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Journal of Clinical Microbiology, July 2008, p. 2227-2230, Vol. 46, No. 7
0095-1137/08/$08.00+0     doi:10.1128/JCM.00073-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

PCR-Based Assay Using Occult Blood Detection Cards for Detection of Diarrheagenic Escherichia coli in Specimens from U.S. Travelers to Mexico with Acute Diarrhea{triangledown}

Kevin A. Grimes,1 Jamal A. Mohamed,1 Herbert L. DuPont,1,2,3 Ranjit S. Padda,1 Zhi-Dong Jiang,2 Jose Flores,1 Jaime Belkind-Gerson,4 Francisco G. Martinez-Sandoval,5 and Pablo C. Okhuysen1,2,3*

Division of Infectious Diseases, The University of Texas Medical School, Houston, Texas,1 Center for Infectious Diseases, The University of Texas School of Public Health, Houston, Texas,2 Baylor College of Medicine, Houston, Texas,3 Instituto Nacional de Salud Publica, Cuernavaca, México,4 Universidad Autónoma de Guadalajara, Guadalajara, México5

Received 14 January 2008/ Returned for modification 26 February 2008/ Accepted 6 May 2008

Large field studies of travelers' diarrhea for multiple destinations are limited by the need to perform stool cultures on site in a timely manner. A method for the collection, transport, and storage of fecal specimens that does not require immediate processing and refrigeration and that is stable for months would be advantageous. This study was designed to determine if enterotoxigenic Escherichia coli (ETEC) and enteroaggregative E. coli (EAEC) DNA could be identified from cards that were processed for the evaluation of fecal occult blood. U.S. students traveling to Mexico during 2005 to 2007 were monitored for the occurrence of diarrheal illness. When ill, students provided a stool specimen for culture and occult blood by the standard methods. Cards then were stored at room temperature prior to DNA extraction. Fecal PCR was performed to identify ETEC and EAEC in DNA extracted from stools and from occult blood cards. Significantly more EAEC cases were identified by PCR that was performed on DNA that was extracted from cards (49%) or from frozen feces (40%) than from culture methods that used HEp-2 adherence assays (13%) (P < 0.001). Similarly, more ETEC cases were detected from card DNA (38%) than from fecal DNA (30%) or by culture that was followed by hybridization (10%) (P < 0.001). The sensitivity and specificity of the card test were 75 and 62%, respectively, compared to those for EAEC by culture and were 50 and 63%, respectively, compared to those for ETEC. DNA extracted from fecal cards that was used for the detection of occult blood is of use in identifying diarrheagenic E. coli.

* Corresponding author. Mailing address: Division of Infectious Diseases, University of Texas Health Science Center—Houston, Medical School, 6431 Fannin St., MSB 2.2112, Houston, TX 77030. Phone: (713) 500-6765. Fax: (713) 500-5495. E-mail: Pablo.C.Okhuysen{at}uth.tmc.edu

{triangledown} Published ahead of print on 14 May 2008.

Journal of Clinical Microbiology, July 2008, p. 2227-2230, Vol. 46, No. 7
0095-1137/08/$08.00+0     doi:10.1128/JCM.00073-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • de Saussure, P. P. H. (2009). Review: Management of the returning traveler with diarrhea. Therapeutic Advances in Gastroenterology 2: 367-375 [Abstract]  
  • Galbadage, T., Jiang, Z.-D., DuPont, H. L. (2009). Improvement in Detection of Enterotoxigenic Escherichia coli in Patients with Travelers' Diarrhea by Increasing the Number of E. coli Colonies Tested. Am J Trop Med Hyg 80: 20-23 [Abstract] [Full Text]  


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