Disease burden due to enterotoxigenic Escherichia coli in the first 2 years of life in an urban community in Bangladesh.
A cohort of 321 children was followed from birth up to 2 years of age to determine the incidence of enterotoxigenic Escherichia coli (ETEC) in Bangladesh. The average number of diarrheal days and incidence rates were 6.6 and 2.3/child/year, respectively. ETEC was the most common pathogen and was isolated in 19.5% cases, with an incidence of 0.5 episode/child/year. The prevalence of rotavirus diarrhea was lower (10%). ETEC expressing the heat-stable enterotoxin (ST) was predominant. Strains isolated from diarrheal cases were positive for colonization factors (CFs) in higher frequency (66%) than from healthy children (33%) (P < 0.001). The heat-labile toxin (LT)-positive strains from healthy children were more often CF negative (92%) than those isolated from children with diarrhea (73%) (P < 0.001). In children with symptomatic or asymptomatic infections by CFA/I, CS1 plus CS3, CS2 plus CS3, or CS5 plus CS6 strains, a repeat episode of diarrhea or infection by the homologous CF type was uncommon. Repeat symptomatic infections were noted mostly for LT- and ST-expressing ETEC. ETEC diarrhea was more prevalent in children in the A and AB groups than in those in the O blood group (P = 0.032 to 0.023). Children with ETEC diarrhea were underweight and growth stunted at the 2-year follow-up period, showing the importance of strategies to prevent and decrease ETEC diarrheal morbidity in children.
Qadri
Firdausi
F
International Centre for Diarrheal Disease Research, Laboratory Sciences Division B, Dhaka 1000, Bangladesh. fqadri@icddrb.org
Saha
Amit
A
Ahmed
Tanvir
T
Al Tarique
Abdullah
A
Begum
Yasmin Ara
YA
Svennerholm
Ann-Mari
AM
D000017:ABO Blood-Group System; D001427:Bacterial Toxins / Q000096:biosynthesis*; D001459:Bangladesh / Q000453:epidemiology; D001942:Breast Feeding; D003968:Diarrhea, Infantile / Q000453:epidemiology / Q000382:microbiology; D004768:Enterotoxins / Q000096:biosynthesis*; D004797:Enzyme-Linked Immunosorbent Assay; D004926:Escherichia coli / Q000145:classification* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000097:blood / Q000453:epidemiology* / Q000382:microbiology* / Q000473:pathology; D029968:Escherichia coli Proteins / Q000096:biosynthesis*; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D012401:Rotavirus / Q000302:isolation & purification; D012400:Rotavirus Infections / Q000453:epidemiology; D012621:Seasons; D014505:Urban Population
D000017:ABO Blood-Group System; D001427:Bacterial Toxins; D004768:Enterotoxins; D029968:Escherichia coli Proteins; C034151:heat stable toxin (E coli); C027538:heat-labile enterotoxin, E coli