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Journal of Clinical Microbiology, November 2002, p. 4185-4190, Vol. 40, No. 11
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.11.4185-4190.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

Rate of Occurrence and Pathogenic Effect of Enteroaggregative Escherichia coli Virulence Factors in International Travelers

Zhi-Dong Jiang,1* David Greenberg,2 James P. Nataro,3 Robert Steffen,4 and Herbert L. DuPont1,2,5

The University of Texas Health Science Center School of Public Health,1 Baylor College of Medicine,2 St. Luke's Episcopal Hospital, Houston, Texas,5 University of Maryland School of Medicine, Baltimore, Maryland,3 University of Zurich Travel Clinic, Zurich, Switzerland4

Received 26 April 2002/ Returned for modification 25 June 2002/ Accepted 25 July 2002

One or more putative enteroaggregative Escherichia coli (EAEC) virulence factors (aggA, aggR, aspU, or aafA) were identified in 60 (70%) of 86 EAEC isolates from travelers with diarrhea compared with a rate of 7 (8%) of 90 in patients with diarrhea who were infected with nonadherent E. coli (odds ratio, 27.36; 95% confidence interval, 11.30 to 65.91). The presence of aggR or one or more virulence factors in EAEC from patients with diarrhea was associated with a statistically increased concentration of interleukin-8 (IL-8) in feces compared with that in EAEC negative for these factors: for aggR positive (9 of 12 [75%]; median, 800 pg/ml) versus aggR negative (5 of 18 [28%]; median, 0), P < 0.05; and for isolates positive for >=1 virulence factor (13 of 21 [62%]; median, 360 pg/ml) versus those negative for >=1 virulence factor (1 of 9 [11%]; median, 0), P < 0.05. Other fecal cytokines (IL-1ß and IL-1ra) were found in increased concentrations (P < 0.05 when at least one EAEC virulence factor was present compared with the concentrations when EAEC negative for multiple virulence factors was found in patients with diarrhea. Putative virulence factors were commonly found in EAEC from patients with diarrhea, and the pathogenicity of many strains was suggested by showing an association between the presence of plasmid-borne virulence factors and the presence of fecal cytokines. The different patterns of virulence factors of EAEC revealed several clusters demonstrating diversity among the isolates from the various regions.

* Corresponding author. Mailing address: Center for Infectious Disease, UT School of Public Health, 1200 Herman Pressler Room 706, Houston, TX 77030. Phone: (713) 500-9375. Fax: (713) 500-9364. E-mail: zjiang{at}sph.uth.tmc.edu.

Journal of Clinical Microbiology, November 2002, p. 4185-4190, Vol. 40, No. 11
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.11.4185-4190.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.



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