Investigation of pathogenic Escherichia coli strains in patients with diarrhea

Abstract

The role of certain serogroups and serotypes of Escherichia coli in the etiology of gastroenteritis is increasingly appreciated. It is important to detect the virulence factors of diarrheagenic E.coli strains that differentiate them from nonpathogenic members of normal intestinal flora for the diagnosis and treatment. The aims of this study were to determine the serotypes of E.coli isolates that cause gastroenteritis and to investigate the presence of virulence genes by polymerase chain reaction (PCR). A total of 202 watery, bloody or mucoid stool samples sent to microbiology laboratory collected from patients with diarrhea who were admitted to outpatient clinics of Trakya University Health Research and Application Hospital between February to October 2009, were included in the study. A total of 254 predominantly grown E.coli strains have been isolated and identified with conventional methods from the cultures of those 202 samples. All strains were tested by slide agglutination (SA) that includes 6 units of O serogroups polyvalent antisera of enteropathogenic E.coli (EPEC), enterotoxigenic E.coli (ETEC) and enteroinvasive E.coli (EIEC). The samples which yielded positive results with SA test and the same number of negative samples selected with mapping method as controls were studied for the presence of virulence genes belonging EPEC, ETEC and EIEC by conventional PCR. In the study, 14.3% (29/202) of the samples were serogrouped with SA, of them 13 (6.4%) were identified as EPEC, 11 (5.4%) as EIEC and five (2.4%) as ETEC. Only five isolates belonging to EPEC serogroup could be defined by monovalent antiserum and they were all in O1 serogroup. Out of 29 pathogenic E.coli serotyped, 3 (10.3%) of them harbored the virulence genes of diarrheagenic strains. One sample which was positive for eaeA gene of EPEC, did not harbor bfpA and stx genes and was defined as atypical EPEC. Out of other two samples, one was positive for estA gene of ETEC and the other one for ial gene of EIEC. One strain serotyped as EPEC detected to carry estA gene of ETEC with PCR. All of the 29 control isolates that give negative results with polyvalent antisera were also negative for the presence of virulence genes. In conclusion, since serotyping and conventional PCR methods did not reveal similar results for the identification of pathogenic E.coli, multicenter and large-scaled studies performed with standardized methods are needed.