Abstract
In this paired case-control study of children with diarrhea in Rivers state, the association between HEp-2–adherent Escherichia coli strains and diarrhea was examined. Escherichia coli isolates from stool specimens of children with diarrhea were matched with controls and tested in HEp-2 cell adherence assay. A total of 266 E. coli strains (2 strains for every test subject) from both 83 children with diarrhea and 50 apparently healthy controls were examined for virulent traits using HEp-2 cells. Statistically significant (P<0.05) adherent strains were obtained from the diarrheic children 18 (21.7%) as against 5(10%) from the control. While EPEC (3.6% vs 0%) and EAEC (10.8% vs 4%) strains were significantly associated with diarrhea (P<0.05), EPEC was isolated only in children <3 years old while EAEC was more distributed on the age ranges studied. There was no significant association of DAEC (7.2% vs 2%) strains isolated from the test subjects and the control group (P>0.05%). High prevalence of parasites were seen on both groups although the diarrheal group had a statistical significant (26.5% vs 16%) prevalence (P<0.05), this showed that intestinal parasites are also important factor in the etiology of diarrhea in this area. The parasites were mostly seen in older children from both groups and this might be attributed to their wandering, playing and eating habits. No mixed infection between parasites, parasite and adherent E. coli or between two adherents E. coli was observed. The adherent isolates showed poor sensitivity to traditional drugs like Ampicillin, Cotrimoxazole and Chloramphenicol, while Cefuroxime and Ceftazidime showed good sensitivity. These data suggest that EAEC may be a pathotype that is increasing in incidence as a cause of diarrhea in children in these areas.Keywords: Adherent E. coli (DEC); Enteropathogenic E. coli (EPEC); Enteroaggregative E. coli (EAEC); Diffusely adherent E. coli (DAEC); Mixed Infections; Intestinal Parasites
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