Abstract
Some clinical isolates of enteropathogenic Escherichia coli (EPEC) lack bundle-forming pili and are termed atypical EPEC. The aim of this study was to determine if atypical EPEC are pathogens by comparing the clinical features of patients infected with atypical EPEC with those of children infected with other causative agents of diarrhea. Fecal samples obtained from children attending the Royal Children's Hospital in Melbourne for investigation of diarrhea were examined for adenovirus, rotavirus, Campylobacter spp., Salmonella spp., protozoa, and pathogenic E. coli. Clinical data were obtained by using a standardized pro forma and analyzed separately. Patients infected with atypical EPEC experienced mild, nondehydrating, and noninflammatory diarrhea that was not particularly associated with fever, vomiting, or abdominal pain. However, the duration of diarrhea in patients infected with atypical EPEC was significantly longer than that caused by the other species or where no pathogens were identified. Infection with atypical EPEC is associated with prolonged diarrhea.
Highlights
Some clinical isolates of enteropathogenic Escherichia coli (EPEC) lack bundle-forming pili and are termed atypical EPEC
Persistent diarrhea was significantly more common in patients infected with atypical EPEC than in those infected with adenovirus, rotavirus, Campylobacter, Salmonella, and those with no pathogen identified (Table 4)
In agreement with our findings from a community-based study in Melbourne and reports from investigators in Brazil, Norway, and elsewhere [9,20,21], the atypical EPEC strains obtained in this study were highly heterogeneous in terms of O:H serotype and intimin type, which indicates that the high frequency of atypical EPEC was not due to an outbreak caused by a limited number of strains
Summary
Some clinical isolates of enteropathogenic Escherichia coli (EPEC) lack bundle-forming pili and are termed atypical EPEC. Enteropathogenic E. coli (EPEC) shares several key virulence determinants with the most common varieties of EHEC but does not produce Shiga toxins nor cause hemorrhagic colitis or hemolytic uremic syndrome Instead, it causes nonspecific gastroenteritis, especially in children in developing countries [3,4]. EPEC differs from other pathotypes of E. coli in that it typically carries an EPEC adherence factor plasmid (pEAF) This plasmid encodes 1) bundle-forming pili (Bfp), which promote bacterial adherence to epithelial cells and are an essential virulence determinant [5], and 2) a transcriptional activator, Per, that upregulates genes within a chromosomal pathogenicity island, termed the locus for enterocyte effacement [6,7]. To determine if atypical EPEC are responsible for diarrhea in hospitalized children, we undertook a comprehensive microbiologic study of patients with diarrhea at the Royal Children’s Hospital in Melbourne
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