Diarrheagenic Escherichia coli infection in Baltimore, Maryland, and New Haven, Connecticut.
BACKGROUND
Diarrhea remains a common complaint among US patients who seek medical attention.


METHODS
We performed a prospective study to determine the etiology of diarrheal illness among patients and control subjects of all ages presenting to the emergency departments and outpatient clinics of 2 large academic hospitals in Baltimore, Maryland, and New Haven, Connecticut. We used molecular methods to detect the presence of diarrheagenic Escherichia coli pathotypes, including enteroaggregative E. coli (EAEC), as well as Shiga toxin-producing, cytodetaching, enterotoxigenic and enteropathogenic E. coli.


RESULTS
Of the pathotypes sought, only EAEC was found in an appreciable proportion (4.5%) of case patients, and it was found more frequently among case patients than control subjects (P<.02). Surprisingly, EAEC was the most common bacterial cause of diarrhea in our population. EAEC was common in all age strata and was not associated with foreign travel or immunodeficiency. EAEC infection is frequently accompanied by fever and abdominal pain, though this did not happen more frequently in patients with EAEC infection than in patients with diarrhea due to other causes.


CONCLUSIONS
Our data suggest that EAEC infection should be considered among persons with diarrhea that does not yield another known etiologic agent.
Nataro
James P
JP
Center for Vaccine Development, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA. jnataro@medicine.umaryland.edu
Mai
Volker
V
Johnson
Judith
J
Blackwelder
William C
WC
Heimer
Robert
R
Tirrell
Shirley
S
Edberg
Stephen C
SC
Braden
Christopher R
CR
Glenn Morris
J
J
Hirshon
Jon Mark
JM
D000293:Adolescent; D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003237:Connecticut / Q000453:epidemiology; D004403:Dysentery / Q000453:epidemiology / Q000382:microbiology*; D004926:Escherichia coli / Q000302:isolation & purification* / Q000472:pathogenicity; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D011446:Prospective Studies