[Influence of classic enteropathogenic Escherichia coli on small bowel bacterial proliferation in infant's acute and persistent diarrhea].
Bacterial proliferation of the colonic microflora can occur in up to 50% of the infants with acute and persistent diarrhea. EPEC strains are frequently associated with bacterial proliferation in the small bowel lumen. The persistence of diarrhea might be due to the proliferation of EPEC in the intestinal lumen.


OBJECTIVE
The present study was aimed at comparing the magnitude of the bacterial proliferation in the small bowel lumen in infants with acute and persistent diarrhea due to EPEC and other agents.


METHODS
Fourty infants with diarrhea (23 with acute diarrhea and 17 with persistent diarrhea) underwent a naso-jejunal intubation for intestinal secretion culture of aerobes and anaerobes microorganisms. Stool samples were also collected for the investigation of enteropathogenic agents.


RESULTS
Bacterial proliferation in the small bowel was detected in 32 (80%) infants; in 30 (75%) infants there was proliferation of aerobic microorganisms while in 17 (43%) infants there was proliferation of microorganisms belonging to the anaerobic microflora. There was no statistical difference in the bacterial proliferation between patients with acute and persistent diarrhea. In 16 patients EPEC strains were identified in the stool culture, and all of them showed bacterial overgrowth above 10(3) microorganisms/mL. In contrast in the 24 patients without EPEC in the stools only 16 (67%) showed bacterial overgrowth in the small bowel lumen (p < 0.01). The mean concentration of E. coli in the intestinal secretion was 8 x 10(5) microorganisms/mL among the patients with EPEC in the stools and 3 x 10(2) microorganisms/mL among the patients with no EPEC in the stools (p < 0.05).


CONCLUSIONS
EPEC infection either acute or persistent induce favorable conditions for bacterial proliferation in the small bowel secretion in infants with diarrhea.
da Cruz
A S
AS
Hospital São Paulo e Hospital Umberto I, Departamento de Pediatria, Universidade Federal de São Paulo-Escola Paulista de Medicina.
Fagundes Neto
U
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D000208:Acute Disease; D003968:Diarrhea, Infantile / Q000382:microbiology*; D004926:Escherichia coli / Q000254:growth & development*; D004927:Escherichia coli Infections / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007421:Intestine, Small / Q000382:microbiology*; D008297:Male; D011446:Prospective Studies