Relative Importance of Enteropathogens in Acute Endemic Diarrhea and Food-Borne Diarrheal Illness

Abstract

Establishing the etiology of acute diarrhea is complex because of the many variables influencing its cause and/or detection, including age, geographic location, season, and availability of laboratory procedures necessary to fully identify the various agents. Regardless of the part of the world in which it occurs, acute infectious diarrhea cannot be attributed to any one enteropathogen. The presence of rotavirus (RV) in stool specimens of a substantial proportion of children with diarrhea is evidence of the importance of this agent in endemic illness. A correlation exists between identification of RV in stool specimens and serologic response to infection. Enterotoxigenic E. coli. (ETEC) is an important cause of diarrhea in persons from industrialized countries during travel to developing regions, but it does not account for a large number of endemic cases of diarrhea in children in the United States. Serotype-determined enteropathogenic E. coli (EPEC) is an important cause of infantile diarrhea, yet the relative frequency of occurrence and mechanisms of pathogenesis are unknown. Intestinal infections due to Shigella and Salmonella generally occur in the summer months in children over 3 months of age and in adults. G. lamblia is a cause of acute, chronic, and recurrent diarrhea in all age groups. Other agents which require specialized laboratory techniques for identification have been shown to cause diarrhea on occasion.