title: Epidemiology and clinical manifestations of enteroaggregative Escherichia coli.
abstract: Enteroaggregative Escherichia coli (EAEC) represents a heterogeneous group of E. coli strains. The pathogenicity and clinical relevance of these bacteria are still controversial. In this review, we describe the clinical significance of EAEC regarding patterns of infection in humans, transmission, reservoirs, and symptoms. Manifestations associated with EAEC infection include watery diarrhea, mucoid diarrhea, low-grade fever, nausea, tenesmus, and borborygmi. In early studies, EAEC was considered to be an opportunistic pathogen associated with diarrhea in HIV patients and in malnourished children in developing countries. In recent studies, associations with traveler's diarrhea, the occurrence of diarrhea cases in industrialized countries, and outbreaks of diarrhea in Europe and Asia have been reported. In the spring of 2011, a large outbreak of hemolytic-uremic syndrome (HUS) and hemorrhagic colitis occurred in Germany due to an EAEC O104:H4 strain, causing 54 deaths and 855 cases of HUS. This strain produces the potent Shiga toxin along with the aggregative fimbriae. An outbreak of urinary tract infection associated with EAEC in Copenhagen, Denmark, occurred in 1991; this involved extensive production of biofilm, an important characteristic of the pathogenicity of EAEC. However, the heterogeneity of EAEC continues to complicate diagnostics and also our understanding of pathogenicity.
authors: Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark.
authors: Betina
authors: B
authors: Hebbelstrup Jensen
authors: Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark.
authors: Katharina E P
authors: KE
authors: Olsen
authors: Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark.
authors: Carsten
authors: C
authors: Struve
authors: Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark kak@ssi.dk.
authors: Karen Angeliki
authors: KA
authors: Krogfelt
authors: Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark Department of Gastroenterology, Hvidovre Hospital, Copenhagen, Denmark Department of Clinical Microbiology, Hvidovre Hospital, Copenhagen, Denmark.
authors: Andreas Munk
authors: AM
authors: Petersen
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D002648:Child; D060085:Coinfection; D019049:Developed Countries; D003906:Developing Countries; D003967:Diarrhea / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D004196:Disease Outbreaks; D004197:Disease Reservoirs / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000187:drug effects / Q000472:pathogenicity / Q000502:physiology*; D004927:Escherichia coli Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission; D015658:HIV Infections; D006801:Humans; D014195:Travel; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents