Diarrhea burden due to natural infection with enterotoxigenic Escherichia coli in a birth cohort in a rural Egyptian community.
Enterotoxigenic Escherichia coli (ETEC) is commonly associated with diarrhea in Egyptian children. Children less than 3 years old in Abu Homos, Egypt, had approximately five diarrheal episodes per child every year, and at least one of these episodes was due to ETEC. The epidemiology of ETEC diarrhea among children living in a rural Egyptian community was further evaluated in this study. Between January 2004 and April 2007, 348 neonates were enrolled and followed for 2 years. Children were visited twice weekly, and a stool sample was obtained every 2 weeks regardless of symptomatology. A stool sample was obtained whenever a child had diarrhea. From the routine stool culture, five E. coli-like colonies were selected and screened for heat-labile and heat-stable toxins by GM1 enzyme-linked immunosorbent assay (ELISA) and further typed for colonization factor antigens by dot blot assay. Incidence of ETEC infection was estimated among children with diarrhea (symptomatic) and without diarrhea (asymptomatic). Incidence of diarrhea and ETEC-associated diarrhea was 7.8 and 1.48 per child-year, respectively. High risk of repeated ETEC diarrhea was associated with being over 6 months of age, warm season, male gender, and crowded sleeping conditions. Exclusive breast-feeding was protective for repeated ETEC infection. ETEC-associated diarrhea remains common among children living in the Nile Delta. The protective role of breast-feeding demonstrates the importance of promoting exclusive breast-feeding during, at least, the first 6 months of life.
United States Naval Medical Research Unit No. 3, Cairo, Egypt Adel.mansour.eg@med.navy.mil.
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Mansour
United States Naval Medical Research Unit No. 3, Cairo, Egypt.
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Shaheen
Ministry of Health and Population, Cairo, Egypt.
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Amine
United States Naval Medical Research Unit No. 3, Cairo, Egypt.
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Hassan
United States Naval Medical Research Unit No. 3, Cairo, Egypt.
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Sanders
United States Naval Medical Research Unit No. 3, Cairo, Egypt.
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Riddle
United States Naval Medical Research Unit No. 3, Cairo, Egypt.
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Armstrong
Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.
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Svennerholm
United States Naval Medical Research Unit No. 3, Cairo, Egypt.
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Sebeny
United States Naval Medical Research Unit No. 3, Cairo, Egypt.
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Klena
United States Naval Medical Research Unit No. 3, Cairo, Egypt.
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Young
United States Naval Medical Research Unit No. 3, Cairo, Egypt.
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Frenck
D015331:Cohort Studies; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology*; D004534:Egypt / Q000453:epidemiology; D054307:Enterotoxigenic Escherichia coli / Q000302:isolation & purification*; D004797:Enzyme-Linked Immunosorbent Assay; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D015151:Immunoblotting; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D012424:Rural Population; D037521:Virulence Factors / Q000032:analysis
D037521:Virulence Factors