Prevalence of diarrheagenic Escherichia coli in acute childhood enteritis: a prospective controlled study.
OBJECTIVE
Since diarrheagenic E. coli are not identified by common clinical laboratory techniques, we hypothesized that these organisms might be an unrecognized cause of enteritis in children in the U.S.


METHODS
1327 children with acute gastroenteritis were identified prospectively by active surveillance in the Emergency Department (ED) and the inpatient units at Cincinnati Children's Hospital Medical Center. Stool samples were evaluated for diarrheagenic E. coli using a panel of DNA probes and adherence pattern to HEp-2 cells. Stool samples from a reference group of 555 well children were studied for comparison.


RESULTS
Gene probe studies, but not HEp-2 cell adherence, demonstrated that enteroaggregative, diffusely adherent and enteropathogenic E. coli were associated with clinical illness. Each was isolated significantly more often from study subjects in the ED than controls. In children <1 year of age, enteroaggregative E. coli were isolated significantly more often from both inpatients (4.7%, Odds Ratio = 3.4, 95% confidence intervals 1.3-9.1, p <0.03) and ED patients (10.0%, Odds Ratio = 7.2, 95% confidence intervals 2.9-18.2, p <0.001) than from well children (1.4%).


CONCLUSIONS
Diarrheagenic E. coli , especially enteroaggregative E. coli , may be an important, unrecognized cause of childhood diarrhea in the U.S.
Cohen
Mitchell B
MB
Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. mitchell.cohen@cchmc.org
Nataro
James P
JP
Bernstein
David I
DI
Hawkins
Jennifer
J
Roberts
Nancy
N
Staat
Mary A
MA
D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000382:microbiology* / Q000821:virology; D004926:Escherichia coli / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000175:diagnosis*; D005243:Feces / Q000382:microbiology / Q000821:virology; D005260:Female; D005759:Gastroenteritis / Q000382:microbiology* / Q000821:virology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012401:Rotavirus / Q000302:isolation & purification