Abstract
Enterotoxigenic Escherichia coli (ETEC) is a well-established cause of traveller's diarrhoea and occasional domestic foodborne illness outbreaks in the USA. Although ETEC are not detected by conventional stool culture methods used in clinical laboratories, syndromic culture-independent diagnostic tests (CIDTs) capable of detecting ETEC have become increasingly prevalent in the last decade. This study describes the epidemiology of ETEC infections reported to the Minnesota Department of Health (MDH) during 2016-2017. ETEC-positive stool specimens were submitted to MDH to confirm the presence of ETEC DNA by polymerase chain reaction (PCR). Cases were interviewed to ascertain illness and exposures. Contemporaneous Salmonella cases were used as a comparison group in a case-case comparison analysis of risk factors. Of 222 ETEC-positive specimens received by MDH, 108 (49%) were concordant by PCR. ETEC was the sixth most frequently reported bacterial enteric pathogen among a subset of CIDT-positive specimens. Sixty-nine (64%) laboratory-confirmed cases had an additional pathogen codetected with ETEC, including enteroaggregative E. coli (n = 40) and enteropathogenic E. coli (n = 39). Although travel is a risk factor for ETEC infection, only 43% of cases travelled internationally, providing evidence for ETEC as an underestimated source of domestically acquired enteric illness in the USA.
Highlights
Enterotoxigenic Escherichia coli (ETEC) infection is characterised by watery diarrhoea that typically lasts 3–5 days; illness can range from mild and self-limiting to cholera-like
Probable cases were those with no labile enterotoxin (LT) or ST toxin gene detected by polymerase chain reaction (PCR) at the Minnesota Department of Health (MDH) Public Health Laboratory (PHL)
Most cases tested positive for ETEC at clinical laboratories that used the FilmArray gastrointestinal panel (GIP) (n = 240, 98.4%)
Summary
Enterotoxigenic Escherichia coli (ETEC) infection is characterised by watery diarrhoea that typically lasts 3–5 days; illness can range from mild and self-limiting to cholera-like. It is a major cause of diarrhoea among children living in developing countries, as well as among travellers to developing countries [1]. ETEC infection has been associated mostly with traveller’s diarrhoea among visitors to endemic developing countries, causing an estimated 10 000 000 cases of traveller’s diarrhoea annually [5]. In the USA, an estimated 40 000 ETEC cases occur annually, with 55% associated with international travel and 45% acquired domestically through foodborne transmission [6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
