Abstract
A total of 271 stool specimens were collected from children (diarrheagenic, n = 115 and control, n = 54) and adults (diarrheagenic, n = 73 and control, n = 29) from Tunis, Tunisia, and processed to detect bacterial enteropathogens, parasites, and viruses. Diarrheagenic Escherichia coli (DEC) were identified by their virulence genes (polymerase chain reaction) and adherence patterns (tissue culture assays). The most frequently isolated enteric pathogens from diarrheagenic children were enterotoxigenic E. coli (ETEC, 32.3%), enteroaggregative E. coli (EAEC, 11.3%), enteroinvasive E. coli (EIEC, (11.3%), adenovirus (10.4%), enterohemorrhagic E. coli (EHEC, 10.4%), and Salmonella spp. (9.5%). For children in the control group, ETEC (37%), EAEC (15%), EHEC (11.1%), and typical enteropathogenic E. coli (EPEC, 11.1%) were the most common enteric pathogens. In adults in the diarrheagenic group, Salmonella spp. (34.2%), ETEC (12.3%), adenovirus (7%), and Shigella spp. (4%) were the most common enteric pathogens. In adults in the control group, ETEC (31%) was the most common enteric pathogen. Multiple pathogens were recovered from 22% of the diarrheagenic children and 7% of the diarrheagenic adults. Escherichia coli strains showed high resistance rates to tetracycline, streptomycin, and beta-lactams. The most frequent combinations were ETEC-rotavirus and ETEC-adenovirus. Pulsed-field gel electrophoresis for DEC indicated a large number of DEC clones (five major clones) persistent in the community reservoir for a considerable period of time that caused diarrhea in the population. This suggests the confluence of small epidemics by clonally related DEC strains circulating in this region.
Highlights
IntroductionEspecially acute diarrhea, remains a major public health problem
Diarrhea, especially acute diarrhea, remains a major public health problem
Bloody diarrhea was associated with diarrheagenic Escherichia coli (DEC) in children (EIEC n ס10, enterotoxigenic E. coli (ETEC) n ס3) and adults (ETEC n ס4)
Summary
Especially acute diarrhea, remains a major public health problem. An estimated 12 or more diarrheal episodes per child per year occur within the first five years of life. Approximately 4.6 million pediatric deaths, approximately 25–30% of all deaths among children less than five years of age, can be attributed to acute diarrhea.[1,2] Acute diarrhea contributes considerably to morbidity and medical expenses in developed countries.[3] Adult residents of developing countries are less likely to have sporadic diarrhea, and when it occurs, it is unlikely to be life-threatening. Diarrheal pathogens in adults in developing countries have been the subject of few investigations, and little is known about the etiologic epidemiology of pathogens other than epidemic Vibrio cholerae and Shigella
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