title: Prevalence, seasonality and severity of disease caused by pathogenic Escherichia coli in children with diarrhoea in Bolivia.
abstract: The prevalence of infection caused by different categories of diarrhoeagenic E. coli (DEC) strains, including enteroaggregative (EAEC), enteropathogenic (EPEC), enterotoxigenic (ETEC), enteroinvasive (EIEC) and enterohaemorrhagic (EHEC) E. coli, in children who suffered from diarrhoea (n = 3943) or did not have diarrhoea (n = 1026) were analysed in two areas in Bolivia over a period of 4 years. We also analysed the seasonality of DEC infections and severity of diarrhoea in children with DEC infection and compared antibiotic resistance in DEC strains isolated from children with and without diarrhoea. Stool samples were analysed for the presence of DEC by culturing followed by PCR. The most prevalent DEC categories in samples from the children were: EAEC (11.2 %); ETEC (6.6 %); EPEC (5.8 %); and EIEC and EHEC (<1 %). DEC strains were isolated significantly more often from diarrhoea cases (21.6 %) than from controls (17.6 %; P = 0.002). The number of children with diarrhoea associated with EAEC, EPEC and ETEC infections peaked in the Bolivian winter (April-September), although the proportion of DEC-positive stool samples was higher during the warm rainy season (October-March). High levels of antibiotic resistance were detected among the DEC strains. In particular, resistance to tetracycline and sulfamethoxazole-trimethoprim was significantly higher in strains isolated from individuals with diarrhoea than in samples from controls. The severity of disease in children infected with EAEC, EPEC and ETEC varied from mild to severe diarrhoea, although disease severity did not differ significantly between the different DEC categories. ETEC, EPEC and EAEC are commonly found in Bolivia and may cause severe disease in children.
authors.affiliation: Instituto de Biología Molecular y Biotecnología, Universidad Mayor de San Andrés, Facultad de Ciencias Puras y Naturales, Campus Universitario Cota-Cota, Calle 27 s/n La Paz, Bolivia.|Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Box 435, 405 30 Gothenburg, Sweden.
authors.forename: Lucia
authors.initials: L
authors.lastname: Gonzales
authors.affiliation: Instituto de Biología Molecular y Biotecnología, Universidad Mayor de San Andrés, Facultad de Ciencias Puras y Naturales, Campus Universitario Cota-Cota, Calle 27 s/n La Paz, Bolivia.|Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Box 435, 405 30 Gothenburg, Sweden.
authors.forename: Enrique
authors.initials: E
authors.lastname: Joffre
authors.affiliation: Instituto de Biología Molecular y Biotecnología, Universidad Mayor de San Andrés, Facultad de Ciencias Puras y Naturales, Campus Universitario Cota-Cota, Calle 27 s/n La Paz, Bolivia.
authors.forename: Rosario
authors.initials: R
authors.lastname: Rivera
authors.affiliation: Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Box 435, 405 30 Gothenburg, Sweden.
authors.forename: Åsa
authors.initials: Å
authors.lastname: Sjöling
authors.affiliation: Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Box 435, 405 30 Gothenburg, Sweden.
authors.forename: Ann-Mari
authors.initials: AM
authors.lastname: Svennerholm
authors.affiliation: Instituto de Biología Molecular y Biotecnología, Universidad Mayor de San Andrés, Facultad de Ciencias Puras y Naturales, Campus Universitario Cota-Cota, Calle 27 s/n La Paz, Bolivia.
authors.forename: Volga
authors.initials: V
authors.lastname: Iñiguez
mesh_terms: D001838:Bolivia / Q000453:epidemiology; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology*; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000145:classification* / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012621:Seasons