Epidemiology of enterotoxigenic Escherichia coli diarrhea in a pediatric cohort in a periurban area of lower Egypt.
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.
Abu-Elyazeed
R
R
US Naval Medical Research Unit No. 3, Cairo, Egypt.
Wierzba
T F
TF
Mourad
A S
AS
Peruski
L F
LF
Kay
B A
BA
Rao
M
M
Churilla
A M
AM
Bourgeois
A L
AL
Mortagy
A K
AK
Kamal
S M
SM
Savarino
S J
SJ
Campbell
J R
JR
Murphy
J R
JR
Naficy
A
A
Clemens
J D
JD
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