Classic Enteropathogenic Escherichia coli (EPEC) associated with diarrhea in children users of the Hospital Pereira Rossell
Clinical aspects and characteristics of involved strains
Keywords:
INFANT DIARRHEA, ACUTE ILLNESS, FECES, INFECTIONS BY ESCHERICHIA COLI, ESCHERICHIA COLI
Abstract
Background: acute diarrhea disease (EDA) is responsible of 12.000 deaths per day in Asia, Africa and Latin America. Classic Enteropathogenic Escherichia coli (EPEC) is an important virotype associated with EDA episodes in children under five years of those regions.
Objectives: to know clinical manifestations of diarrhea cases due to EPEC in children users of a Public Health centre and to establish the characteristics of involved strains.
Methods: ninety-five children with EDA were studied. Every child underwent clinical history and copromi-crobiologic studies. EPEC strains were detected by reaction chain polymerase (PCR) of eae and were completely characterized including determination of genetic variations of eae and bfp gens.
Results: twenty-six EPEC strains were isolated, 15 typical and 11 atypical. The most frequent variant of bfp was b and 9 variants of eae were seen. Most of the infected children with EPEC presented watery diarrhea associated with vomiting, and fever in half of the cases. Blood and fecal leukocytes were found in 20% of the children.
Conclusions: as it happens in other areas, typical EPEC strains appear as frequent enteropathogens in this group of children. Atypical cultures also play an important rol as agents of diarrhea. Clinical characteristics do not differ from those of children with diarrhea in developed countries; no differences were seen with other agents.
References
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(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.
Published
2007-09-30
How to Cite
1.
Varela G, Jasinski C, Gadea P, Tanzi MN, Mota MI, Arenas C, Pardo L, González S, González G, Sirok A, Schelotto F. Classic Enteropathogenic Escherichia coli (EPEC) associated with diarrhea in children users of the Hospital Pereira Rossell. Rev. Méd. Urug. [Internet]. 2007Sep.30 [cited 2024Nov.26];23(3):153-6. Available from: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/610
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