimbriae produced by enteropathogenic Escherichia coli. J Bacteriol 1993; 175: 7391-403.
(15) Stone KD, Zhang HZ, Carlson LK, Donnenberg MS. A cluster of fourteen genes from enteropathogenic Escherichia coli is sufficient for the biogenesis of a type IV pilus. Mol Microbiol 1996; 20: 325-37
(16) Tobe T, Hayashi T, Han C, Schoolnik GK, Ohtsubo E, Sasakawa C. Complete DNA sequence and structural analysis of the enteropathogenic Escherichia coli adherence factor plasmid. Infect Immun 1999; 67: 5455-62.
(17) Blank TE, Zhong H, Bell AL, Whittam TS, Donnenberg MS. Molecular variation among type IV pilin (bfpA) genes from diverse enteropathogenic Escherichia coli strains. Infect Immun 2000; 68: 7028-38.
(18) Trabulsi LR, Keller R, Tardelli Gomes TA. Typical and atypical enteropathogenic Escherichia coli. Emerg Infect Dis 2002; 8: 508-13.
(19) Yatsuyanagi J, Saito S, Miyajima Y, Amano K, Enomoto K. Characterization of atypical enteropathogenic Escherichia coli strains harboring the astA gene that were associated with a waterborne outbreak of diarrhea in Japan. J Clin Microbiol 2003; 41: 2033-9.
(20) Alikhani MY, Mirsalehian A, Aslani MM. Detection of typical and atypical enteropathogenic Escherichia coli (EPEC) in Iranian children with and without diarrhoea. J Med Microbiol 2006; 55: 1159-63.
(21) World Health Organization Programme for control of diarrheal diseases. Manual for laboratory investigations of acute enteric infections. Ginebra: WHO, 1987.
(22) Evaluación del crecimiento del niño. In: Cusminsky M. Organización Panamericana de la Salud. Manual de crecimiento y desarrollo del niño. 2 ed. (Serie Paltex, 8). Washinton: OPS, 1993: 23-52.
(23) Torres ME, Pírez MC, Schelotto F, Varela G, Parodi V, Allende F, et al. Etiology of children’s diarrhea in Montevideo, Uruguay: associated pathogens and unusual isolates. J Clin Microbiol 2001; 39: 2134-9.
(24) Aranda KR, Fagundes-Neto U, Scaletsky IC. Evaluation of multiplex PCRs for diagnosis of infection with diarrheagenic Escherichia coli and Shigella spp. J Clin Microbiol 2004; 42: 5849-53.
(25) Nguyen TV, Le Van P, Huy C, Nguyen Gia K, Weintraub A. Detection and characterization of diarrheagenic Escherichia coli from young children in Hanoi, Vietnam. J Clin Microbiol 2005; 43: 755-60.
(26) Ewing WH. The genus Escherichia coli. In: Edwards and Ewing’s identification of enterobacteriaceae. 4 ed. New York: Elsevier, 1985: 93-134.
(27) Clinical and Laboratory Standars Institute/NCCLS. Performance standards for antimicrobial susceptibility testing: 15º informational suppl. (Document M100-S15). Pennsylvania: CLSI, 2005.
(28) Blanco M, Blanco JE, Dahbi G, Mora A, Alonso MP, Varela G, et al. Typing of intimin (eae) genes from enteropathogenic Escherichia coli (EPEC) isolated from children with diarrhoea in Montevideo, Uruguay: identification of two novel intimin variants (muB and xiR/beta2B). J Med Microbiol 2006; 55: 1165-74
(29) Tompkins DS, Hudson MJ, Smith HR, Eglin RP, Wheeler JG, Brett MM, et al. A study of infectious intestinal disease in England: microbiological findings in cases and controls. Commun Dis Public Health 1999; 2:108-13.
(30) Olesen B, Neimann J, Böttiger B, Ethelberg N, Schiellerup P, Jensen C, et al. Etiology of diarrhea in young children in Denmark: a case-control study. J Clin Microbiol 2005; 43: 3636-41.
(31) Miller JR, Barrett L, Kotloff K, Guerrant RL. A rapid diagnostic test for infectious and inflammatory enteritis. Arch Intern Med 1994; 154: 2660-4.
(32) Cheng A, Mac Donald JR, Thielman NM. Infectious diarrhea in developed and developing countries. J Clin Gastoenterol 2005; 39: 757-72.
(33) Scaletsky IC, Fabbricotti SH, Silva SO, Morais MB, Fagundes-Neto U. HEp-2-adherent Escherichia coli strains associated with acute infantile diarrhea, Sao Paulo, Brazil. Emerg Infect Dis 2002; 8: 855-8.
(34) Rodrigues J, Thomazini CM, Morelli A, de Batista G. Reduced eiological role for enteropathogenic Escherichia coli in cases of diarrhea in brazilian infants. J Clin Microbiol 2004; 42: 398-400.
(35) Yatsuyanagi J, Saito S, Sato H, Miyajima H, Amano K, Enomoto K. Characterization of enteropathogenic and enteroaggregative Escherichia coli isolated from diarrheal outbreak. J Clin Microbiol 2002; 40:294-7.
(36) Scotland SM, Smith HR, Cheasty T, Said B, Willshaw GA, Stokes N, et al. Use of gene probes and adhesion tests to characterize E. coli belonging to enteropathogenic serogroups isolated in United Kingdom. J Med Microbiol 1996; 44: 438-43.
(37) Hartland E, Batchelor M, Delahay RM, Hale C, Matthews S, Dougan G, et al. Binding of intimin from enteropathogenic Escherichia coli to tir and to host cells. Mol Microbiol 1999; 32: 151-8.
(38) Carvalho H, Teel LD, Kokai-Kun JF, O’Brien AD. Antibody against the carboxyl terminus of intimin a reduces enteropathogenic Escherichia coli adherence to tissue culture cells and subsequent induction of actin polymerization. Infect Immun 2005; 73: 2541-6.
(39) Blank TE, Zhong H, Bell AL, Whittam TS, Donnenberg JK. Molecular variation among type IV pilin (bfpA) genes from diverse enteropathogenic Escherichia coli strains. Infect Immun 2000; 68: 7028-38.
(40) Loureiro I, Frankel G, Adu-Bobie J, Dougan G, Trabulsi LR, Carneiro-Sampaio MM. Human colostrum contains IgA antibodies reactive to enteropathogenic Escherichia coli virulence-associated proteins: intimin, BfpA, EspA, and EspB. J Pediatr Gastroenterol Nutr 1998; 27: 166-71.
Publicado
2007-09-30
Cómo citar
1.
Varela G, Jasinski C, Gadea P, Tanzi MN, Mota MI, Arenas C, Pardo L, González S, González G, Sirok A, Schelotto F. Escherichia coli enteropatógeno clásico (EPEC) asociado a casos de diarrea en niños usuarios del Hospital Pereira Rossell. Rev. Méd. Urug. [Internet]. 30 de septiembre de 2007 [citado 26 de noviembre de 2024];23(3):153-6. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/610
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