Strains of from sporadic cases of diarrhoea and belonging to serotypes O44:H18, O55:H7, O111:H21 O111:H25 or O126:H25 or O126:H27 were examined for virulence properties. With the exception of O111:H25 these are considered to be classical enteropathogenic (EPEC) serotypes. The strains had been isolated in Britain from the faeces of children <3 years old. Of the serotypes examined, 7 of 13 O44:H18 strains, all of 10 O111:H21 strains and 13 of 21 O126:H27 strains belonged to the enteroaggregative class of (EAggEC) that attached to HEp-2 cells in the characteristic aggregative pattern and hybridised with the EAggEC probe. They also caused mannose-resistant haemagglutination of rat erythrocytes, a property which may be a useful marker for their identification. Strains of O44:H18 with similar properties were also isolated from three small outbreaks in Britain, one of which involved elderly patients. EAggEC have not been considered previously as aetiological agents of diarrhoea in developed countries and have rarely been reported as belonging to EPEC serotypes. All 15 O55:H7 strains and seven of eight O111:H25 strains were also considered to be potentially diarrhoeagenic as they gave localised attachment (LA) to HEp-2 cells that resulted in a positive fluorescence actinstaining test. This test is considered to correlate with the attaching-and-effacing virulence mechanisms of EPEC . None of the strains in this study hybridised with the EPEC adherence-factor (EAF) probe. Neither the aggregative EPEC nor the LA-positive EAF-negative EPEC described here would be identified in epidemiological surveys when the EAF probe is used in the absence of cell tests.


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