Involvement of main diarrheagenic Escherichia coli, with emphasis on enteroaggregative E. coli, in severe non-epidemic pediatric diarrhea in a high-income country.

Joshua Tobias,Eias Kassem,Dani Cohen,Anya Bialik,Assaf Rokney,Khitam Muhsen,Lea Valinsky,Armando Navaro,Moshe Ephros,Uri Rubinstein,Sreekanth-Reddy Vutukuru

doi:10.1186/s12879-015-0804-4

Abstract

BackgroundBacterial and viral enteric pathogens are the leading cause of diarrhea in infants and children. We aimed to identify and characterize the main human diarrheagenic E. coli (DEC) in stool samples obtained from children less than 5 years of age, hospitalized for acute gastroenteritis in Israel, and to examine the hypothesis that co-infection with DEC and other enteropathogens is associated with the severity of symptoms.MethodsStool specimens obtained from 307 patients were tested by multiplex PCR (mPCR) to identify enteroaggregative E. coli (EAEC), enterohemorrhagic (EHEC), enteropathogenic E. coli (EPEC) and enterotoxigenic E. coli (ETEC). Specimens were also examined for the presence of rotavirus by immunochromatography, and of Shigella, Salmonella and Campylobacter by stool culture; clinical information was also obtained.ResultsFifty nine (19%) children tested positive for DEC; EAEC and atypical EPEC were most common, each detected in 27 (46%), followed by ETEC (n = 3; 5%), EHEC and typical EPEC (each in 1 child; 1.5%). Most EAEC isolates were resistant to cephalexin, cefixime, cephalothin and ampicillin, and genotypic characterization of EAEC isolates by O-typing and pulsed-field gel electrophoresis showed possible clonal relatedness among some. The likelihood of having > 10 loose/watery stools on the most severe day of illness was significantly increased among patients with EAEC and rotavirus co-infection compared to children who tested negative for both pathogens: adjusted odds ratio 7.0 (95% CI 1.45-33.71, P = 0.015).ConclusionDEC was common in this pediatric population, in a high-income country, and mixed EAEC and rotavirus infection was characterized by especially severe diarrhea.

Highlights

Bacterial and viral enteric pathogens are the leading cause of diarrhea in infants and children
We aimed to examine the presence of the 4 diarrheagenic E. coli (DEC) categories (EAEC, enterohemorrhagic E. coli (EHEC), enteropathogenic E. coli (EPEC) and enterotoxigenic E. coli (ETEC)) in stool samples obtained from children less than 5 years of age hospitalized for acute diarrhea in Israel and examine the association between mixed infection of DEC with other enteropathogens and clinical manifestation of disease
Distribution of DEC pathotypes among the E. coli isolates Isolates from 307 children were examined by multiplex polymerase chain reaction (PCR) (mPCR), using specific primers as previously described [12], of which 59 (19.2%) were positive for at least one of the four tested DEC

Summary

Introduction

Bacterial and viral enteric pathogens are the leading cause of diarrhea in infants and children. We aimed to identify and characterize the main human diarrheagenic E. coli (DEC) in stool samples obtained from children less than 5 years of age, hospitalized for acute gastroenteritis in Israel, and to examine the hypothesis that co-infection with DEC and other enteropathogens is associated with the severity of symptoms. Diarrheal disease is a leading cause of pediatric morbidity and mortality in developing countries [1,2], and it is associated with a significant burden in industrialized countries. We aimed to examine the presence of the 4 DEC categories (EAEC, EHEC, EPEC and ETEC) in stool samples obtained from children less than 5 years of age hospitalized for acute diarrhea in Israel and examine the association between mixed infection of DEC with other enteropathogens and clinical manifestation of disease

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Conclusion