title: Concomitant enterotoxigenic Escherichia coli infection induces increased immune responses to Vibrio cholerae O1 antigens in patients with cholera in Bangladesh.
abstract: Vibrio cholerae O1 and enterotoxigenic Escherichia coli (ETEC) are major bacterial pathogens that cause dehydrating disease requiring hospitalization of children and adults. The cholera toxin (CT) produced by V. cholerae O1 and the heat-labile toxin (LT) and/or heat-stable toxin (ST) of ETEC are responsible for secretory diarrhea. We have observed that about 13% of hospitalized diarrheal patients are concomitantly infected with V. cholerae O1 and ETEC. In order to understand the outcome of such dual infections on the clinical and immunological responses in cholera patients, we studied patients infected with V. cholerae O1 (group VC; n = 25), those infected with both V. cholerae O1 and ETEC (group VCET; n = 25), and those infected with ETEC only (group ET; n = 25). The VCET group showed more severe dehydration and had a higher intake of intravenous fluid and more vomiting than the ETEC group (P = 0.01 to 0.003). The VCET patients showed higher vibriocidal responses and increased antibody titers to cholera toxin and lipopolysaccharide (LPS) in plasma than did the V. cholerae O1 patients (P = 0.02 to <0.001). All responses in the V. cholerae O1 and in the VCET groups were more robust than those seen in the group infected with ETEC only (P = 0.01 to <0.001). We thus show that concomitant colonization with ETEC induces immune responses to V. cholerae antigens that are more robust than those seen with V. cholerae O1 infection alone. It is possible that LT or other factors expressed by ETEC may play a role as a mucosal adjuvant in enhancing the immune responses to V. cholerae O1.
authors.affiliation: International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.
authors.forename: Fahima
authors.initials: F
authors.lastname: Chowdhury
authors.forename: Yasmin A
authors.initials: YA
authors.lastname: Begum
authors.forename: Mohammad Murshid
authors.initials: MM
authors.lastname: Alam
authors.forename: Ashraful I
authors.initials: AI
authors.lastname: Khan
authors.forename: Tanvir
authors.initials: T
authors.lastname: Ahmed
authors.forename: M Saruar
authors.initials: MS
authors.lastname: Bhuiyan
authors.forename: Jason B
authors.initials: JB
authors.lastname: Harris
authors.forename: Regina C
authors.initials: RC
authors.lastname: LaRocque
authors.forename: Abu S G
authors.initials: AS
authors.lastname: Faruque
authors.forename: Hubert
authors.initials: H
authors.lastname: Endtz
authors.forename: Edward T
authors.initials: ET
authors.lastname: Ryan
authors.forename: Alejandro
authors.initials: A
authors.lastname: Cravioto
authors.forename: Ann-Mari
authors.initials: AM
authors.lastname: Svennerholm
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Calderwood
authors.forename: Firdausi
authors.initials: F
authors.lastname: Qadri
mesh_terms: D000293:Adolescent; D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood; D000942:Antigens, Bacterial / Q000276:immunology*; D001459:Bangladesh; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000150:complications* / Q000276:immunology*; D054307:Enterotoxigenic Escherichia coli / Q000276:immunology*; D004927:Escherichia coli Infections / Q000150:complications* / Q000276:immunology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D041241:Vibrio cholerae O1 / Q000276:immunology*; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial