Prevalence of intestinal infections caused by diarrheagenic Escherichia coli in Bedouin infants and young children in Southern Israel.

Abstract

To evaluate the prevalence of different Escherichia coli categories in symptomatic and asymptomatic infants and children residing in a Bedouin township in Southern Israel. A total of 1613 stool samples were collected from a cohort of 234 infants and young children followed from birth up to 2 years of age. E. coli colonies from stool cultures from children during a diarrhea episode and those from nondiarrhea stools were hybridized with DNA probes specific for enteropathogenic, enteroinvasive, enterotoxigenic (ETEC), enteroaggregative, diffuse adherent and enterohemorrhagic strains. There were 1469 of 1613 (91%) samples positive for E. coli. The prevalence of E. coli categories was: enteroaggregative (25.9%); diffuse adherent (21.8%), ETEC (12.9%); enteropathogenic (7.3%); enterohemorrhagic (0.5%); and enteroinvasive (0.2%). ETEC, expressing the heat-stable enterotoxin (ST), was the only category isolated significantly more often from cases than from controls (P = 0.005). Of the two heat-stable enterotoxins screened in this study, only ETEC-heat stable enterotoxin (STh), the form isolated from human pathogenic ETEC, could be associated with diarrhea, whereas ETEC-STp, produced by ETEC of porcine origin, was not related to diarrhea. ETEC infections peaked during the warm, dry season. Prolonged shedding of E. coli postdiarrhea was not found in this population. The present cohort study confirmed that in this semiurban area, highly endemic for diarrheal disease, ETEC is an important cause of diarrhea in children.