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Infection and Immunity, August 2007, p. 3961-3968, Vol. 75, No. 8
0019-9567/07/$08.00+0     doi:10.1128/IAI.00459-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Disease Burden Due to Enterotoxigenic Escherichia coli in the First 2 Years of Life in an Urban Community in Bangladesh{triangledown}

Firdausi Qadri,1* Amit Saha,1 Tanvir Ahmed,1 Abdullah Al Tarique,1 Yasmin Ara Begum,1 and Ann-Mari Svennerholm2

International Centre for Diarrheal Disease Research, Bangladesh, GPO Box 128, Dhaka 1000, Bangladesh,1 Göteborg University Vaccine Research Institute (GUVAX) and Department of Microbiology and Immunology, the Sahlgrenska Academy at Göteborg University, Box 435 S-40530, Göteborg, Sweden2

Received 29 March 2007/ Returned for modification 9 May 2007/ Accepted 21 May 2007

A cohort of 321 children was followed from birth up to 2 years of age to determine the incidence of enterotoxigenic Escherichia coli (ETEC) in Bangladesh. The average number of diarrheal days and incidence rates were 6.6 and 2.3/child/year, respectively. ETEC was the most common pathogen and was isolated in 19.5% cases, with an incidence of 0.5 episode/child/year. The prevalence of rotavirus diarrhea was lower (10%). ETEC expressing the heat-stable enterotoxin (ST) was predominant. Strains isolated from diarrheal cases were positive for colonization factors (CFs) in higher frequency (66%) than from healthy children (33%) (P < 0.001). The heat-labile toxin (LT)-positive strains from healthy children were more often CF negative (92%) than those isolated from children with diarrhea (73%) (P < 0.001). In children with symptomatic or asymptomatic infections by CFA/I, CS1 plus CS3, CS2 plus CS3, or CS5 plus CS6 strains, a repeat episode of diarrhea or infection by the homologous CF type was uncommon. Repeat symptomatic infections were noted mostly for LT- and ST-expressing ETEC. ETEC diarrhea was more prevalent in children in the A and AB groups than in those in the O blood group (P = 0.032 to 0.023). Children with ETEC diarrhea were underweight and growth stunted at the 2-year follow-up period, showing the importance of strategies to prevent and decrease ETEC diarrheal morbidity in children.

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

{triangledown} Published ahead of print on 4 June 2007.

Editor: W. A. Petri, Jr.

Infection and Immunity, August 2007, p. 3961-3968, Vol. 75, No. 8
0019-9567/07/$08.00+0     doi:10.1128/IAI.00459-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.



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