title: Analysis of incidence of infection with enterotoxigenic Escherichia coli in a prospective cohort study of infant diarrhea in Nicaragua.
abstract: Diarrheal episodes with enterotoxigenic Escherichia coli (ETEC) were prospectively monitored during the first 2 years of life in a cohort of 235 infants from Leon, Nicaragua. ETEC was an etiological finding in 38% (310 of 808) of diarrheal episodes and in 19% (277 of 1,472) of samples taken as asymptomatic controls at defined age intervals (P = <0.0001). The majority of diarrheal episodes (80%) occurred before 12 months of age. The major ETEC type was characterized by colonization factor CFA I and elaboration of both heat-labile enterotoxin and heat-stable enterotoxin (ST). The proportion of E. coli strains with CFA I was significantly higher in cases with diarrhea (P = 0.002). The second most prevalent type showed putative colonization factor PCFO166 and production of ST. The prevalence of PCFO166 was approximately 20%, higher than reported before. Children with a first CFA I episode contracted a second ETEC CFA I infection 24% of the time, compared with 46% for ETEC strains of any subtype. Most of the ETEC episodes were of moderate severity, and only 5% (15 of 310) were characterized as severe. In conclusion, our results give valuable information for the planning of intervention studies using ETEC vaccines.
authors.affiliation: Department of Microbiology, National Autonomous University (UNAN), Léon, Nicaragua.
authors.forename: M
authors.initials: M
authors.lastname: Paniagua
authors.forename: F
authors.initials: F
authors.lastname: Espinoza
authors.forename: M
authors.initials: M
authors.lastname: Ringman
authors.forename: E
authors.initials: E
authors.lastname: Reizenstein
authors.forename: A M
authors.initials: AM
authors.lastname: Svennerholm
authors.forename: H
authors.initials: H
authors.lastname: Hallander
mesh_terms: D000367:Age Factors; D001426:Bacterial Proteins / Q000032:analysis; D003968:Diarrhea, Infantile / Q000453:epidemiology* / Q000382:microbiology; D004768:Enterotoxins / Q000032:analysis* / Q000235:genetics; D004926:Escherichia coli / Q000737:chemistry / Q000302:isolation & purification* / Q000472:pathogenicity; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D036781:Fimbriae Proteins; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D009527:Nicaragua / Q000453:epidemiology; D011446:Prospective Studies; D012008:Recurrence
chemical_list: D001426:Bacterial Proteins; D004768:Enterotoxins; C022924:colonization factor antigens; D036781:Fimbriae Proteins