Abstract
Neter E. J Pediatr 1959;55:223-39 In the 1950s, if a child with diarrhea was not infected with Salmonella, Shigella, or Vibrio cholerae, the cause would remain unknown. In this context, Neter reviewed mid-century knowledge of enteropathogenic Escherichia coli (EPEC). Elegant studies by Varela, et al1Varela G.A. Aquirre A. Carrillo J. E coli-gomez, nueva especie aislada de un caso mortal de diarrea.Boletin Medico Hospital Infantil (Mexico). 1946; 3: 623-627Google Scholar and Bray and Beavan in the 1940s1Varela G.A. Aquirre A. Carrillo J. E coli-gomez, nueva especie aislada de un caso mortal de diarrea.Boletin Medico Hospital Infantil (Mexico). 1946; 3: 623-627Google Scholar (neither of which were cited in Neter's review), introduced a definable diarrheagenic subset of E. coli. termed EPEC,3Neter E. Westphal O. Luderitz O. Gino R.M. Gorzynski E.A. Demonstration of antibodies against enteropathogenic Escherichia coli in sera of children of various ages.Pediatrics. 1955; 16: 801-808PubMed Google Scholar which belonged to a limited number of serotypes. EPEC caused severe epidemics into the 1980's in this country. Typical EPEC are defined by their clustered adherence to epithelial cells, in and their ability to induce cytoskeletal rearrangements in host cells. EPEC are fascinating phylogenetically: many distantly related EPEC contain similar suites of chromosomal and plasmid-borne virulence genes. Atypical EPEC (aEPEC) are also pathogens; some aEPEC are enterohemorrhagic E coli (EHEC) that have lost Shiga toxin genes.4Bielaszewska M. Middendorf B. Köck R. Friedrich A.W. Fruth A. Karch H. et al.Shiga toxin-negative attaching and effacing Escherichia coli: distinct clinical associations with bacterial phylogeny and virulence traits and inferred in-host pathogen evolution.Clin Infect Dis. 2008; 47: 208-217Crossref PubMed Scopus (88) Google Scholar It is ironic that as our understanding of EPEC biology has blossomed, the epidemiological and clinical importance of EPEC has been overshadowed by other diarrheagenic E coli, including EHEC and aEPEC.2Bray's discovery of pathogenic Esch. coli as a cause of infantile gastroenteritis.Arch Dis Child. 1973; 48: 923-926Crossref PubMed Scopus (16) Google Scholar, 4Bielaszewska M. Middendorf B. Köck R. Friedrich A.W. Fruth A. Karch H. et al.Shiga toxin-negative attaching and effacing Escherichia coli: distinct clinical associations with bacterial phylogeny and virulence traits and inferred in-host pathogen evolution.Clin Infect Dis. 2008; 47: 208-217Crossref PubMed Scopus (88) Google Scholar, 5Ochoa T.J. Barletta F. Contreras C. Mercado E. New insights into the epidemiology of enteropathogenic Escherichia coli infection.Trans R Soc Trop Med Hyg. 2008; 102: 852-856Abstract Full Text Full Text PDF PubMed Scopus (145) Google Scholar However, except for EHEC O157:H7 (which has aEPEC characteristics), clinicians cannot easily identify diarrheagenic E coli. Many diarrheal episodes remain undiagnosed even when stools are subjected to comprehensive evaluations. We are seeing genomic- and viromic-based nominations of many new candidate enteric pathogens. Investigators will be challenged to expeditiously confirm or refute the virulence of such agents with the rigor and curiosity of the investigators from the 1940's and 1950's.
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