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Infection and Immunity, May 2009, p. 2059-2064, Vol. 77, No. 5
0019-9567/09/$08.00+0     doi:10.1128/IAI.01571-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Children with the Le(a+b–) Blood Group Have Increased Susceptibility to Diarrhea Caused by Enterotoxigenic Escherichia coli Expressing Colonization Factor I Group Fimbriae {triangledown}

Tanvir Ahmed,1,2* Anna Lundgren,2 Mohammad Arifuzzaman,1 Firdausi Qadri,1 Susann Teneberg,3 and Ann-Mari Svennerholm2

International Centre for Diarrheal Disease Research, Bangladesh, GPO Box 128, Dhaka 1000, Bangladesh,1 WHO Reference Laboratory for Research on ETEC, Department of Microbiology and Immunology,2 Department of Medical Biochemistry and Cell Biology, the Sahlgrenska Academy at University of Gothenburg, Box 435, S-40530 Gothenburg, Sweden3

Received 25 December 2008/ Returned for modification 27 January 2009/ Accepted 25 February 2009

Recent studies have shown that children with blood group A have increased susceptibility to enterotoxigenic Escherichia coli (ETEC) diarrhea and that Lewis blood group "a" antigen (Lea) may be a candidate receptor for ETEC colonization factor (CF) antigen I (CFA/I) fimbriae. Based on these findings, we have attempted to determine if children with the Le(a+b–) phenotype may be more susceptible to diarrhea caused by ETEC, in particular ETEC expressing CFA/I and related fimbriae of the CFA/I group, than Le(a–b+) children. To test this hypothesis, we have determined the Lewis antigen expression in 179 Bangladeshi children from a prospective birth cohort study in urban Dhaka in which ETEC expressing major CFs such as CFA/I, CS3, CS5, and CS6 was the most commonly isolated diarrhea pathogen during the first 2 years of life. The Lewis blood group phenotypes were determined by a dot blot immunoassay using saliva samples and by a tube agglutination test using fresh red blood cells. The results indicate that Le(a+b–) children more often had symptomatic than asymptomatic ETEC infections (P < 0.001), whereas symptomatic and asymptomatic ETEC infections were equally frequent in Le(a–b+) children. We also show that children with the Le(a+b–) blood type had significantly higher incidences of diarrhea caused by ETEC expressing fimbriae of the CFA/I group than Le(a–b+) children (P < 0.001). In contrast, we did not find any association between the Lewis blood group phenotype and diarrhea caused by ETEC expressing CS6 or rotavirus.

* Corresponding author. Mailing address: Laboratory Sciences Division, ICDDR, B, GPO Box 128, Dhaka 1000, Bangladesh. Phone: 880 2 8860523-32, ext. 2422. Fax: 880 2 8823116. E-mail: dr_tanvir{at}icddrb.org

{triangledown} Published ahead of print on 9 March 2009.

Editor: W. A. Petri, Jr.

Infection and Immunity, May 2009, p. 2059-2064, Vol. 77, No. 5
0019-9567/09/$08.00+0     doi:10.1128/IAI.01571-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.





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