title: Phenotypic and genotypic analysis of enterotoxigenic Escherichia coli in samples obtained from Egyptian children presenting to referral hospitals.
abstract: Hospital surveillance was established in the Nile River Delta to increase the understanding of the epidemiology of diarrheal disease among Egyptian children. Between September 2000 and August 2003, samples obtained from children less than 5 years of age who had diarrhea and who were seeking hospital care were cultured for enteric bacteria. Colonies from each culture with a morphology typical of that of Escherichia coli were tested for the heat-labile (LT) and heat-stable (ST) toxins by a GM-1-specific enzyme-linked immunosorbent assay and colonization factor (CF) antigens by an immunodot blot assay. Enterotoxigenic E. coli (ETEC) isolates were recovered from 320/1,540 (20.7%) children, and ETEC isolates expressing a known CF were identified in 151/320 (47%) samples. ST CFA/I, ST CS6, ST CS14, and LT and ST CS5 plus CS6 represented 75% of the CFs expressed by ETEC isolates expressing a detectable CF. Year-to-year variability in the proportion of ETEC isolates that expressed a detectable CF was observed (e.g., the proportion that expressed CFA/I ranged from 10% in year 1 to 21% in year 3); however, the relative proportions of ETEC isolates expressing a CF were similar over the reporting period. The proportion of CF-positive ETEC isolates was higher among isolates that expressed ST. ETEC isolates expressing CS6 were isolated significantly less often (P < 0.001) than isolates expressing CFA/I in children less than 1 year of age. Macrorestriction profiling of CFA/I-expressing ETEC isolates by using the restriction enzyme XbaI and pulsed-field gel electrophoresis demonstrated a wide genetic diversity among the isolates that did not directly correlate with the virulence of the pathogen. The genome plasticity demonstrated in the ETEC isolates collected in this work suggests an additional challenge to the development of a globally effective vaccine for ETEC.
authors.affiliation: U.S. Naval Medical Research Unit No. 3, Cairo, Egypt. hind.shaheen.eg@med.navy.mil
authors.forename: H I
authors.initials: HI
authors.lastname: Shaheen
authors.forename: I A
authors.initials: IA
authors.lastname: Abdel Messih
authors.forename: J D
authors.initials: JD
authors.lastname: Klena
authors.forename: A
authors.initials: A
authors.lastname: Mansour
authors.forename: Z
authors.initials: Z
authors.lastname: El-Wakkeel
authors.forename: T F
authors.initials: TF
authors.lastname: Wierzba
authors.forename: J W
authors.initials: JW
authors.lastname: Sanders
authors.forename: S B
authors.initials: SB
authors.lastname: Khalil
authors.forename: D M
authors.initials: DM
authors.lastname: Rockabrand
authors.forename: M R
authors.initials: MR
authors.lastname: Monteville
authors.forename: P J
authors.initials: PJ
authors.lastname: Rozmajzl
authors.forename: A M
authors.initials: AM
authors.lastname: Svennerholm
authors.forename: R W
authors.initials: RW
authors.lastname: Frenck
mesh_terms: D001427:Bacterial Toxins / Q000096:biosynthesis; D002675:Child, Preschool; D016000:Cluster Analysis; D016172:DNA Fingerprinting; D004269:DNA, Bacterial / Q000378:metabolism; D015252:Deoxyribonucleases, Type II Site-Specific / Q000378:metabolism; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology*; D004534:Egypt / Q000453:epidemiology; D016521:Electrophoresis, Gel, Pulsed-Field; D054307:Enterotoxigenic Escherichia coli / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification / Q000378:metabolism*; D004768:Enterotoxins / Q000096:biosynthesis; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology*; D029968:Escherichia coli Proteins / Q000096:biosynthesis; D036781:Fimbriae Proteins / Q000096:biosynthesis; D014644:Genetic Variation; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017720:Molecular Epidemiology; D012150:Polymorphism, Restriction Fragment Length
chemical_list: D001427:Bacterial Toxins; D004269:DNA, Bacterial; D004768:Enterotoxins; D029968:Escherichia coli Proteins; C022924:colonization factor antigens; C034151:heat stable toxin (E coli); D036781:Fimbriae Proteins; C027538:heat-labile enterotoxin, E coli; C025580:endodeoxyribonuclease XBAI; D015252:Deoxyribonucleases, Type II Site-Specific