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Journal of Clinical Microbiology, September 1999, p. 2829-2833, Vol. 37, No. 9
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

Prospective Cohort Study of Enterotoxigenic Escherichia coli Infections in Argentinean Children

Gloria I. Viboud,1,2,dagger Mabel J. Jouve,1,Dagger Norma Binsztein,1,* Marta Vergara,3 Marta Rivas,1 Marina Quiroga,3 and Ann-Mari Svennerholm2

Departamento de Bacteriologia, Instituto Nacional de Enfermedades Infecciosas, "ANLIS Dr. Carlos G. Malbrán", Ministerio de Salud y Acción Social, (1281) Capital Federal,1 and Cátedra de Bacteriologia, Facultad de Ciencias Exactas, Quimicas y Naturales, Universidad Nacional de Misiones, Posadas,3 Argentina, and Department of Medical Microbiology and Immunology, University of Göteborg, Guldhesdsgatan 10, S-41346 Göteborg, Sweden2

Received 12 April 1999/Returned for modification 14 May 1999/Accepted 26 May 1999

In a follow-up study, enterotoxigenic Escherichia coli (ETEC) infections in 145 children from two communities located in northeastern Argentina were monitored for 2 years. The occurrence of diarrhea was monitored by weekly household visits. Of 730 fecal specimens collected, 137 (19%) corresponded to diarrheal episodes. ETEC was isolated from a significantly higher proportion of symptomatic (18.3%) than asymptomatic (13.3%) children (P = 0.04541). Individuals of up to 24 months of age were found to have a higher risk of developing ETEC diarrhea than older children (odds ratio [OR], 3.872; P = 0.00021). When the toxin profiles were considered, only heat stable enterotoxin (ST)-producing ETEC was directly associated with diarrhea (P = 0.00035). Fifty-five percent of the ETEC isolated from symptomatic children and 19% of the ETEC isolated from asymptomatic children expressed one of the colonization factors (CFs) investigated, i.e., CF antigen I (CFA/I), CFA/II, CFA/III, and CFA/IV; coli surface antigens CS7 and CS17; and putative CFs PCFO159, PCFO166, and PCFO20, indicating a clear association between diarrhea and ETEC strains that carry these factors (P = 0.0000034). The most frequently identified CFs were CFA/IV (16%), CFA/I (10%), and CS17 (9%). CFs were mostly associated with ETEC strains that produce ST and both heat-labile enterotoxin and ST. Logistic regression analysis, applied to remove confounding effects, revealed that the expression of CFs was associated with illness independently of the toxin type (OR, 4.81; P = 0.0003). When each CF was considered separately, CS17 was the only factor independently associated with illness (OR, 16.6; P = 0.0151). Most CFs (the exception was CFA/IV) fell within a limited array of serotypes, while the CF-negative isolates belonged to many different O:H types. These results demonstrate that some CFs are risk factors for the development of ETEC diarrhea.

* Corresponding author. Mailing address: Departamento de Bacteriologia, Instituto Nacional de Enfermedades Infecciosas, ANLIS "Dr. Carlos G. Malbrán," Av. Vélez Sarsfield 563, (1281) Capital Federal, Argentina. Phone and fax: 54 11 43031801. E-mail: ileya{at}interserver.com.ar.

dagger Present address: Department of Molecular Genetics and Microbiology, School of Medicine, State University of New York at Stony Brook, Stony Brook, NY 11794-5222.

Dagger Present address: Unité de Pathogénie Bacteriénne des Muqueuses, Institut Pasteur, 75724 Paris cedex 15, France.

Journal of Clinical Microbiology, September 1999, p. 2829-2833, Vol. 37, No. 9
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.


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