Abstract
The impact of enteroaggregative E. coli (EAEC) infection on childhood malnutrition and inflammation has been suggested, regardless of diarrhea. We investigated whether EAEC and its virulence-related genes (VRGs) are associated with malnutrition in a case–control study. Children aged 6–24 months from Brazil were enrolled as malnourished if weight-for-age Z-score (WAZ) ≤ −2 and nourished if WAZ > −1. Stools were cultured and examined for E. coli. DNA was extracted from fecal isolates and tested for EAEC by polymerase chain reaction (PCR). Positive samples were analyzed by 5 multiplex PCRs to identify 20 EAEC VRGs. Biomarkers of intestinal barrier function and inflammation were measured. The prevalence of EAEC was 39.94%. Samples that presented both aaiC and aatA genes were associated with malnutrition (P = 0.045). A high prevalence of VRGs was observed and the aafC gene was significantly associated with malnourished (P = 0.0101). Strains lacking aar and pic genes were associated with malnutrition (P = 0.018), while the concomitant presence of aar, pic, agg4A, and capU genes was associated with nourished (P = 0.031). These data reinforce the EAEC impact on malnutrition, the importance of aar as negative regulator and the great contribution of AAF/II fimbria for the pathobiology of EAEC.
Highlights
Enteroaggregative Escherichia coli has been cited as an important childhood enteric pathogen worldwide (Jensen et al, 2014)
The different outcomes associated with enteroaggregative E. coli (EAEC) infection, ranging from acute and persistent diarrhea to subclinical conditions, are a challenge for understanding its pathobiology and proposing therapeutic approaches (Jensen et al, 2014)
The high prevalence of EAEC found in the study population (39.94%), based on the presence of either aaiC or aatA genes, corroborates with other studies that employed one selected virulence marker for EAEC diagnostic definition among subjects without diarrhea (Bafandeh et al, 2015; Lima et al, 2013; Pereira et al, 2007)
Summary
Enteroaggregative Escherichia coli has been cited as an important childhood enteric pathogen worldwide (Jensen et al, 2014). A recent large and lethal German outbreak caused by a Shiga toxin (Stx)-producing EAEC, brought attention to this pathogen (Scheutz et al, 2011). EAEC causes only a subclinical enteric infection or gut colonization in some subjects (Bueris et al, 2007; Lima et al, 2013). Recent large multi-center studies evaluating children from low and middle-income countries did not find association between EAEC and diarrhea (Kotloff et al, 2013). The association of EAEC colonization with height-for-age Z-score (HAZ) has been recently shown in Panamanian children (Gutiérrez et al, 2014), highlighting the contribution of EAEC to childhood stunting regardless of the presence of diarrhea
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