1887

Abstract

Enterotoxigenic (ETEC) is one of the most common causes of diarrhoea among young children in developing countries. ETEC vaccines offer promise in reducing the burden of ETEC disease, but the development of these vaccines relies on the characterization of ETEC isolates from a variety of settings. To best reflect the full spectrum of ETEC disease in León, Nicaragua, the aim of this study was to characterize ETEC strains isolated from children with diarrhoea attending different settings (hospital, primary care clinics and in the community) and children from different age groups. We characterized ETEC isolates in terms of their colonization factors (CFs) and enterotoxins, and determined whether these factors varied with setting and age group. Diarrhoeal stool samples were obtained from children under the age of 60 months from: (1) the regional public hospital, (2) four public primary care clinics, and (3) a population-based cohort. In total, 58 ETEC-positive isolates were analysed by multiplex-PCR assays for the identification of CFs (CS1, CS2, CS3, CS4, CS5, CS6, CS7, CS8, CS12, CS13, CS14, CS15, CS17, CS18, CS19, CS20, CS21, CS22 and CFA/I), and enterotoxins [heat-labile toxin (LT) and heat-stable variants STh and STp]. The frequency of CFs and enterotoxins was compared among the three settings and for different age groups, using Fisher’s exact test or a χ test. At least one CF was detected among one-half of samples; CS19 was detected among all strains in which a CF was identified, either alone or in combination with another CF. Among all CFs detected, 91.7 % were identified as members of the class 5 fimbrial family. CFs were detected more commonly among samples from infants captured in the health facility setting compared with the community setting. Overall, LT was detected among 67.2 % of samples, STh was detected among 20.7 % and both enterotoxins were detected among 12.1 %. The enterotoxin STh was detected more commonly among cases in the community, whilst a combination of STh and LT was detected more commonly among cases treated in health facilities. Our results suggest that, to protect against diarrhoeal cases associated with this pathotype in León, Nicaragua, an ETEC vaccine that effectively targets the archeotype CFA/I of the class 5 fimbrial family would be the most effective in this setting.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.066779-0
2014-05-01
2019-12-13
Loading full text...

Full text loading...

/deliver/fulltext/jmm/63/5/729.html?itemId=/content/journal/jmm/10.1099/jmm.0.066779-0&mimeType=html&fmt=ahah

References

  1. Anantha R. P., McVeigh A. L., Lee L. H., Agnew M. K., Cassels F. J., Scott D. A., Whittam T. S., Savarino S. J.. ( 2004;). Evolutionary and functional relationships of colonization factor antigen i and other class 5 adhesive fimbriae of enterotoxigenic Escherichia coli. . Infect Immun 72:, 7190–7201. [CrossRef][PubMed]
    [Google Scholar]
  2. Becker-Dreps S., Meléndez M., Liu L., Zambrana L. E., Paniagua M., Weber D. J., Hudgens M. G., Cáceres M., Källeståll C.. & other authors ( 2013;). Community diarrhea incidence before and after rotavirus vaccine introduction in Nicaragua. . Am J Trop Med Hyg 89:, 246–250. [CrossRef][PubMed]
    [Google Scholar]
  3. CLSI (2012). Performance Standards for Antimicrobial Susceptibility Testing; 22nd Informational Supplement; Approved Standard M100–S22. Wayne, PA, USA: Clinical and Laboratory Standards Institute.
  4. Del Canto F., Valenzuela P., Cantero L., Bronstein J., Blanco J. E., Blanco J., Prado V., Levine M., Nataro J.. & other authors ( 2011;). Distribution of classical and nonclassical virulence genes in enterotoxigenic Escherichia coli isolates from Chilean children and tRNA gene screening for putative insertion sites for genomic islands. . J Clin Microbiol 49:, 3198–3203. [CrossRef][PubMed]
    [Google Scholar]
  5. Del Canto F., Botkin D. J., Valenzuela P., Popov V., Ruiz-Perez F., Nataro J. P., Levine M. M., Stine O. C., Pop M.. & other authors ( 2012;). Identification of Coli Surface Antigen 23, a novel adhesin of enterotoxigenic Escherichia coli. . Infect Immun 80:, 2791–2801. [CrossRef][PubMed]
    [Google Scholar]
  6. den Engelsen C., van der Werf C., Matute A. J., Delgado E., Schurink C. A. M., Hoepelman A. I. M.. ( 2009;). Infectious diseases and the use of antibiotics in outpatients at the emergency department of the University Hospital of León, Nicaragua. . Int J Infect Dis 13:, 349–354. [CrossRef][PubMed]
    [Google Scholar]
  7. Girón J. A., Viboud G. I., Sperandio V., Gómez-Duarte O. G., Maneval D. R., Albert M. J., Levine M. M., Kaper J. B.. ( 1995;). Prevalence and association of the longus pilus structural gene (lngA) with colonization factor antigens, enterotoxin types, and serotypes of enterotoxigenic Escherichia coli. . Infect Immun 63:, 4195–4198.[PubMed]
    [Google Scholar]
  8. Isidean S. D., Riddle M. S., Savarino S. J., Porter C. K.. ( 2011;). A systematic review of ETEC epidemiology focusing on colonization factor and toxin expression. . Vaccine 29:, 6167–6178. [CrossRef][PubMed]
    [Google Scholar]
  9. Kaper J. B., Nataro J. P., Mobley H. L.. ( 2004;). Pathogenic Escherichia coli. . Nat Rev Microbiol 2:, 123–140. [CrossRef][PubMed]
    [Google Scholar]
  10. Kotloff K. L., Nataro J. P., Blackwelder W. C., Nasrin D., Farag T. H., Panchalingam S., Wu Y., Sow S. O., Sur D.. & other authors ( 2013;). Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. . Lancet 382:, 209–222. [CrossRef][PubMed]
    [Google Scholar]
  11. Nicaraguan Ministry of Health MINSA-Nicaragua ( 2012;). Epidemiological bulletin. . http://www.minsa.gob.ni/index.php/direccion-general-de-vigilancia-de-la-salud-publica/boletin-epidemiologico.
  12. Pan American Health Organization ( 2007;). Health Systems Profile: Nicaragua. . Available at: http://www.paho.org/hia/archivosvol2/paisesing/Nicaragua%20English.pdf. Accessed February 18, 2013.
  13. Paniagua M., Espinoza F., Ringman M., Reizenstein E., Svennerholm A. M., Hallander H.. ( 1997;). Analysis of incidence of infection with enterotoxigenic Escherichia coli in a prospective cohort study of infant diarrhea in Nicaragua. . J Clin Microbiol 35:, 1404–1410.[PubMed]
    [Google Scholar]
  14. Peña R., Pérez W., Meléndez M., Källestål C., Persson L. A.. ( 2008;). The Nicaraguan Health and Demographic Surveillance Site, HDSS-Leon: a platform for public health research. . Scand J Public Health 36:, 318–325. [CrossRef][PubMed]
    [Google Scholar]
  15. Qadri F., Svennerholm A. M., Faruque A. S. G., Sack R. B.. ( 2005;). Enterotoxigenic Escherichia coli in developing countries: epidemiology, microbiology, clinical features, treatment, and prevention. . Clin Microbiol Rev 18:, 465–483. [CrossRef][PubMed]
    [Google Scholar]
  16. Qadri F., Saha A., Ahmed T., Al Tarique A., Begum Y. A., Svennerholm A. M.. ( 2007;). Disease burden due to enterotoxigenic Escherichia coli in the first 2 years of life in an urban community in Bangladesh. . Infect Immun 75:, 3961–3968. [CrossRef][PubMed]
    [Google Scholar]
  17. Rodas C., Iniguez V., Qadri F., Wiklund G., Svennerholm A. M., Sjöling A.. ( 2009;). Development of multiplex PCR assays for detection of enterotoxigenic Escherichia coli colonization factors and toxins. . J Clin Microbiol 47:, 1218–1220. [CrossRef][PubMed]
    [Google Scholar]
  18. Rodas C., Mamani R., Blanco J., Blanco J. E., Wiklund G., Svennerholm A. M., Sjöling A., Iniguez V.. ( 2011;). Enterotoxins, colonization factors, serotypes and antimicrobial resistance of enterotoxigenic Escherichia coli (ETEC) strains isolated from hospitalized children with diarrhea in Bolivia. . Braz J Infect Dis 15:, 132–137. [CrossRef][PubMed]
    [Google Scholar]
  19. Sommerfelt H., Steinsland H., Grewal H. M., Viboud G. I., Bhandari N., Gaastra W., Svennerholm A. M., Bhan M. K.. ( 1996;). Colonization factors of enterotoxigenic Escherichia coli isolated from children in north India. . J Infect Dis 174:, 768–776. [CrossRef][PubMed]
    [Google Scholar]
  20. Steinsland H., Valentiner-Branth P., Gjessing H. K., Aaby P., Mølbak K., Sommerfelt H.. ( 2003;). Protection from natural infections with enterotoxigenic Escherichia coli: longitudinal study. . Lancet 362:, 286–291. [CrossRef][PubMed]
    [Google Scholar]
  21. Vidal R. M., Valenzuela P., Baker K., Lagos R., Esparza M., Livio S., Farfán M., Nataro J. P., Levine M. M., Prado V.. ( 2009;). Characterization of the most prevalent colonization factor antigens present in Chilean clinical enterotoxigenic Escherichia coli strains using a new multiplex polymerase chain reaction. . Diagn Microbiol Infect Dis 65:, 217–223. [CrossRef][PubMed]
    [Google Scholar]
  22. Vilchez S., Reyes D., Paniagua M., Bucardo F., Möllby R., Weintraub A.. ( 2009;). Prevalence of diarrhoeagenic Escherichia coli in children from León, Nicaragua. . J Med Microbiol 58:, 630–637. [CrossRef][PubMed]
    [Google Scholar]
  23. Wennerås C., Erling V.. ( 2004;). Prevalence of enterotoxigenic Escherichia coli-associated diarrhoea and carrier state in the developing world. . J Health Popul Nutr 22:, 370–382.[PubMed]
    [Google Scholar]
  24. World Health Organization ( 2000;). Handbook-Integrated Management of Childhood Illness. Chapter 8: Diarrhoea, pp. 25–31. Geneva:: World Health Organization;.
    [Google Scholar]
  25. World Health Organization ( 2006;). Future directions for research on enterotoxigenic Escherichia coli vaccines for developing countries. . Wkly Epidemiol Rec 81:, 97–104.[PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.066779-0
Loading
/content/journal/jmm/10.1099/jmm.0.066779-0
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error