title: Surveillance of DiarrheagenicEscherichia coliStrains Isolated from Diarrhea Cases from Children, Adults and Elderly at Northwest of Mexico.
abstract: DiarrheagenicEscherichia coli(DEC) strains are a main cause of gastrointestinal disease in developing countries. In this study we report the epidemiologic surveillance in a 4-year period (January 2011 to December 2014) of DEC strains causing acute diarrhea throughout the Sinaloa State, Mexico. DEC strains were isolated from outpatients of all ages with acute diarrhea (N= 1,037). Specific DEC pathotypes were identified by PCR-amplification of genes encoding virulence factors. The adhesion phenotype and antibiotic resistance were also investigated. DEC strains were detected in 23.3% (242/1037) of cases. The most frequently DEC strain isolated was EAEC [(12.2%), 126/242] followed by EPEC [(5.1%), 53/242], ETEC [(4.3%), 43/242] DAEC [(1.4%), 15/242], STEC [(0.3%), 3/242], and EIEC [(0.2%), 2/242]. EHEC strains were not detected. Overall DEC strains were more prevalent in children ≤2 years of age with EPEC strains the most common of DEC pathotypes. While ∼65% of EAEC strains were classified as typical variant based on the aggregative adherence toin vitrocultures of HEp-2 cells, a high proportion of EPEC strains was classified as atypical strains. EAEC, EPEC, ETEC, and DAEC strains were distributed in the north, central and south regions of Sinaloa state. Among all DEC strains, >90% were resistant to at least one commonly prescribed antibiotic. Strains were commonly resistant to first-line antibiotics such as tetracycline, ampicillin, and sulfamethoxazole-trimethoprim. Furthermore, more than 80% of DEC isolates were multi-drug resistant and EPEC and DAEC were the categories with major proportion of this feature. In conclusion, in nearly one out of four cases of acute diarrhea in Northwestern Mexico a multi-drug resistant DEC strain was isolated, in these cases EAEC was the most prevalent (52%) pathotype.
authors.affiliation: CIASaP, School of Medicine, Autonomous University of SinaloaCuliacan, Mexico; The Women's Hospital, Secretariat of HealthCuliacan, Mexico.
authors.forename: Adrian
authors.initials: A
authors.lastname: Canizalez-Roman
authors.affiliation: CIASaP, School of Medicine, Autonomous University of SinaloaCuliacan, Mexico; The Sinaloa State Public Health Laboratory, Secretariat of HealthCuliacan, Mexico.
authors.forename: Héctor M
authors.initials: HM
authors.lastname: Flores-Villaseñor
authors.affiliation: The Sinaloa State Public Health Laboratory, Secretariat of Health Culiacan, Mexico.
authors.forename: Edgar
authors.initials: E
authors.lastname: Gonzalez-Nuñez
authors.affiliation: CIASaP, School of Medicine, Autonomous University of Sinaloa Culiacan, Mexico.
authors.forename: Jorge
authors.initials: J
authors.lastname: Velazquez-Roman
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA.
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Vidal
authors.affiliation: CIASaP, School of Medicine, Autonomous University of Sinaloa Culiacan, Mexico.
authors.forename: Secundino
authors.initials: S
authors.lastname: Muro-Amador
authors.affiliation: CIASaP, School of Medicine, Autonomous University of SinaloaCuliacan, Mexico; Coordinación de Enseñanza e InvestigaciónCuliacan, Mexico.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Alapizco-Castro
authors.affiliation: Instituto de Diagnóstico y Referencia EpidemiológicosMexico City, Mexico; Facultad de Medicina, Universidad Nacional Autónoma de MéxicoMexico City, Mexico.
authors.forename: J Alberto
authors.initials: JA
authors.lastname: Díaz-Quiñonez
authors.affiliation: CIASaP, School of Medicine, Autonomous University of SinaloaCuliacan, Mexico; Pediatric Hospital of SinaloaCuliacan, Mexico.
authors.forename: Nidia
authors.initials: N
authors.lastname: León-Sicairos
keywords: antibiotic resistance; biosurveillance; diarrhea; diarrheagenic E. coli; pathotypes