1887

Abstract

The aim of the present case control study was to investigate the prevalence of atypical enteropathogenic (EPEC) and its possible role in causing diarrhoea among children < 5 years of age in Norway. Stool specimens received in the laboratory from children with suspected gastroenteritis ( = 251) were, in addition to routine testing, analysed for the presence of EPEC by PCR of the , and genes. Specimens from healthy children ( = 210) recruited from Maternal and Child Health Centres were analysed for EPEC only. EPEC isolates ( , ) were classified as typical ( ) or atypical ( ), and were tested for O : K serogroup. Information on duration of diarrhoea was recorded in a questionnaire and from referral forms. Atypical EPEC was diagnosed in 37 patients (14.7 %) compared to 21 (10.0 %) of the healthy controls [Odds ratio (OR) = 1.4, = 0.3]. Only three isolates, all from patients, belonged to EPEC serogroups. One patient had typical EPEC. Twenty (22.5 %) of 89 patients with diarrhoea lasting ⩾14 days had atypical EPEC. The association between atypical EPEC and prolonged diarrhoea (OR = 2.1, = 0.04) was caused by a high prevalence among female patients (40.6 %). In conclusion, atypical EPEC was found to be slightly more prevalent in patients than controls, without any overall significant association with diarrhoea. However, a significant association was observed with diarrhoea lasting 14 days or more, a finding that may indicate a role for atypical EPEC in prolonged disease.

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2004-11-01
2024-03-28
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References

  1. Afset J. E., Bergh K., Bevanger L. 2003; High prevalence of atypical enteropathogenic Escherichia coli (EPEC) in Norwegian children with diarrhoea. J Med Microbiol 52:1015–1019 [CrossRef]
    [Google Scholar]
  2. Bieber D., Ramer S. W., Wu C. Y., Murray W. J., Tobe T., Fernandez R., Schoolnik G. K. 1998; Type IV pili, transient bacterial aggregates, and virulence of enteropathogenic Escherichia coli . Science 280:2114–2118 [CrossRef]
    [Google Scholar]
  3. Blom M., Meyer A., Gerner-Smidt P., Gaarslev K., Espersen F. 1999; Evaluation of Statens Serum Institut enteric medium for detection of enteric pathogens. J Clin Microbiol 37:2312–2316
    [Google Scholar]
  4. Brian M. J., Frosolono M., Murray B. E., Miranda A., Lopez E. L., Gomez H. F., Cleary T. G. 1992; Polymerase chain reaction for diagnosis of enterohemorrhagic Escherichia coli infection and hemolytic-uremic syndrome. J Clin Microbiol 30:1801–1806
    [Google Scholar]
  5. Cerna J. F., Nataro J. P., Estrada-Garcia T. 2003; Multiplex PCR for detection of three plasmid-borne genes of enteroaggregative Escherichia coli strains. J Clin Microbiol 41:2138–2140 [CrossRef]
    [Google Scholar]
  6. Clarke S. C., Haigh R. D., Freestone P. P., Williams P. H. 2002; Enteropathogenic Escherichia coli infection: history and clinical aspects. Br J Biomed Sci 59:123–127
    [Google Scholar]
  7. Darfeuille-Michaud A., Neut C., Barnich N. & 7 other authors; 1998; Presence of adherent Escherichia coli strains in ileal mucosa of patients with Crohn's disease. Gastroenterology 115:1405–1413 [CrossRef]
    [Google Scholar]
  8. Donnenberg M. S. 1995; Enteropathogenic Escherichia coli . In Infections of the Gastrointestinal Tract . pp 709–726 Edited by Blaser M., Smith P., Ravdin J., Greenberg H., Guerrant R. L. New York: Raven Press;
  9. Dulguer M. V., Fabbricotti S. H., Bando S. Y., Moreira-Filho C. A., Fagundes-Neto U., Scaletsky I. C. 2003; Atypical enteropathogenic Escherichia coli strains: phenotypic and genetic profiling reveals a strong association between enteroaggregative E.coli heat-stable enterotoxin and diarrhea. J Infect Dis 188:1685–1694 [CrossRef]
    [Google Scholar]
  10. Echeverria P., Orskov F., Orskov I., Knutton S., Scheutz F., Brown J. E., Lexomboon U. 1991; Attaching and effacing enteropathogenic Escherichia coli as a cause of infantile diarrhea in Bangkok. J Infect Dis 164:550–554 [CrossRef]
    [Google Scholar]
  11. Fagundes-Neto U., Scaletsky I. C. A. 2000; The gut at war: the consequences of enteropathogenic Escherichia coli infection as a factor of diarrhea and malnutrition. São Paulo Med J 118:21–29 [CrossRef]
    [Google Scholar]
  12. Forestier C., Meyer M., Favre-Bonte S., Rich C., Malpuech G., Le Bouguenec C., Sirot J., Joly B., De Champs C. 1996; Enteroadherent Escherichia coli and diarrhea in children: a prospective case-control study. J Clin Microbiol 34:2897–2903
    [Google Scholar]
  13. Gannon V. P., Rashed M., King R. K., Thomas E. J. 1993; Detection and characterization of the eae gene of Shiga-like toxin-producing Escherichia coli using polymerase chain reaction. J Clin Microbiol 31:1268–1274
    [Google Scholar]
  14. Gomes T. A., Rassi V., MacDonald K. L. 7 other authors; 1991; Enteropathogens associated with acute diarrheal disease in urban infants in São Paulo. Brazil. J Infect Dis 164:331–337 [CrossRef]
    [Google Scholar]
  15. Gomes T. A. T., Irino K. and other authors 2002; Escherichia coli eae + EAF stx strains outside the EPEC serogroups. In Abstract Book from the 3rd International EPEC Symposium , abstract no. S1.5 Puerto Vallarta; Mexico:
    [Google Scholar]
  16. Gunzburg S. T., Tornieporth N. G., Riley L. W. 1995; Identification of enteropathogenic Escherichia coli by PCR-based detection of the bundle-forming pilus gene. J Clin Microbiol 33:1375–1377
    [Google Scholar]
  17. Hedberg C. W., Savarino S. J., Besser J. M. & 7 other authors; 1997; An outbreak of foodborne illness caused by Escherichia coli O39 : NM, an agent not fitting into the existing scheme for classifying diarrheogenic E.coli . J Infect Dis 176:1625–1628 [CrossRef]
    [Google Scholar]
  18. Jenkins C., Lawson A. J., Cheasty T., Willshaw G. A., Wright P., Dougan G., Frankel G., Smith H. R. 2003; Subtyping intimin genes from enteropathogenic Escherichia coli associated with outbreaks and sporadic cases in the United Kingdom and Eire. Mol Cell Probes 17:149–156 [CrossRef]
    [Google Scholar]
  19. Jiang Z. D., Okhuysen P. C., Guo D. C., He R., King T. M., DuPont H. L., Milewicz D. M. 2003; Genetic susceptibility to enteroaggregative Escherichia coli diarrhea: polymorphism in the interleukin-8 promotor region. J Infect Dis 188:506–511 [CrossRef]
    [Google Scholar]
  20. Jühlin I., Ericson C. 1961; A new medium for the bacteriologic examination of stools (LSU-agar). Acta Pathol Microbiol Scand 52:185–200
    [Google Scholar]
  21. Kaper J. B. 1996; Defining EPEC. Rev Microbiol 27:130–133
    [Google Scholar]
  22. Knutton S., Shaw R., Phillips A. D., Smith H. R., Willshaw G. A., Watson P., Price E. 2001; Phenotypic and genetic analysis of diarrhea-associated Escherichia coli isolated from children in the United Kingdom. J Pediatr Gastroenterol Nutr 33:32–40 [CrossRef]
    [Google Scholar]
  23. Krokstad S., Haugen I., Nordbø S. A. 2003; Rapid detection and typing of human adenovirus by real-time PCR. J Clin Virol 27:51– 51
    [Google Scholar]
  24. Levine M. M., Edelman R. 1984; Enteropathogenic Escherichia coli of classic serotypes associated with infant diarrhea: epidemiology and pathogenesis. Epidemiol Rev 6:31–51
    [Google Scholar]
  25. Levine M. M., Nataro J. P., Karch H., Baldini M. M., Kaper J. B., Black R. E., Clements M. L., O'Brien A. D. 1985; The diarrheal response of humans to some classic serotypes of enteropathogenic Escherichia coli is dependent on a plasmid encoding an enteroadhesiveness factor. J Infect Dis 152:550–559 [CrossRef]
    [Google Scholar]
  26. Morelli R., Baldassarri L., Falbo V., Donelli G., Caprioli A. 1994; Detection of enteroadherent Escherichia coli associated with diarrhoea in Italy. J Med Microbiol 41:399–404 [CrossRef]
    [Google Scholar]
  27. Nataro J. P., Kaper J. B. 1998; Diarrheagenic Escherichia coli . Clin Microbiol Rev 11:142–201
    [Google Scholar]
  28. Nougayrède J. P., Fernandes P. J., Donnenberg M. S. 2003; Adhesion of enteropathogenic Escherichia coli to host cells. Cell Microbiol 5:359–372 [CrossRef]
    [Google Scholar]
  29. Nunes E. B., Saridakis H. O., Irino K., Pelayo J. S. 2003; Genotypic and phenotypic characterization of attaching and effacing Escherichia coli (AEEC) isolated from children with and without diarrhoea in Londrina. Brazil. J Med Microbiol 52:499–504 [CrossRef]
    [Google Scholar]
  30. Regua-Mangia A. H., Gomes T. A., Vieira M. A., Andrade J. R., Irino K., Teixeira L. M. 2004; Frequency and characteristics of diarrhoeagenic Escherichia coli strains isolated from children with and without diarrhoea in Rio de Janeiro. Brazil. J Infect 48:161–167 [CrossRef]
    [Google Scholar]
  31. Scaletsky I. C., Pedroso M. Z., Oliva C. A., Carvalho R. L., Morais M. B., Fagundes-Neto U. 1999; A localized adherence-like pattern as a second pattern of adherence of classic enteropathogenic Escherichia coli to HEp-2 cells that is associated with infantile diarrhea. Infect Immun 67:3410–3415
    [Google Scholar]
  32. Scaletsky I. C., Fabbricotti S. H., Aranda K. R., Morais M. B., Fagundes-Neto U. 2002a; Comparison of DNA hybridization and PCR assays for detection of putative pathogenic enteroadherent Escherichia coli . J Clin Microbiol 40:1254–1258 [CrossRef]
    [Google Scholar]
  33. Scaletsky I. C., Fabbricotti S. H., Silva S. O., Morais M. B., Fagundes-Neto U. 2002b; HEp-2-adherent Escherichia coli strains associated with acute infantile diarrhea, São Paulo, Brazil. Emerg Infect Dis 8:855–858 [CrossRef]
    [Google Scholar]
  34. Scaletsky I. C. A., Michalsky J. and other authors 2002c; Identification of novel adherence genes found in atypical enteropathogenic Escherichia coli (EPEC) strains. In Abstract book of the 3rd International EPEC Symposium abstract no. S2.5: Puerto Vallarta; Mexico:
    [Google Scholar]
  35. Schoolnik G. K. 1993; PCR detection of Shigella species and enteroinvasive Escherichia coli . In Diagnostic Molecular Microbiology . Principles and Applications pp 277–281 Edited by Persing D., Smith T., Tenover F., White T. Washington, DC: American Society for Microbiology;
    [Google Scholar]
  36. Schultsz C., Pool G. J., van Ketel R., de Wever B., Speelman P., Dankert J. 1994; Detection of enterotoxigenic Escherichia coli in stool samples by using nonradioactively labeled oligonucleotide DNA probes and PCR. J Clin Microbiol 32:2393–2397
    [Google Scholar]
  37. Schultsz C., Moussa M., van Ketel R., Tytgat G. N., Dankert J. 1997; Frequency of pathogenic and enteroadherent Escherichia coli in patients with inflammatory bowel disease and controls. J Clin Pathol 50:573–579 [CrossRef]
    [Google Scholar]
  38. Trabulsi L. R., Keller R., Tardelli Gomes T. A. 2002; Typical and atypical enteropathogenic Escherichia coli . Emerg Infect Dis 8:508–513 [CrossRef]
    [Google Scholar]
  39. Valentiner-Branth P., Steinsland H., Fischer T. K., Perch M., Scheutz F., Dias F., Aaby P., Mølbak K., Sommerfelt H. 2003; Cohort study of Guinean children: incidence, pathogenicity, conferred protection, and attributable risk for enteropathogens during the first 2 years of life. J Clin Microbiol 41:4238–4245 [CrossRef]
    [Google Scholar]
  40. Vallance B., Chan C. and other authors 2003; How noninvasive pathogens induce disease: Lessons from enteropathogenic and enterohemorrhagic Escherichia coli . In Microbial Pathogenesis and the Intestinal Epithelial Cell pp 423–437 Edited by Hecht G. A. Washington, DC: American Society for Microbiology;
    [Google Scholar]
  41. Vieira M. A., Andrade J. R., Trabulsi L. R., Rosa A. C., Dias A. M., Ramos S. R., Frankel G., Gomes T. A. 2001; Phenotypic and genotypic characteristics of Escherichia coli strains of non-enteropathogenic E.coli (EPEC) serogroups that carry EAE and lack the EPEC adherence factor and Shiga toxin DNA probe sequences. J Infect Dis 183:762–772 [CrossRef]
    [Google Scholar]
  42. Viljanen M. K., Peltola T., Junnila S. Y., Olkkonen L., Järvinen H., Kuistila M., Huovinen P. 1990; Outbreak of diarrhoea due to Escherichia coli O111 : B4 in schoolchildren and adults: association of Vi antigen-like reactivity. Lancet 336:831–834 [CrossRef]
    [Google Scholar]
  43. WHO 1987 Programme for control of diarrheal diseases (CDD/83.3 Rev1 In Manual for Laboratory Investigations of Acute Enteric Infections pp 27 Geneva: World Health Organization;
    [Google Scholar]
  44. Yatsuyanagi J., Saito S., Sato H., Miyajima Y., Amano K., Enomoto K. 2002; Characterization of enteropathogenic and enteroaggregative Escherichia coli isolated from diarrheal outbreaks. J Clin Microbiol 40:294–297 [CrossRef]
    [Google Scholar]
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