title: Epidemiology of enterotoxigenic Escherichia coli diarrhea in a pediatric cohort in a periurban area of lower Egypt.
abstract: Enterotoxigenic Escherichia coli (ETEC) are diverse pathogens that express heat-labile (LT) and/or heat-stable (ST) enterotoxins, yet little is known about whether epidemiologic patterns of pediatric ETEC diarrhea vary by the expressed ETEC toxin phenotype. In total, 242 Egyptian children aged <3 years were prospectively followed in 1993-1995. ETEC episodes were detected during twice-weekly home visits, and asymptomatic ETEC excretion was identified from monthly cross-sectional surveys. ETEC episodes were 0.6 per child-year. ST-only ETEC was 2.6 times (P<.001) more common in warmer than cooler months, while LT-only ETEC showed no seasonal variation. Ownership of a household sanitary latrine, but not breast-feeding, was associated with a lower risk of both enterotoxin phenotypes. Coexpression of a colonization factor by LT- or ST-only ETEC strengthened the association with diarrhea. These findings indicate that the epidemiologic patterns of LT-only and ST-only ETEC are not identical and that disease interventions should include improved household sanitation.
authors.affiliation: US Naval Medical Research Unit No. 3, Cairo, Egypt.
authors.forename: R
authors.initials: R
authors.lastname: Abu-Elyazeed
authors.forename: T F
authors.initials: TF
authors.lastname: Wierzba
authors.forename: A S
authors.initials: AS
authors.lastname: Mourad
authors.forename: L F
authors.initials: LF
authors.lastname: Peruski
authors.forename: B A
authors.initials: BA
authors.lastname: Kay
authors.forename: M
authors.initials: M
authors.lastname: Rao
authors.forename: A M
authors.initials: AM
authors.lastname: Churilla
authors.forename: A L
authors.initials: AL
authors.lastname: Bourgeois
authors.forename: A K
authors.initials: AK
authors.lastname: Mortagy
authors.forename: S M
authors.initials: SM
authors.lastname: Kamal
authors.forename: S J
authors.initials: SJ
authors.lastname: Savarino
authors.forename: J R
authors.initials: JR
authors.lastname: Campbell
authors.forename: J R
authors.initials: JR
authors.lastname: Murphy
authors.forename: A
authors.initials: A
authors.lastname: Naficy
authors.forename: J D
authors.initials: JD
authors.lastname: Clemens
mesh_terms: D015331:Cohort Studies; D003968:Diarrhea, Infantile / Q000453:epidemiology* / Q000382:microbiology; D004534:Egypt / Q000453:epidemiology; D004926:Escherichia coli / Q000472:pathogenicity*; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D011446:Prospective Studies; D014505:Urban Population; D014774:Virulence