title: Phenotypic and genetic analysis of diarrhea-associated Escherichia coli isolated from children in the United Kingdom.
abstract: BACKGROUND
  A hospital-based study was performed to (1) compare phenotypic and genotypic diagnostic tests for enteropathogenic Escherichia coli, enteroaggregative E. coli, and diffuse-adhering E. coli (collectively termed adherent E. coli) and (2) to assess the importance of these different classes of adherent E. coli as causes of infant diarrhea in the United Kingdom in comparison with other enteropathogens.
  
  
  METHODS
  E. coli isolated from 1,496 infants with diarrheal disease and from 546 age-related controls were screened for enteropathogenic E. coli, enteroaggregative E. coli, and diffuse-adhering E. coli using HEp-2 cell adherence assays and DNA probes.
  
  
  RESULTS
  Marked discrepancies between the phenotype and genotype of isolates indicate significant heterogeneity among enteroaggregative E. coli and diffuse-adhering E. coli strains. Depending on the assay used, adherent E. coli were isolated as the only putative pathogen in 23% to 27% of diarrhea cases, a significantly higher incidence than in the control group. Individually, enteroaggregative E. coli (8.5-8.6% of cases) and diffuse-adhering E. coli (10.4-11.3% of cases), but not enteropathogenic E. coli (4.5-7.5% of cases), were significantly associated with diarrhea.
  
  
  CONCLUSIONS
  These studies indicate that adherent E. coli may be an important cause of diarrhea in infants in the United Kingdom; they also emphasize the need for more specific virulence-based tests for these putative classes of "diarrheagenic" (diarrhea causing) E. coli.
authors.affiliation: Institute of Child Health, University of Birmingham, Birmingham B4 6NH, United Kingdom. s.knutton@bham.ac.uk
authors.forename: S
authors.initials: S
authors.lastname: Knutton
authors.forename: R
authors.initials: R
authors.lastname: Shaw
authors.forename: A D
authors.initials: AD
authors.lastname: Phillips
authors.forename: H R
authors.initials: HR
authors.lastname: Smith
authors.forename: G A
authors.initials: GA
authors.lastname: Willshaw
authors.forename: P
authors.initials: P
authors.lastname: Watson
authors.forename: E
authors.initials: E
authors.lastname: Price
mesh_terms: D001422:Bacterial Adhesion / Q000235:genetics / Q000502:physiology*; D016022:Case-Control Studies; D002460:Cell Line; D015342:DNA Probes; D003967:Diarrhea / Q000175:diagnosis / Q000235:genetics / Q000382:microbiology*; D004926:Escherichia coli / Q000302:isolation & purification / Q000472:pathogenicity* / Q000502:physiology*; D004927:Escherichia coli Infections / Q000175:diagnosis* / Q000235:genetics; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D008297:Male; D008855:Microscopy, Electron, Scanning; D008858:Microscopy, Phase-Contrast; D010641:Phenotype; D011446:Prospective Studies; D006113:United Kingdom
chemical_list: D015342:DNA Probes