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Journal of Clinical Microbiology, September 1999, p. 2974-2978, Vol. 37, No. 9
0095-1137/99/$04.00+0

Phenotypic Diversity of Enterotoxigenic Escherichia coli Strains from a Community-Based Study of Pediatric Diarrhea in Periurban Egypt

Leonard F. Peruski Jr.,1,* Bradford A. Kay,1,dagger Remon Abu El-Yazeed,1 Sahar H. El-Etr,1,Dagger Alejandro Cravioto,2 Thomas F. Wierzba,1 Malla Rao,3 Nemat El-Ghorab,1 Hind Shaheen,1 Sami B. Khalil,1 Karim Kamal,1 Momtaz O. Wasfy,1 Ann-Mari Svennerholm,4 John D. Clemens,3 and Stephen J. Savarino1

U.S. Naval Medical Research Unit No. 3, Cairo, Egypt1; Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Mexico, D.F., Mexico2; and National Institute of Child Health and Human Development, Bethesda, Maryland3; and Department of Medical Microbiology and Immunology, Goteborg University, Goteborg, Sweden4

Received 22 December 1998/Returned for modification 6 February 1999/Accepted 5 June 1999

No past studies of diarrhea in children of the Middle East have examined in detail the phenotypes of enterotoxigenic Escherichia coli (ETEC) strains, which are important pathogens in this setting. During a prospective study conducted from November 1993 to September 1995 with 242 children under 3 years of age with diarrhea living near Alexandria, Egypt, 125 episodes of diarrhea were positive for ETEC. ETEC strains were available for 98 of these episodes, from which 100 ETEC strains were selected and characterized on the basis of enterotoxins, colonization factors (CFs), and O:H serotypes. Of these representative isolates, 57 produced heat-stable toxin (ST) only, 34 produced heat-labile toxin (LT) only, and 9 produced both LT and ST. Twenty-three ETEC strains expressed a CF, with the specific factors being CF antigen IV (CFA/IV; 10 of 23; 43%), CFA/II (5 of 23; 22%), CFA/I (3 of 23; 13%), PCFO166 (3 of 23; 13%), and CS7 (2 of 23; 9%). No ETEC strains appeared to express CFA/III, CS17, or PCFO159. Among the 100 ETEC strains, 47 O groups and 20 H groups were represented, with 59 O:H serotypes. The most common O serogroups were O159 (13 strains) and O43 (10 strains). O148 and O21 were each detected in five individual strains, O7 and O56 were each detected in four individual strains, O73, O20, O86, and O114 were each detected in three individual strains, and O23, O78, O91, O103, O128, and O132 were each detected in two individual strains. The most common H serogroups were H4 (16 strains), 12 of which were of serogroup O159; H2 (9 strains), all of which were O43; H18 (6 strains); H30 (6 strains); and H28 (5 strains); strains of the last three H serogroups were all O148. Cumulatively, our results suggest a high degree of clonal diversity of disease-associated ETEC strains in this region. As a low percentage of these strains expressed a CF, it remains possible that other adhesins for which we either did not assay or that are as yet undiscovered are prevalent in this region. Our findings point out some potential barriers to effective immunization against ETEC diarrhea in this population and emphasize the need to identify additional protective antigens commonly expressed by ETEC for inclusion in future vaccine candidates.

* Corresponding author. Mailing address: c/o Commanding Officer, U.S. Naval Medical Research Unit No. 3, PSC 452, Box 5000, FPO AE 09835-0007. Phone: 011 20/2 284 1381. Fax: 011 20/2 284 1382. E-mail: boushrah{at}namru3.navy.mil.

dagger Present address: Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333.

Dagger Present address: Department of Veterinary and Biomedical Sciences, University of Nebraska, Lincoln, NE 68583.

Journal of Clinical Microbiology, September 1999, p. 2974-2978, Vol. 37, No. 9
0095-1137/99/$04.00+0


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