Acute diarrhea due to enteropathogenic Escherichia coli: Epidemiological and clinical features in Brasília, Brazil

Abstract

Background: Enteropathogenic Escherichia coli (EPEC) is a major cause of acute diarrhea in developing countries, and the clinical manifestations associated with this organism may be more severe than previously believed. Objectives: To compare the prevalence and clinical manifestations of acute diarrhea caused by EPEC to that caused by other enteric pathogens. Methods: During a 2-year period, 200 infants under 2 years of age with acute diarrhea lasting less than 6 days were compared to 40 healthy infants (controls) matched for age. The nutritional status and the occurrence of food intolerance were examined. The patients were followed for 4 weeks after discharge from hospital. Stool samples were obtained for detection of bacterial, viral, and protozoan enteric agents. Results: EPEC was isolated from 84 (42.0%) children with diarrhea and from 9 (22.5%) healthy children (P < 0.05). Food intolerance was a major complication and the most important factor associated with persistent diarrhea found in children with EPEC diarrhea. In children with EPEC diarrhea, compared to children with diarrhea caused by other pathogens, failure to respond to oral rehydration therapy occurred three times more frequently (P < 0.01), and the mean duration of the disease was 11.7 days and 7.1 days, respectively, in the two groups (P < 0.05). Conclusions: Enteric infections caused by EPEC are common in weaning infants in low income families in Brazil and are associated with significantly more prolonged symptoms and frequent complications compared to acute diarrhea caused by other common enteric pathogens.