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Journal of Clinical Microbiology, December 2004, p. 5588-5595, Vol. 42, No. 12
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.12.5588-5595.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Phenotypic Profiles of Enterotoxigenic Escherichia coli Associated with Early Childhood Diarrhea in Rural Egypt

Hind I. Shaheen,1 Sami B. Khalil,1 Malla R. Rao,2,{dagger} Remon Abu Elyazeed,1,{ddagger} Thomas F. Wierzba,1 Leonard F. Peruski Jr.,1,§ Shannon Putnam,1,¶ Armando Navarro,3 Badria Z. Morsy,4 Alejandro Cravioto,3 John D. Clemens,,5 Ann-Mari Svennerholm,6 and Stephen J. Savarino7*

U.S. Naval Medical Research Unit Number 3, Cairo,1 Egyptian Ministry of Health and Population, Abu Homos, Beheira Governorate, Egypt,4 U.S. Naval Medical Research Center, Silver Spring,7 Division of Epidemiology, Statistics and Prevention Research, National Institute of Child Health and Human Development, Bethesda, Maryland,2 National Autonomous University, Mexico City, Mexico,3 International Vaccine Institute, Seoul, Korea,5 Department of Medical Microbiology and Immunology, Göteborg University, Göteborg, Sweden6

Received 4 May 2004/ Returned for modification 14 June 2004/ Accepted 22 July 2004

Enterotoxigenic Escherichia coli (ETEC) causes substantial diarrheal morbidity and mortality in young children in countries with limited resources. We determined the phenotypic profiles of 915 ETEC diarrheal isolates derived from Egyptian children under 3 years of age who participated in a 3-year population-based study. For each strain, we ascertained enterotoxin and colonization factor (CF) expression, the O:H serotype, and antimicrobial susceptibility. Sixty-one percent of the strains expressed heat-stable enterotoxin (ST) only, 26% expressed heat-labile enterotoxin (LT) alone, and 12% expressed both toxins. The most common CF phenotypes were colonization factor antigen I (CFA/I) (10%), coli surface antigen 6 (CS6) (9%), CS14 (6%), and CS1 plus CS3 (4%). Fifty-nine percent of the strains did not express any of the 12 CFs included in our test panel. Resistance of ETEC strains to ampicillin (63%), trimethoprim-sulfamethoxazole (52%), and tetracycline (43%) was common, while resistance to quinolone antibiotics was rarely detected. As for the distribution of observed serotypes, there was an unusually wide diversity of O antigens and H types represented among the 915 ETEC strains. The most commonly recognized composite ETEC phenotypes were ST CS14 O78:H18 (4%), ST (or LTST) CFA/I O128:H12 (3%), ST CS1+CS3 O6:H16 (2%), and ST CFA/I O153:H45 (1.5%). Temporal plots of diarrheal episodes associated with ETEC strains bearing common composite phenotypes were consistent with discrete community outbreaks either within a single or over successive warm seasons. These data suggest that a proportion of the disease that is endemic to young children in rural Egypt represents the confluence of small epidemics by clonally related ETEC strains that are transiently introduced or that persist in a community reservoir.

* Corresponding author. Mailing address: U.S. Naval Medical Research Center, 503 Robert Grant Ave., Silver Spring, MD 20910. Phone: (301) 319-7650. Fax: (301) 319-7679. E-mail: savarinos{at}nmrc.navy.mil.

{dagger} Present address: National Institute of Allergy and Infectious Diseases, Bethesda, Md.

{ddagger} Present address: Glaxo Smith Kline, Singapore, Singapore.

§ Present address: Indiana University School of Medicine, Gary, Ind.

Present address: U.S. Naval Medical Research Unit No. 2, Jakarta, Indonesia.

Journal of Clinical Microbiology, December 2004, p. 5588-5595, Vol. 42, No. 12
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.12.5588-5595.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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